HFSA/ACC/AHA Statement Addresses Concerns Re: Using RAAS Ant
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Patients with underlying cardiovascular diseases appear to have an increased risk for adverse outcomes with coronavirus disease 2019 (COVID-19). Although the clinical manifestations of COVID-19 are dominated by respiratory symptoms, some patients also may have severe cardiovascular damage. Angiotensin-converting enzyme 2 (ACE2) receptors are the entry point into human cells for SARS-CoV-2, the virus that causes COVID-19.

In a few experimental studies with animal models, both angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been shown to upregulate ACE2 expression in the heart. Though these have not been shown in human studies, or the setting of COVID-19, such potential upregulation of ACE2 by ACE inhibitors or ARBs has resulted in speculation of potential increased risk for COVID-19 infection in patients with background treatment of these medications.

Three major American cardiology societies HFSA/ACC/AHA
have issued a joint statement on the continuation of the renin-angiotensin-aldosterone system (RAAS) antagonists in patients, despite the concerns that their use might worsen outcomes in the event of infection with COVID-19.

"The continued highest standard of care for cardiovascular disease patients diagnosed with COVID-19 is a top priority, but there are no experimental or clinical data demonstrating beneficial or adverse outcomes among COVID-19 patients using ACE-I or ARB medications," said Richard J. Kovacs, MD, FACC.

"We urge urgent, additional research that can guide us to optimal care for the millions of people worldwide with cardiovascular disease and who may contract COVID-19. These recommendations will be adjusted as needed to correspond with the latest research," added Richard J. Kovacs, MD, FACC.

ACE2 is a homolog of angiotensin-converting enzyme (ACE). ACE2 negatively regulates the renin-angiotensin system by converting Angiotensin II to vasodilatory Angiotensin 1-7, diminishing and opposing the vasoconstrictor effect of angiotensin II. ACE2, ACE, angiotensin II, and other renin-angiotensin-aldosterone systems (RAAS) interactions are quite complex, and at times, paradoxical. Furthermore, tissue expression of ACE2 differs in the heart, kidneys, and lungs of healthy patients, cardiovascular disease patients, and coronavirus-infected patients, and its role in the setting of COVID-19 infection in patients with cardiovascular disease is unclear.

Furthermore, in experimental studies, both ACE inhibitors and ARBs have been shown to reduce severe lung injury in certain viral pneumonia, and it has been speculated that these agents could be beneficial in COVID-19.

About societies:-
American Heart Association (AHA) is a non-profit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke

American College of Cardiology (ACC) based in Washington, D.C., is a nonprofit medical association established in 1949. It bestows credentials upon cardiovascular specialists who meet its qualifications.

Heart Failure Society of America (HFSA) is an American organization of heart failure experts who have an interest in heart function and heart failure. Founded in 1995, it provides a forum for experts and patients with the aim of reducing the burden of heart failure.

Source: https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19
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