Τίτλος:
Circulating plasma concentrations of angiotensin-converting enzyme 2 inmen and women with heart failure and effects of renin-angiotensin-aldosterone inhibitors
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Aims The current pandemic coronavirus SARS-CoV-2 infects a wide age group but predominantly elderly individuals, especially men and those with cardiovascular disease. Recent reports suggest an association with use of renin-angiotensin- aldosterone system (RAAS) inhibitors. Angiotensin-converting enzyme 2 (ACE2) is a functional receptor for coronaviruses. Higher ACE2 concentrations might lead to increased vulnerability to SARS-CoV-2 in patients on RAAS inhibitors. Methods and results We measured ACE2 concentrations in 1485 men and 537 women with heart failure (index cohort). Results were validated in 1123 men and 575 women (validation cohort). The median age was 69 years for men and 75 years for women. The strongest predictor of elevated concentrations of ACE2 in both cohorts was male sex (estimate = 0.26, P < 0.001; and 0.19, P < 0.001, respectively). In the index cohort, use of ACE inhibitors, angiotensin receptor blockers (ARBs), or mineralocorticoid receptor antagonists (MRAs) was not an independent predictor of plasma ACE2. In the validation cohort, ACE inhibitor (estimate = - 0.17, P = 0.002) and ARB use (estimate = -0.15, P = 0.03) were independent predictors of lower plasma ACE2, while use of an MRA (estimate = 0.11, P = 0.04) was an independent predictor of higher plasma ACE2 concentrations. Conclusion In two independent cohorts of patients with heart failure, plasma concentrations of ACE2 were higher in men than in women, but use of neither an ACE inhibitor nor an ARB was associated with higher plasma ACE2 concentrations. These data might explain the higher incidence and fatality rate of COVID-19 in men, but do not support previous reports suggesting that ACE inhibitors or ARBs increase the vulnerability for COVID-19 through increased plasma ACE2 concentrations. © The Author(s) 2020.
Συγγραφείς:
Sama, I.E.
Ravera, A.
Santema, B.T.
Van Goor, H.
Ter Maaten, J.M.
Cleland, J.G.F.
Rienstra, M.
Friedrich, A.W.
Samani, N.J.
Ng, L.L.
Dickstein, K.
Lang, C.C.
Filippatos, G.
Anker, S.D.
Ponikowski, P.
Metra, M.
Van Veldhuisen, D.J.
Voors, A.A.
Περιοδικό:
EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY
Εκδότης:
Oxford University Press
Λέξεις-κλειδιά:
angiotensin converting enzyme 2; angiotensin receptor antagonist; mineralocorticoid antagonist; angiotensin converting enzyme 2; angiotensin receptor antagonist; dipeptidyl carboxypeptidase; dipeptidyl carboxypeptidase inhibitor; amino terminal pro brain natriuretic peptide; angiotensin receptor antagonist; brain natriuretic peptide; dipeptidyl carboxypeptidase inhibitor; growth differentiation factor 15; mineralocorticoid antagonist, adult; aged; Article; clinical feature; cohort analysis; controlled study; coronary artery bypass graft; coronavirus disease 2019; drug blood level; drug efficacy; drug use; enzyme blood level; female; heart failure; heart left ventricle ejection fraction; heart rate; human; incidence; major clinical study; male; mortality rate; New York Heart Association class; priority journal; protein processing; Severe acute respiratory syndrome coronavirus 2; sex difference; systolic blood pressure; Betacoronavirus; blood; Coronavirus infection; drug effect; Europe; heart failure; middle aged; pandemic; renin angiotensin aldosterone system; sex factor; virus pneumonia; atrial fibrillation; coronavirus disease 2019; diabetes mellitus; disease association; medical history; Scotland; sex difference; validation process, Aged; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Betacoronavirus; Coronavirus Infections; Europe; Female; Heart Failure; Humans; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Pandemics; Peptidyl-Dipeptidase A; Pneumonia, Viral; Renin-Angiotensin System; Sex Factors
DOI:
10.1093/eurheartj/ehaa373
