Angiotensin-converting enzyme may play a role for the mortality of COVID-19

Best Practice Nordic | Maalis 2020 | COVID-19 |

Experts suggest that people with cardiac diseases, hypertension, or diabetes as well as smokers are at higher risk for severe COVID-19 infection because of an increased expression of angiotensin-converting enzyme (ACE) inhibitors. The most distinctive comorbidities of patients with novel coronavirus disease 2019 (COVID-19) were cerebrovascular diseases, diabetes and hypertension. Most of the patient were treated with ACE inhibitors.1,2,3 Severe acute respiratory syndrome coronavirus (SARS-CoV / and SARS-CoV-2) causing COVID-19 to bind to their target cells through angiotensin-converting enzyme 2, which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels.4 At the same time, we know, that the expression of ACE2 is substantially increased in patients with diabetes, hypertension treated with ACE inhibitors and angiotensin receptor 2 blockers, ARBs, which results in an upregulation of angiotensin receptors. The increased expression of ACE2 would facilitate infection with COVID-19. A further aspect that should be investigated is the genetic predisposition for an increased risk of SARS-CoV-2 infection, which might be due to ACE2 polymorphisms that have been linked to diabetes mellitus, cerebral stroke, and hypertension, specifically in Asian populations. Lei Fang et al. suggest that patients with cardiac diseases, hypertension, or diabetes, who are treated with ACE2-increasing drugs, are at higher risk for severe COVID-19 infection and, therefore, should be monitored for ACE2-modulating medications, such as ACE inhibitors or ARBs.5 Smoking increases the levels of ACE and is it therefore possible that smokers have a higher risk for severe COVID-19 infection. Sources 1. Yang, X., Yu, Y., Xu, J., Shu, H., Liu, H., Wu, Y., ... & Wang, Y. (2020). Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine. 2. Guan, W. J., Ni, Z. Y., Hu, Y., Liang, W. H., Ou, C. Q., He, J. X.,...