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The Dilemma of Coronavirus Disease 2019, Aging, and Cardiovascular DiseaseInsights From Cardiovascular Aging Science

Educational Objective
To understand the role of ACE2 in COVID-19 pathogenesis, and as a component of renin-angiotensin system (RAS) signaling
1 Credit CME

As we brace for the imminent impact of the coronavirus disease 2019 (COVID-19) pandemic, we are faced with a controversy on how to best minimize the risk of lethal disease among the most vulnerable of us. Preliminary epidemiological data show an uneven-handed impact on the population, with an exponential increase in disease severity and mortality in those beyond the sixth decade of life with cardiovascular disease (CVD) and diabetes. Given that angiotensin-converting enzyme 2 (ACE2), an enzyme coopted by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to enter epithelial cells, is upregulated in patients with CVD and diabetes treated with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), it was proposed that this increase in ACE2 expression underpins the greater COVID-19 severity in this population. This has created substantial controversy regarding the approach to patients taking ACEIs/ARBs in preparation for the pandemic, with some advocating for discontinuing these medications while expert opinions recommended against discontinuation, given the lack of strong evidence.1

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Article Information

Corresponding Author: Majd AlGhatrif, MD, MA, Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, 251 Bayview Blvd, Baltimore, MD 21043 (alghatrifm@nih.gov).

Published Online: April 3, 2020. doi:10.1001/jamacardio.2020.1329

Conflict of Interest Disclosures: None reported.

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