COVID-19, LIPID PROFILE DISORDERS, RENIN-ANGIOTENSIN-ALDOSTERON SYSTEM IMBALANCE: PECULIARITIES OF PATHOGENESIS AND TREATMENT (LITERATURE REVIEW)
Abstract
Objective: The present study aimed to determine the peculiarities of pathogenesis and treatment of patients with lipid profile disorders, renin-angiotensin-aldosteron system imbalance and coexistent COVID-19.
Materials and methods. Articles published in 2020-2025 in the PubMed, Scopus, and Google Scholar electronic databases were analyzed.
The limitations of the review are narrative character of the work, different type and design of analyzed publications, parameters of the patients, the presence of conflicting results regarding to the effectiveness of individual therapeutic approaches.
Results and discussion. The connection between severe acute respiratory syndrome coronavirus 2 and angiotensin-converting enzyme 2 leads to the inactivation of this enzyme, increased vasoconstriction and progression of arterial hypertension.
The increased levels of serum amyloid A in patients with COVID-19 displace ApoA-I situated on high density lipoprotein, which leads to the impairment of reverse cholesterol transport, disorders of endothelium and promotion of oxidative stress.
Prescription of rosuvastatin is considered for patients with COVID-19 if it is indicated because of antiinflammotory properties, protection of endothelial cells and further reduction the risk of hospitalization and mortality. Evidence suggests that prolongation of treatment with rosuvastatin is effective for people which have received it before because of lipid profile disorders, coexistent ischemic heart disease, heart failure or increased cardiovascular risk.
The continuation of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ramipril, losartan, valsartan) prescribed previously for treatment of arterial hypertension, heart failure, coexistent lipid profile disorders during hospitalization in patients with COVID-19 as associated with decreased mortality.
Not all clinical trials suggested the improvement of clinical outcomes and mortality rate after using statins and renin-angiotensin-aldosteron system inhibitors.
Conclusions. Management with rosuvastatin, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers prescribed previously because of arterial hypertension, lipid profile disorders, heart failure, ischemic heart disease and increased cardiovascular risk may be beneficial to continua or initiation treatment with those drugs at first in patients with COVID-19 if contraindications are absent because these changes become more severe in the case of such comorbidity for achievement the goal ranges of blood pressure and low density lipoproteins, improvement of endothelial function, reduction the progression of oxidative stress, decrease mortality and prevention of cardiovascular complications.
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