Why are hypertension and heart disease such risk factors?
I don’t think there’s a definitive answer yet. Here’s a March 18, 2020 JAMA Q&A with Dr. Fauci. He talks about hypertension and COVID-19 starting at timestamp 10:20. I found it alarming.
https://edhub.ama-assn.org/jn-learning/video-player/18324866
Walter
Chaim,
There was an article in Lancet (widely respected journal) that asked the same question. I do not think the article had a lot of data to support this possibility but….
The ACE2 receptor probably plays a role in much of this, I think, as the article suggests. Article link: HERE
This group of people are on often ACE inhibitors. ACE stands for angiotensin-converting enzyme.
This medicine treats hypertension and any diabetic with hypertension should be using an ACE inhibitor as treatment for hypertension because the medications prevent many of the complications of diabetes including diabetic retinopathy (eye problems) and kidney problem.
From the Lancet article: “Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV] and SARS-CoV-2) bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels.”
Also of note, whatever you think of the anecdotal or early reports (from small studies) of hydroxychloriquine, the most plausible mechanism for any possible effect is that it reduces the expression of the ACE2 receptor.
Of possible personal use: many recommend Tylenol now and not ibuprofen if you have a fever as iboprofen increases the expression of the ACE2 receptor.
And honestly, I would switch medications if I were on an ACE inhibitor until they found a vaccine (e.g, calcium channel blocker). Or as the authors of the Lancet article say: “…we did not find any evidence to suggest that antihypertensive calcium channel blockers increased ACE2 expression or activity, therefore these could be a suitable alternative treatment in these patients.”
CDC general information links:
Information for Clinicians on Therapeutic Options for COVID-19 Patients
Best,
Jim
[quote]
Also of note, whatever you think of the anecdotal or early reports (from small studies) of hydroxychloriquine, the most plausible mechanism for any possible effect is that it reduces the expression of the ACE2 receptor.
[/quote]Thanks Doctor.
What do you think of the following theories?
- Hydroxychloroquine is an ionophore, which allows zinc to enter cells more easily. (Zinc has been shown to inhibit coronavirus RNA polymerase activity in vitro.
- Hydroxychloroquine might also affect the pH inside the cell, which might also inhibit the replication of the enzyme.
[quote]
Chaim,
I do not have an opinion on these possible mechanisms.
Best,
Jim
At least three studies and clinical trials (including one with a control group) have reported good results using zinc in conjunction with Hydroxychloroquine.
On the other hand, anecdotally a number of doctors have reported that they have not had success with Hydroxychloroquine, especially in patients who were already in bad shape. I have reason to believe that zinc was not administered. I also saw a study that showed little or no benefit to using HCQ, but that too was without zinc.
I don’t have a medical degree, but I do have some experience analyzing data. This experience leads me to believe that the combination of zinc together with HCQ should be prioritized for further study.
The way the dots are being connected with the possible implications of zinc and its possible ionophores having curative powers I find incredibly intriguing. If this turns out to be effective it might open up a lot of exploration on the mechanisms at play. I only wonder if anyone will fund research. It seems that some prostate cancer patients are already using the same idea to induce apoptosis in cancer cells. The other possible zinc ionophores that come up in their discussions are clioquinol, quercetin (found in apples and red onions), and epigallocatechin-gallate (found in green tea). Maybe this is one reason why catechin rich foods when eaten together have been observed to seemingly complement each other e.g. cocoa (zinc) and green tea (EGCG). This is all speculation though and I’d put it in another thread if there was a more pertinent one.
Just interesting. I have no predictions about the results. Especially, since a definitive answer is likely to come from this large study. Results expected this summer which is unheard of for a study like this.
It is of note that Remdesivir is an IV medication and Gilead Sciences has no plans for making a pill that could be used as prophylaxis or early treatment.
I would like to add this caution. Nisser mentioned prolongation of the QT interval. This risk is greater when azithromycin (Z-Pak) is added. From the FDA: “Use with caution ……during concomitant administration with QT interval prolonging drugs such as azithromycin and some other antibacterial drugs.”
The article is behind a Medscape paywall (or signup at least) so a link will not be helpful:
[i]"In perhaps the fastest-moving, large prophylaxis trial, researchers at Duke University are leading a $50 million collaboration across hundreds of American health care systems, which will test 15,000 volunteers. Half the health care workers will take hydroxychloroquine, and half a placebo. Other drugs could be added to the study if they prove promising for preventing or lessening infection, says Adrian Hernandez, the trial’s principle investigator.
The trial is being launched by PCORnet®, the National Patient-Centered Clinical Research Network, a network of health care systems that have come together over the last few years to plan and conduct research trials. Although the collaboration predates COVID-19 by nearly five years, this is precisely the kind of situation it was designed to address, says Hernandez, adding that he hopes the network will soon be able to test COVID-19 vaccine candidates as well."[/i]
Lopinavir and Ritonavir prophylaxis also being tested in France:
“In France, researchers are running a trial with 1,200 health care workers to test prophylactic use of hydroxychloroquine or a combination of two HIV drugs, Lopinavir and Ritonavir, which failed as a treatment in people with severe COVID-19 infections but may work as prevention. It is expected to take 6 months.”
Fascinating.
There is a growing body of thought that some of the disease process in some Covid-19 is related to tiny blood clots. These tiny clots (microthrombi) mean there is reduced blood flow to the air sacs in the lung, and so they have problems oxygenating their blood.
This theory is borne out by the fact that autopsies of Covid-9 bodies have found a high percentage of pulmonary hemorrhaging. That’s weird. And also small thrombi in the periphery of the parenchyma! This might also explain why heart disease is such a risk factor in Covid-19 patients.
…
Chaim,
I think you are right about this being a problem for COVID-19 patients. I think you are probably referring to disseminated intravascular coagulation (DIC).
Paradoxically, these people develop bleeding problems as all of their clotting factors get used up creating intravascular clots. The problem is devastating. It carries a terrible prognosis and is not limited to COVID-19 patients. So I had a healthy fear of this problem even before I heard of COVID-19.
I do not have full access to this journal article but here is a copy of the “take home message:”
[i]"TAKE-HOME MESSAGE
The authors of this retrospective analysis evaluated coagulation parameters in 183 patients admitted with the severe novel coronavirus COVID-19. Median age at admission was 54 years, and 71.4% of non-survivors developed overt disseminated intravascular coagulation (DIC), with a median time from admission to DIC of 4 days. Only 0.6% of survivors developed DIC. On admission, non-surviving patients presented with higher D-dimer levels, prolonged PT, and aPTT compared with surviving patients.
In patients with COVID-19 infection, the development of coagulopathy and overt DIC appears to be associated with a high mortality rate. Larger analyses confirming these findings and investigating both the pathophysiology and impact of correction of coagulopathy on mortality are warranted."[/i]
– Curtis Lachowiez, MD
Doc,
Here are the autopsy reports.
In what may be related news, there is a small but growing group of physicians who believe that ventilators are not the best treatment for the ARDS (Acute Respiratory Distress Syndrome) seen in Covid-19 patients.
from here :
In relation to the above, an article from the NY Times: What Doctors on the Front Lines Wish They’d Known a Month Ago
Media is so good at sensationalizing. Proning is nothing new; it’s a common ICU technique to recruit sick lung tissue. I’m sure it was tried day 1 everywhere.
Hi Nisser,
Yes! Certainly not new for patients already on a ventilator.
Here is a meta-analysis of 2,129 patients (already on a respirator or intubated) with acute respiratory distress syndrome from 2017: Prone Position for Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis.
Here is a good controlled study published in the New England Journal of Medicine from 2013 (again of patients already intubated): Prone Positioning in Severe Acute Respiratory Distress Syndrome
Best,
Jim
Unfortunately not everyone has been able to make it to the hospital. If this is well-known this is the kind of information that needs to be disseminated but for some reason isn’t.
https://emcrit.org/pulmcrit/pulmcrit-eleven-reasons-the-nejm-paper-on-remdesivir-reveals-nothing/
The quality of the paper in NEJM is absolutely shameful; shame on the editors for letting this through. I wouldn’t let this be published in the Journal of Scandinavian potato farming.
Ivermectin is showing to be very promising for treatment of Covid 19. 70% reduction in deaths for those treated with it in a study.
Thanks Chaim. Very interesting study.
I thought this was a good review of some other medications with varying potential: JAMA Review Article
Best,
Jim