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Are patients with hypertension and diabetes at increased risk for COVID-19?
- sgroppino 7y agoFrom the article: "ACE2 can also be increased by thiazolidinediones and ibuprofen. These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19."
- chrismeller 7y agoConsidering that lisinopril (Prinivil, Zestrel, etc, an ACE inhibitor) is, according to any list I could find, easily in the top 10 meds prescribed in the US (and by some top three or number one), this is something that should definitely be more publicly known. I’m not saying anyone should just stop taking their hypertension drugs, that’s a horrible idea. But if you do suspect that you might have COVID-19, you should probably call your doctor - there’s no shortage of other options. One of those lists: https://www.medicinenet.com/top_drugs_prescribed_in_the_us/views.htm https://www.medicinenet.com/top_drugs_prescribed_in_the_us/v...
- FeteCommuniste 7y agoA virologist gives a different view in this thread: https://twitter.com/angie_rasmussen/status/1238946940882006016 https://twitter.com/angie_rasmussen/status/12389469408820060... Btw, ACE2 expression is decreased in unmedicated diabetics and HTN patients and the elderly which would imply that those groups should have some degree of protection from the virus (ceteris paribus, obviously). In fact that seems to be exactly the opposite of what we see. Some research even indicates that ACE2 could help prevent ARDS-induced lung injury: https://www.nature.com/articles/srep27911 https://www.nature.com/articles/srep27911 But in that article the injury wasn't induced by COVID-19 so really we don't know enough yet. (Ref. for decreased ACE2 expression in diabetes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992757/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992757/)
- ianai 7y agoIt is widely known (to some extent) that preexisting conditions severely contribute to the harm of covid-19.
- snapetom 7y agoACE != ACE2. ACE inhibitors have no effect on ACE2. https://www.nrcresearchpress.com/doi/10.1139/y02-021 https://www.nrcresearchpress.com/doi/10.1139/y02-021
- mikedilger 7y agohttps://www.researchgate.net/publication/26859747_Upregulation_of_angiotensin-converting_enzyme_ACE_2_in_hepatic_fibrosis_by_ACE_inhibitors https://www.researchgate.net/publication/26859747_Upregulati... "Upregulation of angiotensin-converting enzyme (ACE) 2 in hepatic fibrosis by ACE inhibitors"
- wolfi1 7y agoare those ACE inhibitors also prescribed in China? I really doubt that
- pkaye 7y agoWhy do you doubt they are prescribed in China?
- onetimemanytime 7y agoany reason to doubt it? I mean they are made of flesh and blood as well.
- wolfi1 7y agohypertension is a western disease
- mlrtime 7y agohttps://www.theguardian.com/world/2020/mar/14/anti-inflammatory-drugs-may-aggravate-coronavirus-infection https://www.theguardian.com/world/2020/mar/14/anti-inflammat...
- takeda 7y agoWas about to say this. They advise is to use acetaminophen. It really comes down how covid-19 kills people, whether it is by directly attacking the body, or by triggering cytokine release syndrome (CRS). In later case, medication that suppresses the immune system would be better, but in former case it could make things worse.
- zozbot234 7y ago> It really comes down how covid-19 kills people, whether it is by directly attacking the body, or by triggering cytokine release syndrome (CRS). It seems to be both. Plausibly at least, CRS may be often involved in damage to the respiratory system, but COVID-19 is not unlike SARS in that severe forms can directly attack other parts of the body. So any treatment based on lowering inflammation or any other part of the immune response will have to be carefully tuned.
- sjg007 7y agoThey think the virus enters the cell via Ace2 receptors. The hypothesis is these drugs increase ace2 receptor expression which makes the cells more likely to get infected. Your lung, heart and kidney cells express this receptor.
- dmurray 7y agoIbuprofen, along with paracetamol, is generally considered very safe. All over the world they are prescribed for any kind of pain, fever, inflammation or discomfort. Of course, there are some known side effects, but they are generally considered minor. Does it make sense that a virus would evolve to favour these conditions? Or is it just an unfortunate coincidence? I guess it depends on whether the virus being "worse" means it helps spread faster, or just compromises the host faster - after all, the virus doesn't gain from killing its host. Also, animals don't get treated with NSAIDs to the same degree, so if nCovid-19 came from a non-human host that's another argument for it being coincidence.
- throwawayy477 7y agoIbuprofen is an anti-inflammation drug, which means it weakens somewhat your immune system (which is responsible for the inflammation in the first place). It makes sort of sense that taking such medication while infected with a virus for which there is no treatment can be dangerous. In related news, there have been cases of "severe" forms of Covid-19 among young people with no antecedents, all of them having taken ibuprofen. Please don't take ibuprofen.
- neuronic 7y agoWhy are you putting severe in quotation marks? What makes you feel qualified to give medical advice on an Internet forum? There might be negatives to taking ibuprofen in relation to COVID-19, but so far no official guidelines exist. Only internet stories. Responsible institutes have not handed out such advice, nowhere.
- throwawayy477 7y ago> Why are you putting severe in quotation marks? Because I don't know the official terminology. >What makes you feel qualified to give medical advice on an Internet forum? Because of where I work I have been given "primary sources", but of course you are free to not believe me. This is my own sentiment, feel free to look things up yourself. > no official guidelines exist. Only internet stories. Not in the US, maybe, but such guidelines definitely exist where I live. Again, you do you
- lousken 7y agowhy is this keep popping up??? https://news.ycombinator.com/item?id=22582568 https://news.ycombinator.com/item?id=22582568 https://news.ycombinator.com/item?id=22576721 https://news.ycombinator.com/item?id=22576721 stop spamming this
- azinman2 7y agoThose other ones got flagged, but this is from the lancet which is a credible source.
- jbattle 7y agoAfter a couple of asthmatic attacks after taking aspirin and ibuprofen I went to an allergist and she told me that I have an allergic reaction to all NSAIDs. The syndrome is called 'NSAIDs-Exacerbated Respiratory Disease'. I felt equally proud and ashamed that the medical establishment officially diagnosed me as a NERD https://en.wikipedia.org/wiki/NSAID_hypersensitivity_reactions https://en.wikipedia.org/wiki/NSAID_hypersensitivity_reactio...
- takeda 7y agoSadly NERD doesn't refer to you, but to the disease ;P
- silviogutierrez 7y agoCould argue diseased as a noun works (to refer to them, as “the diseased”)
- WilsonPaige 7y agoYet he nonetheless does have the "NERD disease".
- happycube 7y agoBettridge's law may be wrong here... sounds like the answer is "maybe"
- geofft 7y agoBut this isn't even the real headline. The real headline is "Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?" And it's not even a headline, it's a title of a medical note to other researchers to advance a hypothesis. This isn't a news source, this is work in progress in the early stages of the scientific method.
- he0001 7y agoHow do you follow up one these “articles”. I understand that it is a hypothesis, but unfortunately these articles do create some nasty rumors, where these tend to be treated as facts instead of just a hypothesis.
- geofft 7y agoThe actual title of this article is, "Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?" The relevant portion about ibuprofen, lightly edited to make it more readable, is: > Coronaviruses bind to their target cells through ACE2. The expression of ACE2 is substantially increased in patients with diabetes, who are treated with ACE inhibitors and ARBs. Hypertension is also treated with ACE inhibitors and ARBs, which results in an upregulation of ACE2. ACE2 can also be increased by thiazolidinediones and ibuprofen. These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19. More broadly, they're saying that many of the medical notes of patients who died mentioned that the patients also had diabetes or hypertension, and they're wondering if the correlation is about the treatment for those conditions and not about the conditions themselves. It's not clear to me whether they're implying that anyone who takes ibuprofen (e.g. for a headache or even for a COVID-19 fever) will have more ACE2 and therefore be more susceptible to severe and fatal COVID-19, or if that effect only happens in the context of treatment for diabetes and hypertension. I can see how you can read it in the first way, but it feels like they would have titled it clearer if that were what they were actually saying. In particular, there is plenty of advice for people with mild COVID-19 cases to do the normal things they'd do to take care of a flu at home, including take ibuprofen. If that's a bad idea, I feel like they would have said that more loudly. (For instance - does it matter whether you've got more ACE2 if you're already infected and trying to keep the symptoms under control?) EDIT: Thanks to 'FeteCommuniste in another comment for linking this Twitter thread https://twitter.com/angie_rasmussen/status/1238946937916682241 https://twitter.com/angie_rasmussen/status/12389469379166822... which points out that this is an un-peer-reviewed hypothesis.
- dharma1 7y agoit's worth watching this lecture from last week to understand the role of ACE2 in SARS-CoV-1 and SARS-CoV-2 - very informative https://www.youtube.com/watch?v=jAW6VBWTiAA https://www.youtube.com/watch?v=jAW6VBWTiAA
- 7y ago
- zackmorris 7y agoI'm wondering if some of the downside of anti-inflammatories is that they often lower fevers. A fever is the body's natural response to infection, to raise the rate of chemical reactions and make more immune cells: https://www.sciencedaily.com/releases/2011/11/111101130200.htm https://www.sciencedaily.com/releases/2011/11/111101130200.h... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869589/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869589/ I also think that this is part of the mechanism that makes zinc effective against viruses as a catalyst. Generally, I think that it's good to keep fevers down for non-lethal infections like the common cold, especially for children. Just beware that aspirin may cause Reye's syndrome in the young: https://www.healthline.com/health/headache-reyes-syndrome https://www.healthline.com/health/headache-reyes-syndrome But for serious infections like Covid-19, maybe it would be better to maintain a relatively safe temperature of say 101-102 F (38-39 C)? I'm honestly curious to know what doctors think of this.
- fhars 7y agoThat is probably completely dependent on the infection you are treating. Sometimes it may be better to reduce stress on the patient, sometimes higher temperatures help stop the infection. After all, someone got a Nobel prize for infecting people with malaria to cure them of syphilis https://en.m.wikipedia.org/wiki/Pyrotherapy https://en.m.wikipedia.org/wiki/Pyrotherapy
- topkai22 7y agoGood summary, althoughI would be more forceful about aspirin- don't use it for children under 12 without a medical professional recommending it. While Reyes syndrome is rare, acetaminophen and ibuprofen are equally effective, available, and do not carry the risk.
- robocat 7y agoTaking too much acetaminophen (Paracetomol) is the most common cause of acute liver failure in the United States. There has been a huge PR push (in advertising etc) against Aspirin and for other NSAIDs. Of course, take care, but don’t be sucked in by marketing.
- mrb 7y agoFrench sources specifically mention severe cases of covid-19 in "young and healthy" patients (eg. see https://lefigaro.fr/sciences/coronavirus-alerte-sur-l-ibuprofene-et-autres-anti-inflammatoires-20200314 https://lefigaro.fr/sciences/coronavirus-alerte-sur-l-ibupro... ) but this important piece of information has NOT been relayed by international medias. Jean Paul Hamon, medical doctor and president of the Federation of French Doctors said on TV to NOT take NSAIDs (anti-inflammatory drugs) if #covid19 is suspected. The ONLY common point among young covid-19 patients they have witnessed in critical care centers in France was that they all took NSAIDs.
- dukha 7y agoTranslation from French: paracetamol is preferred over nonsteroidal anti-inflammatory drugs (NSAID). Dose of paracetamol should not exceed 3g/day and doses should be spaced throughout the day.
- slowmovintarget 7y ago"Paracetamol" a.k.a. "acetaminophen", common brand: Tylenol.
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- arcticbull 7y agoWhich is itself the leading cause of acute liver failure in the US. The active dose is very close to the lethal dose, much more so than naproxen or ibuprofen.
- calebsurfs 7y agoThe active dose is nowhere near the lethal dose. It is however close to the dose where you could see some minor damage to the liver. It causes problems because people are addicted to opioid drugs that are typically combined with acetaminophen, not because they are loading up on acetaminophen itself.
- fatjokes 7y agoMorbidity aside, this must be an exciting time to be an epidemiologist.
- SubiculumCode 7y agoCurious. Melatonin is anti-inflammatory. Would this pose a similar (hypothetical) danger as NSAIDs?
- bryanrasmussen 7y agoIbuprofen is also used among people with arthritis and gout, gout is strongly linked with diabetes.
- earthtourist 7y agoAny information on cough suppressants? Whether they're a good or bad for people with COVID-19? I've had my doctor recommend against cough suppressants in the past. But I've had trouble sleeping with a bad cough, and so if cough suppressants make sleep possible, it seems like a net-win. Is there any data yet?
- Enginerrrd 7y agoI've looked and haven't found any. My gut says it sounds like a bad idea. Usually they want pneumonia patients to cough, and use their incentive spirometer frequently.
- nradov 7y agoAre you asking about dextromethorphan or some other cough suppressant? I don't think there's any real evidence one way or the other yet.
- earthtourist 7y agoYes, dextromethorphan. Thanks.