THE IMPACT OF SARS-COV-2 ON VESSELS AND THE MUTUAL INFLUENCE OF THE MEDICINES

Аннотация

In March 2020 the World Health Organization (WHO) declared the Coronavirus disease 2019 (COVID-2019) outbreak a global pandemic. Almost two years later, there have been more than 600 million cases and more than 6.5 million deaths worldwide [1]. Despite the exact mechanisms underlying severe COVID-19 remaining unknown, it has been suggested that during the response to SARS-CoV-2 the immune dysregulation and the high levels of pro-inflammatory cytokines might represent pivotal causes of tissue damage. In this context, statins, which are usually used to treat dyslipidemia, gained attention due to their potential role in COVID-19 prognosis [2]. Several studies highlighted their anti- inflammatory, immunomodulatory, antithrombotic, and antiviral properties that may translate into improved short- and long-term outcomes in COVID-19 patients. Apparently, vascular lesions in COVID-19 are more significant than the cytotoxicity of the virus in cardiomyocytes. Of course, cardiovascular implications of COVID-19 are most dangerous for those who, on the basis of preexisting atherosclerosis, already have chronic lesions ofthe coronary/cerebral arteries and marginally reduced perfusion reserves of the myocardium and othervital organs. Key words:COVID-19 ,dyslipidemia, inflammation,cytokines. This study aimed to assess whether preadmission statin use in patients with CVDs who tested positive for SARS-CoV-2 and were hospitalized was associated with less severe COVID-19 prognosis. The population under study included all inhabitants (≥18 years old) in the territory of Bergamo- and Brescia-HPA, Italy, with a CVD such as ischemic heart disease, peripheral vascular disease, cerebrovascular disease and heart failure, and who tested positive for SARS-CoV-2 and were hospitalized between 20 February 2020 and 31 December 2020. For each selected individual, demographic characteristics such as sex and age were extracted at ID, whereas clinical information (comorbidities and drug exposure) were investigated in the period prior to the ID. Data on comorbidities were retrieved by using the chronic disease registry updated on 1 January 2020. In the chronic disease registry, each disease is assessed by merging data from different data sources such as pharmacy claims and inpatient and outpatient care. Therefore, for each selected individual the presence of the following comorbidities was evaluated: Alzheimer or dementia, respiratory diseases, hypertension, diabetes, chronic liver diseases, rheumatic diseases, cancer, and infection with human immunodeficiency virus (HIV). Among the statins users, atorvastatin was the most prescribed (60.4%) medication, followed by simvastatin (20%), rosuvastatin (16.3%), pravastatin (2.1%), fluvastatinn (1.1%), and lovastatin (0.2%); 71% of users showed high adherence (PDC ≥ 80%) to the treatment in the year prior to the ID. Statin users were more likely to be male compared with LLT non-users (69% vs. 57%), whereas no age difference was observed between groups. Statins users also 98,7:ROTCAFTCAPMI.SECNEICSLACIDEM ,5202 ,lirpA,5emuloV gro.srehsilbupcimedaca.www reported significantly higher prevalence of diabetes (40% vs. 26%) compared with non-LLT users. Use of statins prior to hospitalization was not associated with significant changes in the risk of need of MV (OR: 1.00; 95% CI: 0.38–2.67) and ICU access (OR: 0.54; 95% CI: 0.22–1.32) In this retrospective cohort analysis of patients with CVDs who tested positive for SARS- CoV-2 and were hospitalized, statins use before hospital admission was not associated with a decreased risk of ICU access and MV need compared with non-LLT users. Similar results were found in different ages, genders, and levels of statins exposure, regardless of whether the participants had comorbidities. On the other hand, results suggested a protective role of statins on mortality at 30 days. Additionally, sensitivity analyses performed by selecting only patients with specific CVD (i.e., ischemic heart diseases, cerebrovascular diseases, heart failure) were consistent with the main results. Our findings on ICU access and MV need are in line with those reported in most published studies, suggesting no association between statins use and variation in the risk of ICU access and/or need of MV in hospitalized COVID-19 patients withhistory of CVDs Indeed, the 61% decreased risk of mortality at 30 days in statin users is also consistent with therange of 30–70% lower mortality risk reported in previous studies [2]but it does contrast withother two studies reporting noassociation between statinsuseand in-hospital mortality. CVDs, prominent risk factors for developing severe COVID-19, are commonly treated with statins. Therefore, in COVID-19 patients, a complex interplay between the effects of these diseases and statins can be hypothesized. For example, statins might inhibit either the main protease of SARS-CoV-2 with consequent alteration of its infectivity properties, or the expression of receptor