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Cardiovasc Res ; 118(10): 2253-2266, 2022 Jul 27.
Article in English | MEDLINE | ID: covidwho-2032022


Cardiovascular (CV) disease (CVD) remains the leading cause of major morbidity and CVD- and all-cause mortality in most of the world. It is now clear that regular physical activity (PA) and exercise training (ET) induces a wide range of direct and indirect physiologic adaptations and pleiotropic benefits for human general and CV health. Generally, higher levels of PA, ET, and cardiorespiratory fitness (CRF) are correlated with reduced risk of CVD, including myocardial infarction, CVD-related death, and all-cause mortality. Although exact details regarding the ideal doses of ET, including resistance and, especially, aerobic ET, as well as the potential adverse effects of extreme levels of ET, continue to be investigated, there is no question that most of the world's population have insufficient levels of PA/ET, and many also have lower than ideal levels of CRF. Therefore, assessment and promotion of PA, ET, and efforts to improve levels of CRF should be integrated into all health professionals' practices worldwide. In this state-of-the-art review, we discuss the exercise effects on many areas related to CVD, from basic aspects to clinical practice.

Cardiorespiratory Fitness , Cardiovascular Diseases , Cardiorespiratory Fitness/physiology , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/prevention & control , Exercise/physiology , Humans , Risk Factors
Am J Cardiovasc Drugs ; 20(5): 413-418, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-691058


Amiodarone, one of the most widely prescribed antiarrhythmic drugs to treat both ventricular and supraventricular arrhythmias, has been identified as a candidate drug for use against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present the rationale of using amiodarone in the COVID-19 scenario, as well as whether or not amiodarone administration represents a potential strategy to prevent SARS-CoV-2 infection, rather than simply used to treat patients already symptomatic and/or with severe coronavirus disease 2019 (COVID-19), based on current evidence.

Amiodarone/pharmacology , Arrhythmias, Cardiac , Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Angiotensin-Converting Enzyme 2 , Anti-Arrhythmia Agents/pharmacology , Antiviral Agents/pharmacology , Arrhythmias, Cardiac/drug therapy , Arrhythmias, Cardiac/virology , Betacoronavirus/drug effects , Betacoronavirus/physiology , COVID-19 , Coronavirus Infections/drug therapy , Coronavirus Infections/metabolism , Coronavirus Infections/physiopathology , Coronavirus Infections/prevention & control , Humans , Pandemics/prevention & control , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/drug therapy , Pneumonia, Viral/metabolism , Pneumonia, Viral/physiopathology , Pneumonia, Viral/prevention & control , Risk Assessment , SARS-CoV-2 , Treatment Outcome , Virus Internalization/drug effects
Mayo Clin Proc ; 95(6): 1222-1230, 2020 06.
Article in English | MEDLINE | ID: covidwho-31641


Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, is being defined as the worst pandemic disease of modern times. Several professional health organizations have published position papers stating that there is no evidence to change the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in the management of elevated blood pressure in the context of avoiding or treating COVID-19 infection. In this article, we review the evidence on the relationship between the renin-angiotensin-aldosterone system and COVID-19 infection. In agreement with current guidelines, patients with hypertension should continue taking antihypertensive medications as prescribed without interruption. Because ACEIs and ARBs are also used to retard the progression of chronic kidney disease, we suggest that these recommendations also apply to the use of these agents in chronic kidney disease. No differences generally exist between ARBs and ACEIs in terms of efficacy in decreasing blood pressure and improving other outcomes, such as all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, and end-stage renal disease. The ACEIs are associated with cough secondary to accumulation of bradykinin and angioedema, and withdrawal rates due to adverse events are lower with ARBs. Given their equal efficacy but fewer adverse events, ARBs could potentially be a more favorable treatment option in patients with COVID-19 at higher risk for severe forms of disease.

Angiotensin Receptor Antagonists/pharmacology , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Coronavirus Infections , Hypertension , Pandemics , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral , Renin-Angiotensin System/drug effects , Angiotensin-Converting Enzyme 2 , Betacoronavirus/isolation & purification , COVID-19 , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/metabolism , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Hypertension/metabolism , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/metabolism , SARS-CoV-2