key: cord-0726152-231xuqbh
authors: Rossato, Marco; Di Vincenzo, Angelo
title: Smoking and Angiotensin-converting Enzyme Inhibitor/Angiotensin Receptor Blocker Cessation to Limit Coronavirus Disease 2019
date: 2020-07-14
journal: Eur Cardiol
DOI: 10.15420/ecr.2020.20
sha: 473e4073147b90bfd8ed4fe6db10f1dd85a3b80c
doc_id: 726152
cord_uid: 231xuqbh

nan

In a recent published paper, we reported that among 132 patients hospitalised at the University Hospital of Padova for pneumonia, none were current smokers, 84.8% were former smokers and 15.2% had never smoked. 7 Nonetheless, we are far from hypothesising that cigarette smoking has a 'protective' role regarding susceptibility to SARS-CoV-2 infection or COVID-19 complications.

We are also aware that any public health policy perspective cannot be left only to science. If scientific evidence shows that smoking is protective against COVID-19, we absolutely cannot suggest people smoke to avoid SARS-CoV-2 infection.

Researchers have to gain more insight into the pathogenesis of SARS-CoV-2 to discover any possible biological mechanism related to the low prevalence of smokers among COVID-19 patients, considering for example the role of ACE2 expression that has been shown to be downregulated by cigarette smoking at least in experimental animals. 8 Furthermore, Komiyama and Hasegawa state that ACE inhibitors (ACEis) and angiotensin receptor blockers (ARBs) increase the expression of ACE2, the putative receptor that SARS-CoV-2 uses to enter the host cell. 1 To this regard, they report that many scientific societies, including the European Society of Cardiology (ESC), have issued alerts suggesting patients discontinue ACEis and ARBs and switch to calcium antagonists. This is not correct. In its recent position statement, the ESC Council on Hypertension has expressed concern over any speculation about the safety of ACEi or ARB treatment in relation to COVID-19, since this does not have any scientific basis or evidence to be supported at yet. In that statement, patients are recommended to continue their usual antihypertensive therapy because of a lack of any clinical or scientific evidence to suggest that treatment with ACEis or ARBs should be discontinued to prevent SARS-CoV-2 infection or reduce COVID-19 severity. 9 Many other highly reputable scientific societies, including the American Heart Association, the American College of Cardiology and the Heart Failure Society of America, have issued similar recommendations. 10 

Smoking cessation as a public health measure to limit the coronavirus disease 2019 pandemic

Key facts

SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor

Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19)

Low rate of daily active tobacco smoking in patients with symptomatic COVID-19

Renin-angiotensinaldosterone system blockers and the risk of Covid-19

Current smoking is not associated with COVID-19

Nicotine and the reninangiotensin system

Position statement of the ESC Council on Hypertension on ACE-inhibitors and angiotensin receptor blockers

HFSA/ACC/AHA statement addresses concerns re: using RAAS antagonists in COVID-19