IJCS | Volume 33, Nº4, July and August 2020

DOI: https://doi.org/10.36660/ijcs.20200081 Introduction Cardiovascular diseases (CVD) are the main cause not only of global mortality but also of reduced quality of life. They cover ischemic heart disease, stroke, heart failure, peripheral arterydisease, andvarious other heart and vascular conditions. In 2017, CVDs caused about 17.8 million deaths worldwide, corresponding to 330 million years of life lost and another 35.6 million years of life with disabilities. Almost 80% of deaths occur in low- and middle-income countries, such as Brazil, where the occurrence of CVDs and their risk factors are on the rise as a result of an ongoing epidemiological transition. 1 In low-income countries CVDs greatly affect working-age populations, and the total economic loss resulting from this group of diseases is high, representing 2% of Gross Domestic Product. In addition, the disability caused by CVDs has economic consequences at multiple levels: individual, family, economic agents, public institutions, government, and society as a whole. 2 Recent studies also show that chronic conditions, such as CVD, increase the risk of aggravation and death associated with the new coronavirus 2019 disease (COVID-19), whose outbreak was characterized as a pandemic by the World Health Organization (WHO) in March 2020. The new coronavirus is a betacoronavirus calledSARS-CoV-2 (SevereAcuteRespiratorySyndrome coronavirus 2), phylogenetically identical to other coronaviruses capable of determining acute respiratory distress syndrome (ARDS), which is responsible for numerous deaths. The most common symptoms of COVID-19 include fever, cough, dyspnea, myalgia, fatigue, diarrhea, sore throat, chest pain, confusion, and lethargy. Acute and chronic cardiovascular complications have also been observed in the course of COVID-19, being attributed to several mechanisms, such as relative ischemia, systemic inflammation mediated by pathogens, with increased levels of several biomarkers. In this context, studies point to the relevance not only of chronic conditions, such as hypertension, but also of the age and immunological status of the host, characterizing a complex, multifactorial, and bidirectional model that can comprehend the drugs used to treat these pathologies. 3 It is important to note that there is no vaccine for prophylaxis, nor specific drug therapy for the treatment of COVID-19. The repositioning of medications such as chloroquine, hydroxychloroquine, and some antivirals has been considered for the treatment of this disease. 4 However, the clinical effectiveness of this approach has not yet been adequately proven. In addition, the literature points out that the combination of lopinavir / ritonavir antivirals alters cardiac conduction, with prolongation of the QT interval and atrioventricular block. 5 This change in heart rate is also seen in the use of chloroquine / hydroxychloroquine, which can contribute to the development of cardiomyopathy in patients with rheumatic diseases. 4 These cardiotoxic effects are particularly uninteresting in patients with CVDs, such as those using β-blockers, with which these drugs may have a pharmacodynamic drug interaction with regard to atrioventricular conduction. Lifestyle changes andcardiovascular pharmacotherapy play a truly important role in the management of CVDs across their spectrum. Drug therapy has 404 VIEWPOINT International Journal of Cardiovascular Sciences. 2020; 33(4):404-411 Mailing Address: Scaramello, Christianne Rua Prof. Hernani Mello, 101. Postal Code: 24210-130, São Domingos, Niterói, Rio de Janeiro, RJ – Brazil. E-mail: chrisbretas@gmail.com Challenges in Pharmacological Management of Cardiovascular Diseases in Covid-19: do Benefits Outweigh Risks? Samuel de Sousa Pedr o , Fernanda Carla Ferreira de Brit o , Christianne Bretas Vieira Scaramell o Universidade Federal Fluminense, Instituto Biomédico, Niterói, Rio de Janeiro, RJ – Brazil. Manuscript received on April 24, 2020; reviewed on May 11, 2020; accepted on May 31, 2020. Cardiovascular Diseases/mortality; Coronavirus/ complications; COVID-19/complications; Pandemics; SARS Severe Acute Respiratory Syndrome; Dyspnea; Fever; Anticoagulants. Keywords