IJCS | Volume 33, Nº4, July and August 2020

405 proven to be a life-saving or life-prolonging tool in some cases, as well as to improve the quality of life in others, as a result of its role in improving debilitating symptoms. 6 The reduction of blood pressure using one or more drugs in association is fundamental for the prevention and treatment of CVDs. Globally, 62% of cerebrovascular diseases and 49% of ischemic heart diseases were attributed to suboptimal blood pressure control. Similarly, the development of drugs to control serum lipid levels has had an important impact on the prevention and treatment of these diseases. Statins can reduce the risk of cardiovascular events by 20%, and the benefits of therapy increase with their duration. In addition, antiplatelet drugs, such as low-dose acetyl salicylic acid, play an important role in preventing ischemic heart disease and stroke. As the mechanism of action of the main pharmacotherapeutic options for the prevention of CVDs (antihypertensives, hypolipemiants and antiplatelet agents) are independent, fixed dose combinations of these substances are adopted. 7 Although the different classes of antihypertensive drugs have similar efficacy for preventing the vascular results of interest, the literature points that β-blockers appear to be inferior to others for the prevention of major cardiovascular events, such as stroke and renal failure. In the case of heart failure prevention, while diuretics appear to be superior, calcium channel blockers are inferior; however, for stroke prevention they are superior. The combination of these agents with angiotensin-converting enzyme inhibitors (ACEI) has proven to be more effective in preventing CVDs than the ACEI-diuretic association. 8 However, the benefit not only of ACE inhibitors but also of angiotensin receptor blockers (ARB) in the course of COVID-19 is controversial. 3 In view of the above, the aim of the present review was to analyze the risk-benefit ratio of cardiovascular pharmacotherapy in patients with COVID-19. Methods The electronic databases LILACS, MEDLINE and SCOPUS were consulted, crossing the term COVID-19 with the different CVDs individually, as well as with the different pharmacological groups associated with the treatment of these pathologies, without delimiting the time for the research that was conducted in April 2020. Figure 1 illustrates the selection process of the researched studies and the number of publications found at each stage. A total of 84 results were found, from which articles that were not available in English and / or Portuguese were excluded. Studies were also discarded after reading the titles and abstracts, as well as after reading the full text. After screening, 15 articles were selected because they showed a direct relationship with the subject of the present study. Results and Discussion Antithrombotic and Statins Antithrombotics include anticoagulants, antiplatelet agents, and fibrinolytics. These agents are prescribed in several situations related to hemostasis disorders that favor the formation of thrombi. Anticoagulants can be for oral use, such as warfarin and xabans, or for parenteral use, such as high and low molecular weight heparins (LMWHs). 9,10 Statins are drugs used to treat dyslipidemia, reducing the risk of cardiovascular disease. 7 These agents, as well as antiplatelet inhibitors of P2Y12 activity (clopidogrel and ticagrelor) and oral anticoagulants, present pharmacokinetic interactions with lopinavir / ritonavir, antiviral agents evaluated in prospective studies, as well as ribavirin and remdesivir, leading to the need for revision of the therapeutic regimen to avoid toxicity if used in combination. The literature also points to an interesting anti-inflammatory effect of statins to mitigate the course of COVID-19. 11 Anticoagulant therapy with heparins, mainly with LMWHs, such as enoxaparin, seems to be associated with a better prognosis inpatientswith severeCOVID-19 provided they meet the criteria for sepsis-induced coagulopathy or with markedly high D-dimer levels. All of this is due to the risk of disseminated intravascular coagulation and venous thromboembolism. 9,10 Although COVID-19 is characterized by hyper brinolysis, studies that attempt to restore fibrinolytic function have not been reported. 12 The literature points to an association between viral load and the severity of COVID-19 so that individuals with a higher viral load can develop severe acute lung injury, requiring hospitalization in an intensive care unit with poor prognosis. Mortality of patients developing ARDS is 49%. Many patients with COVID-19 develop multiple organ failure. The main causes of death are ARDS, septic shock with multiple Pedro et al. Cardiovascular pharmacotherapy and covid-19 Int J Cardiovasc Sci. 2020; 33(4):404-411 Viewpoint