IJCS | Volume 33, Nº4, July and August 2020

410 1. Mensah GA, Roth GA, Fuster V. The global burden of cardiovascular diseases and risk factors 2020 and beyond. J Am Coll Cardiol. 2019;74(20):2529-32. 2. GheorgheA, Griffiths U, MurphyA, Legido-QuigleyH, Lamptey P, Perel P. The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review. BMC Public Health. 2018;18(1):975. 3. Oliveira GMM, Pinto FJ. COVID-19: a matter close to the heart. Int J Cardiovasc Sci. 2020;33(3):199-202. 4. Noel F, Lima J. Pharmacological aspects and clues for the rational use of chloroquine/hydroxychloroquine facing the therapeutics challenges of COVID-19 pandemic. Lat Am J Clin Sci Med Technol. 2020 Apr;2:28-34. 5. Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, BondiZoccai G, et al. Cardiovascular considerations for patients, health care workers, and health systems during the coronavirus disease 2019 (COVID-19) pandemic. J Am Coll Cardiol. 2020;75(18):2352-71. 6. Kaski JC, Kjeldsen KP. Cardiovascular pharmacotherapy: a new ESC Handbook comprehensively adresses pharmacological treatment issues for patients with cardiovascular disease. Eur Heart J Cardiovasc Pharmacother. 2019;5(4):185-6. 7. Wirtz VJ, Kaplan WA, Kwan GF, Laing RO. Access to medications for cardiovascular diseases in low- and middle-income countries. Circulation. 2016;133(21):2076-85. 8. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular References Final Considerations To date, there is no evidence on the risk-benefit ratio of the use of most cardiovascular drugs in patients with COVID-19. The evidence that points to benefits is particularly related to the improvement of ARDS and not to the treatment of CVD per se. The use of antiplatelet drugs seems to be inadvisable, not only due to the pharmacokinetic drug interaction with lopinavir / ritonavir, an association that may prove to be effective in the treatment of COVID-19, as also observed for statins, but also because it may lead to reduced levels of platelets and bleeding. Due to the pharmacodynamic drug interaction with these promising antivirals, β-blockers may also be inadvisable. In order to especially mitigate ARDS, the use of nifedipine, acetazolamide, phosphodiesterase inhibitors, and LMWH seems to be recommended, provided that, in the case of the latter, eligibility criteria are clear. Ma n y e x p e r t s wa r n t h a t d i s c o n t i n u i n g antihypertensive pharmacotherapy is a dangerous choice and the clinical benefit associated with the use of ACEI / ARB in patients with heart failure is also widely described. As the literature points to the dual effect of these agents in patients with COVID-19 by promoting ACE2 overload in tissues such as the lungs, favoring virus infection, but also reducing the severity of lung injury, perhaps the risk-benefit ratio may suggest the maintenance of pharmacotherapy with these agents for patients with CVD during the course of COVID-19. In this context, it may also be interesting to maintain statins in dyslipidemic patients who do not use the lopinavir / ritonavir association. In view of all these considerations, it is important to point out that it ismandatory that the health teamremains attentive to the clinical manifestations because the studies associated to the disease caused by the new coronavirus still include a relatively small number of individuals, with much to be elucidated about the polynomial COVID-19- ARDS-CVD-cardiovascular pharmacotherapy. Acknowledgements National Council for Scientific and Technological Development (CNPq) for the scientific initiation scholarship granted to the first author of the work. Author Contributions Conception and design of the research: Pedro SS, Scaramello CBV. Acquisition of data: Scaramello CBV. Writing of the manuscript: Pedro SS, Scaramello CBV. Critical revision of themanuscript for intellectual content: Brito FCF, Scaramello CBV. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. Ethics Approval and Consent to Participate This article does not contain any studies with human participants or animals performed by any of the authors. Pedro et al. Cardiovascular pharmacotherapy and covid-19 Int J Cardiovasc Sci. 2020; 33(4):404-411 Viewpoint