A novel betacoronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly across the globe since December 2019. Coronavirus disease 2019 (COVID-19) has a significantly higher mortality rate than seasonal influenza and has disproportionately affected older adults, especially those with cardiovascular disease and related risk factors. Adverse cardiovascular sequelae, such as myocarditis, acute myocardial infarction, and heart failure, have been reported in patients with COVID-19. No established treatment is currently available; however, several therapies, including remdesivir, hydroxychloroquine and chloroquine, and interleukin (IL)-6 inhibitors, are being used off-label and evaluated in ongoing clinical trials. Considering these therapies are not familiar to cardiovascular clinicians managing these patients, this review describes the pharmacology of these therapies in the context of their use in patients with cardiovascular-related conditions.

BACKGROUND

The first cases of pneumonia due to a novel betacoronavirus were first identified in December 2019 in Wuhan, China. 1 Later named, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), has infected hundreds of thousands across 6 continents. 1 The overall case-fatality rate of COVID-19 remains in flux but was initially reported to be 2.3% in mainland China, while Italy has reported a case-fatality rate of 7.2%. 2, 3 Of note, case-fatality rates have been reportedly higher in patients with pre-existing cardiovascular disease. 2