Considering this scenario, it is critical to better define the precise strength of the association between cardiovascular disease, diabetes and hypertension, with the prognosis of COVID-19, which might help to create more effective prevention strategies in the population. In 2019, the International Diabetes Federation (IDF) estimated that 8.8% of the world population between 20 and 79В years old were living with diabetes, representing 415 million people. It is relevant to notice that NCDs accounted for 79.5% of total years lived with disability (YLDs) in 2017, with a total of 678 million YLDs for NCDs causes.

These findings represent a worrying public health problem worldwide, when we face the actual burden of non-communicable chronic diseases (NCDs), especially diabetes, hypertension and cardiovascular disease. However, until now, the evidence has been controversial, as potential adverse effects of these agents on the prognosis of individuals with COVID-19 have not been confirmed.ДЄs the pandemic advanced to other continents, data from Europe and Americas have confirmed the disturbing relationship between diabetes, hypertension and cardiovascular disease and COVID-19 outcomes. It has been also hypothesized that some medications could increase ACE2 expression, such as ACE inhibitors and angiotensin 2 receptor blockers (ARBs) that might result in worsening infectivity and severity of SARS-CoV-2 infection due to increased binding to their target cells through ACE2. It was documented that angiotensin-converting enzyme 2 (ACE2) receptor expression is increased in individuals with diabetes. Moreover, medicationsвЂ™ mechanism arise as some explanatory hypothesis emerges for this association. Since the first reports of COVID-19 in Wuhan, China, high frequencies of diabetes, hypertension and cardiovascular disease among hospitalized patients and in those with fatal outcome have shown the importance of these co-morbidities as a risk factor for serious outcomes and lethality.

Despite that, studies have shown a worse prognosis for individuals with chronic diseases, such as diabetes (DM), hypertension (HT) or cardiovascular disease (CVD). The initial symptoms do not seem to differ by the presence of comorbidities and the mild clinical presentation of cases was similar in different countries and at different ages. Current studies and reviews have helped to clarify the clinical profile of COVID-19, regarding to the most prominent symptoms, as well as to factors associated with greater susceptibility to infection and severity of the disease. Д¬onsidering the prognosis of the COVID-19, approximately 80% of patients have mild illness, 14% have severe illness and 5% critical illness. Until the end of May, SARS-CoV-2 infection had already affected more than 200 countries/regions and accounted for more than 360 thousand deaths worldwide. At that time, it affected 114 different countries, being responsible for about 4 thousand deaths around the world. The World Health Organization declared the SARS-CoV-2 outbreak, the Coronavirus DiseaseвЂ“COVID-19, as pandemic on 11th of March of 2020. In conclusion, diabetes, hypertension and especially cardiovascular disease, are important risk factors for severity and mortality in COVID-19 infected people and are targets that must be intensively addressed in the management of this infection. On the contrary, the use of ACEI/ARB, was not associate with severity of COVID-19. Cardiovascular disease was strongly associated with both severity and mortality, respectively. The random-effect meta-analysis showed that diabetes mellitus and hypertension were moderately associated respectively with severity and mortality for COVID-19: Diabetes Hypertension. Forty articles were included involving 18.012 COVID-19 patients. Systematic review of the PubMed, Cochrane Library and SciELO databases was performed to identify relevant articles published from December 2019 to 6th May 2020. The aim of this study is to evaluate the impact of diabetes, hypertension, cardiovascular disease and the use of angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) with severity (invasive mechanical ventilation or intensive care unit admission or O2 saturationвЂ‰<вЂ‰90%) and mortality of COVID-19 cases.

Cma comprehensive meta analysis