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Endothelial injury generated directly by intracellular viral replication and by ACE2 downregulation, exposing cells to angiotensin II in the absence of the modulator effects of angiotensin 17 (270, 271), and vascular chronic inflammation promoting the development of tissue macrophages overloaded by cholesterol (foam cells), both increase the possibility of acquiring a severe COVID-19 infection (170, 209, 258, 259, 272, 273)

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Because tirzepatide engages two incretin pathways, it is technically distinct from single-receptor GLP-1 receptor agonists, even though it is commonly discussed alongside them