Cardiovascular and Renal Risk Factors and Complications Associated With COVID-19

Abstract

The current COVID-19 pandemic, caused by the SARS-CoV-2 virus (Severe Acute Respiratory Syndrome-Coronavirus-2), represents the largest medical challenge in decades. It has exposed unexpected cardiovascular vulnerabilities at all stages of the disease (pre-infection, acute phase and subsequent chronic phase). The major cardiometabolic drivers identified to have epidemiological and mechanistic associations with COVID-19 are abnormal adiposity, dysglycemia, dyslipidemia, and hypertension. Hypertension is of particular interest, because components of the renin-angiotensin system (RAS), which are critically involved in the pathophysiology of hypertension, are also implicated in COVID-19. Specifically ACE2, a multifunctional protein of the RAS, which is part of the protective axis of the RAS, is also the receptor through which SARS-CoV-2 enters host cells causing viral infection. Cardiovascular and cardiometabolic co-morbidities not only predispose to COVID-19, but are complications of SARS-CoV-2 infection. In addition, increasing evidence indicates that acute kidney injury is common in COVID-19, that it occurs early and in temporal association with respiratory failure and is associated with poor prognosis, especially in the presence of cardiovascular risk factors. Here we discuss cardiovascular and kidney disease in the context of COVID-19 and provide recent advances on putative pathophysiological mechanisms linking cardiovascular disease and COVID-19, focusing on the RAS and ACE2 as well as the immune system and inflammation. We provide up-to-date information on the relationship between hypertension, diabetes, and COVID-19 and emphasize the major cardiovascular diseases associated with COVID-19. We also briefly discuss emerging cardiovascular complications associated with long COVID-19, notably postural tachycardia syndrome (POTS).

Long Covid e complicações que impactam na qualidade de vida dos sobreviventes

“…Áreas afetadas Complicações mais frequentes Dennis et al 10 Lui et al 9 Orrù et al 11 Touyz et al 12…”

“…Chippa, Aleem e Anjum 13 Dennis et al 10 Huang et al 7 Orrù et al 11 Touyz et al 12 Valença, Andrade e Peres 5…”

“…Chippa, Aleem e Anjum 13 Dennis et al 10 Lui et al 9 Orrù et al 11 Touyz et al 12 Valença, Andrade e Peres 5 Neurológica Acidente vascular encefálico, encefalopatia, meningoencefalite, convulsões, comprometimento cognitivo, cefaleia, distúrbios do sono, tontura, delírio, disautonomia.…”

Excess Body Mass—A Factor Leading to the Deterioration of COVID-19 and Its Complications—A Narrative Review

“…Additionally, it seems likely that many patients with kidney disease will not return to their pre-COVID-19 renal function. Existing data suggest that 25-35% patients have not returned to baseline kidney function at the time of hospital discharge [47].…”

Endocrinology in the Time of COVID-19: A Rapid Evolution of Knowledge and Care

“…It is now well established that patients with diabetes are at a vastly higher risk of contracting more severe forms of the disease [4,5]; in fact, the relationship appears to be bidirectional [6]. Individuals with diabetes are at higher risk of life-threatening complications, mainly of a cardiopulmonary and renal nature [7,8]. Obese persons with previously existing pre-diabetes or mild diabetes, when exposed to the SARS-CoV-2 virus, develop a greatly advanced form of hyperglycemia that frequently requires life-sustaining care and hospitalization [9].…”