COVID-19 and the cardiovascular system

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects host cells through ACE2 receptors, leading to coronavirus disease (COVID-19)-related pneumonia, while also causing acute myocardial injury and chronic damage to the cardiovascular system. Therefore, particular attention should be given to cardiovascular protection during treatment for COVID-19.

Kidney disease is associated with in-hospital death of patients with COVID-19

“…Given that ACE2 is a functional receptor for SARS-CoV-2, the safety and potential effects of RAAS inhibitors in patients with COVID-19 should be carefully considered. 24 These potentially harmful effects may account for the low proportion of RAAS inhibitors used by physicians in our cohort, especially in AKI patients who had higher level of creatinine on admission. Due to the small number of AKI patients and the bias in different therapy of COVID-19 patients, causal relationship between drug and AKI in COVID-19 patients remains undetermined.…”

Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic

“…In addition, COVID-19 infection may trigger pathways unique to this pathogen which contribute to outcomes in CVD patients. For instance, higher expression of ACE2 in patients with hypertension and CVD has been postulated to enhance susceptibility to SARS-CoV2, although the data are conflicting and without clear suggestion for treatment ( Figure 1) (5). Additional study is needed to understand the potential mechanistic relationships between CVD and COVID-19 outcomes.…”

“…As the ACE2 receptor is the mechanism of entry for SARS-CoV2, some data suggest that ACE inhibitors (ACEi) and angiotensin receptor blockers (ARB) may upregulate ACE2, thereby increasing susceptibility to the virus (Figure 1) (5). In contrast other studies show that ACEi/ARB may potentiate the lung protective function of ACE2, which is an angiotensin II inhibitor (80)(81)(82).…”

“…Preexisting cardiovascular disease (CVD) may predispose to COVID-19 infection. Those with CVD who are infected by the virus have an elevated risk of adverse outcomes; and infection, itself, is associated with cardiovascular complications (4)(5)(6). Moreover, COVID-19 infection may also have numerous indirect effects relevant to CV health.…”

Renin-angiotensin system at the heart of COVID-19 pandemic

“…ACE2 is an 805-amino acids captopril-insensitive carboxypeptidase with a 17-amino acids Nterminal signal peptide and a C-terminal membrane anchor [4]. ACE2 catalyzes the cleavage of angiotensin I into angiotensin 1-9, and of angiotensin II into the vasodilator angiotensin 1-7, thus playing a key role in systemic blood pressure homeostasis, counterbalancing the vasoconstrictive action of angiotensin II, which is generated by cleavage of angiotensin I catalyzed by ACE [5]. Although ACE2 mRNA is present in all organs, its protein expression dominates on lung alveolar epithelial cells, enterocytes, arterial and venous endothelial cells, and arterial smooth muscle cells [6].…”