COVID-19-associated cardiovascular morbidity in older adults: a position paper from the Italian Society of Cardiovascular Researches

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects host cells following binding with the cell surface ACE2 receptors, thereby leading to coronavirus disease 2019 (COVID-19). SARS-CoV-2 causes viral pneumonia with additional extrapulmonary manifestations and major complications, including acute myocardial injury, arrhythmia, and shock mainly in elderly patients. Furthermore, patients with existing cardiovascular comorbidities, such as hypertension and coronary heart disease, have a worse clinical outcome following contraction of the viral illness. A striking feature of COVID-19 pandemics is the high incidence of fatalities in advanced aged patients: this might be due to the prevalence of frailty and cardiovascular disease increase with age due to endothelial dysfunction and loss of endogenous cardioprotective mechanisms. Although experimental evidence on this topic is still at its infancy, the aim of this position paper is to hypothesize and discuss more suggestive cellular and molecular mechanisms whereby SARS-CoV-2 may lead to detrimental consequences to the cardiovascular system. We will focus on aging, cytokine storm, NLRP3/inflammasome, hypoxemia, and air pollution, which is an emerging cardiovascular risk factor associated with rapid urbanization and globalization. We will finally discuss the impact of clinically available CV drugs on the clinical course of COVID-19 patients. Understanding the role played by SARS-CoV2

Sex‐related differences in COVID‐19 lethality

“…Actually, a large number of COVID-19 patients exhibit severe cardiovascular damage (Moccia et al, 2020) and, as reported above, patients with pre-existing cardiovascular diseases (CVDs) appear to have an increased risk of death (also see below).…”

COVID‐19 diagnostic testing: Technology perspective

“…The specimen and collection time from infected patient may have great influence on the detection result. 30,86,87 Currently nasal swabs and pharyngeal swabs are the major clinical samples used for nucleic acid testing. However, collection of nasopharyngeal specimens is uncomfortable for the patients and increases the risk of infection to health-care workers.…”

The role of Frailty on Adverse Outcomes Among Older Patients with COVID-19

“…The novel severe acute respiratory syndrome coronavirus-2 disease (COVID-19) pandemic has brought an enormous burden to current healthcare systems worldwide with poor outcomes especially among older people. 1 However, other comorbidities besides age were shown to affect the prognostic risk, suggesting that we need a more comprehensive approach. 2 The assessment and adaptation of frailty using appropriate tools in clinical practice to dehttps://doi.org/10.1016/j.jinf.2020.09.029 0163-4453/© 2020 The British Infection Association.…”