Key result
COVID-19 exploits cardiometabolic comorbidities to drive direct and indirect cardiovascular and renal complications.
Why the study?
COVID-19 has exposed unexpected cardiovascular and renal vulnerabilities at all stages of infection, driven by shared cardiometabolic and renin-angiotensin system mechanisms.
This review highlights the complex interplay between COVID-19 and the cardiovascular system, emphasizing that underlying cardiometabolic conditions worsen prognosis and that RAS inhibitors should not be discontinued.
May warrant closer cardiometabolic monitoring in COVID-19; leaves open mechanisms of direct viral cardiotoxicity for prospective trials.
The current COVID-19 pandemic, caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus, 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 as having epidemiologic 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, angiotensin-converting enzyme-2 (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 comorbidities not only predispose people to COVID-19, but also are complications of SARS-CoV-2 infection. In addition, increasing evidence indicates that acute kidney injury is common in COVID-19, 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 relationships among 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).
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Touyz et al. (2021) conducted a review in COVID-19 with cardiovascular and renal complications. SARS-CoV-2 infection was evaluated. COVID-19 is a systemic disease that exposes cardiovascular vulnerabilities, with cardiometabolic comorbidities predisposing individuals to severe infection and SARS-CoV-2 causing direct and indirect cardiovascular and renal complications.
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