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Review
. 2020 Apr 29;22(5):34.
doi: 10.1007/s11886-020-01293-2.

Cardiovascular Risks in Patients with COVID-19: Potential Mechanisms and Areas of Uncertainty

Paul Cheng  1 , Han Zhu  1   2 , Ronald M Witteles  1   2 , Joseph C Wu  1   2 , Thomas Quertermous  1   2 , Sean M Wu  1   2 , June-Wha Rhee  3   4
Affiliations
Review

Cardiovascular Risks in Patients with COVID-19: Potential Mechanisms and Areas of Uncertainty

Paul Cheng et al. Curr Cardiol Rep. .

Abstract

Purpose of review: COronaVirus Disease 2019 (COVID-19) has spread at unprecedented speed and scale into a global pandemic with cardiovascular risk factors and complications emerging as important disease modifiers. We aim to review available clinical and biomedical literature on cardiovascular risks of COVID-19.

Recent findings: SARS-CoV2, the virus responsible for COVID-19, enters the cell via ACE2 expressed in select organs. Emerging epidemiological evidence suggest cardiovascular risk factors are associated with increased disease severity and mortality in COVID-19 patients. Patients with a more severe form of COVID-19 are also more likely to develop cardiac complications such as myocardial injury and arrhythmia. The true incidence of and mechanism underlying these events remain elusive. Cardiovascular diseases appear intricately linked with COVID-19, with cardiac complications contributing to the elevated morbidity/mortality of COVID-19. Robust epidemiologic and biologic studies are urgently needed to better understand the mechanism underlying these associations to develop better therapies.

Keywords: ACE2; Arrhythmia; COVID-19; Cardiovascular risk factors; Mortality; Myocardial injury.

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Conflict of interest statement

June-Wha Rhee, Paul Cheng, Han Zhu, Ronald M. Witteles, Thomas Quertermous, Joseph C. Wu, and Sean M. Wu declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The role of ACE2 in COVID-19. a The spike protein of SARS-CoV-2 binds ACE2 on a cellular membrane, which triggers 1) endocytosis of the virus and subsequent sequestration of ACE2 or 2) cleavage of the viral spike protein via an enzyme TMPRSS2 leading to the entry of viral contents into the cytoplasm. b Normalized RNA expression of different tissue types from three transcriptomics datasets (HPA, GTEx, and FANTOM5) shows significant ACE2 expression in GI organs, the kidney, and the heart
Fig. 2
Fig. 2
Potential mechanisms for myocardial injury caused by COVID-19
See this image and copyright information in PMC

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