Systemic Inflammation and COVID-19 Mortality in Patients with Major Noncommunicable Diseases: Chronic Coronary Syndromes, Diabetes and Obesity

Abstract

COVID-19 is currently considered an inflammatory disease affecting the entire organism. In severe forms, an augmented inflammatory response leads to the fulminant "cytokine storm", which may result in severe multisystemic end-organ damage. Apart from the acute inflammatory response, it seems that chronic inflammation also plays a major role in the clinical evolution of COVID-19 patients. Pre-existing inflammatory conditions, such as those associated with chronic coronary diseases, type 2 diabetes mellitus or obesity, may be associated with worse clinical outcomes in the context of COVID-19 disease. These comorbidities are reported as powerful predictors of poor outcomes and death following COVID-19 disease. Moreover, in the context of chronic coronary syndrome, the cytokine storm triggered by SARS-CoV-2 infection may favor vulnerabilization and rupture of a silent atheromatous plaque, with consequent acute coronary syndrome, leading to a sudden deterioration of the clinical condition of the patient. This review aims to present the current status of knowledge regarding the link between COVID-19 mortality, systemic inflammation and several major diseases associated with poor outcomes, such as cardiovascular diseases, diabetes and obesity.

Keywords: chronic coronary syndrome; cytokine storm; inflammation; obesity; type 2 diabetes.

Figure 1

The link between COVID-19 cytokine storm and acute coronary syndrome (ACS). Usually, ACS is produced by the rupture of an atheromatous plaque, after a long evolution of a chronic coronary syndrome, which may be associated with persistent, long-term inflammation. The sudden augmentation of systemic inflammation in the context of cytokine storm initiated by COVID-19 disease may trigger early rupture of a pre-existing plaque and consequent ACS.