Depression pandemic and cardiovascular risk in the COVID-19 era and long COVID syndrome: Gender makes a difference

Abstract

The ongoing COVID-19 pandemic highlighted a significant interplay between cardiovascular disease (CVD), COVID-19 related inflammatory status, and depression. Cardiovascular (CV) injury is responsible for a substantial percentage of COVID-19 deaths while COVID-19 social restrictions emerged as a non-negligible risk factor for CVD as well as a variety of mental health issues, and in particular, depression. Inflammation seems to be a shared condition between these two disorders. Gender represents a potential modifying factor both in CVD and depression, as well as in COVID-19 short- and long-term outcomes, particularly in cases involving long-term COVID complications. Results from emerging studies indicate that COVID-19 pandemic affected male and female populations in different ways. Women seem to experience less severe short-term complications but suffer worse long-term COVID complications, including depression, reduced physical activity, and deteriorating lifestyle habits, all of which may impact CV risk. Here, we summarize the current state of knowledge about the interplay between COVID-19, depression, and CV risk in women.

Keywords: COVID-19; Cardiovascular disease; Depression; Gender medicine; Inflammation; Long COVID.

Fig. 1

Summary of the interplay between cardiovascular disease (CVD), COVID-19, depression, inflammation and gender. Inflammation and depression play a significant role in female gender, both in terms of CV risk and COVID-19 short and long-term outcomes. Left: Men have worst short-term complications and longer recovery after COVID-19 than women. On the other hand, women experience worst short and long-term mental issues and have higher risk of long COVID than men; moreover, physical inactivity after COVID-19 is more prevalent in women than in men. Right: Despite women and men share similar ‘traditional’ CV risk factors, their relative weight and impact on CVD seems to be modulated by gender (in red, the CV risk factors that have long been recognized to confer greater risk of CVD in women compared with men).