COVID-19: A Comprehensive Review on Cardiovascular Alterations, Immunity, and Therapeutics in Older Adults

Abstract

Here, we present a review focusing on three relevant issues related to COVID-19 and its impact in older adults (60 years and older). SARS-CoV-2 infection starts in the respiratory system, but the development of systemic diseases accompanied by severe clinical manifestations has also been reported, with cardiovascular and immune system dysfunction being the major ones. Additionally, the presence of comorbidities and aging represent major risk factors for the severity and poor prognosis of the disease. Since aging-associated decline has been largely related to immune and cardiovascular alterations, we sought to investigate the consequences and the underlying mechanisms of these pathologies to understand the severity of the illness in this population. Understanding the effects of COVID-19 on both systems should translate into comprehensive and improved medical care for elderly COVID-19 patients, preventing cardiovascular as well as immunological alterations in this population. Approved therapies that contribute to the improvement of symptoms and a reduction in mortality, as well as new therapies in development, constitute an approach to managing these disorders. Among them, we describe antivirals, cytokine antagonists, cytokine signaling pathway inhibitors, and vaccines.

Keywords: COVID-19; SARS-CoV-2; cardiovascular diseases; cytokine antagonist; cytokine storm; elderly; heart failure; immune response; vaccines.

Figure 1

Impact of SARS-CoV-2 infection on cardiovascular system in older adults. Entry of SARS-CoV-2 into host cells (ciliated nasal epithelium; cardiomyocytes and endothelial cells) is mediated by angiotensin-converting enzyme 2 (ACE2) receptor. Main cardiovascular clinical alterations include myocardial injury, myocarditis, acute coronary syndrome, cardiac arrhythmia and thromboembolism. Elevation of D-dimers or prothrombin time, factors involved in blood clotting, are hallmarks of SARS-CoV-2 virus infection. Therapies against SARS-CoV-2 are indicated.

Figure 2

Immune state in elderly people and how SARS-CoV-2 infection affects immune system cells and soluble factors. (A) Several agents are involved in the physiological development of immunosenescence and inflammaging in elderly people. (B) A description of the different alterations that take place in elderly people after SARS-CoV-2 infection is shown. Antagonists of IL-6 and IL-1 and inhibitors of the JAK-STAT pathway are noted.