Cardiovascular disease complicating COVID-19 in the elderly

Abstract

SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (Covid-19). The highly transmissible virus gains entry into human cells primarily by the binding of its spike protein to the angiotensin-converting enzyme 2 receptor, which is expressed not only in lung tissue but also in cardiac myocytes and the vascular endothelium. Cardiovascular complications are frequent in patients with Covid-19 and may be a result of viral-associated systemic and cardiac inflammation or may arise from a virus-induced hypercoagulable state. This pro-thrombotic state is marked by endothelial dysfunction and platelet activation in both macrovascu-lature and microvasculature. In patients with subclinical atherosclerosis, Covid-19 may incite ath-erosclerotic plaque disruption and coronary thrombosis. Hypertension and obesity are common comorbidities in Covid-19 patients that may significantly raise the risk of mortality. Sedentary be-haviors, poor diet, and increased use of tobacco and alcohol, associated with prolonged stay-at-home restrictions, may promote thrombosis, while depressed mood due to social isolation can ex-acerbate poor self-care. Telehealth interventions via smartphone applications and other technolo-gies that document nutrition and offer exercise programs and social connections can be used to mitigate some of the potential damage to heart health.