Vigilance on New-Onset Atherosclerosis Following SARS-CoV-2 Infection

• Published in: Frontiers in medicine Vol. 7; p. 629413
• Main Authors: Liu, Ya, Zhang, Hai-Gang
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 20.01.2021
• Subjects: angiotensin-converting enzyme 2; atherosclerosis; COVID-19; endothelial dysfunction; inflammation; Medicine; SARS-CoV-2; COVID-19; atherosclerosis; SARS-CoV-2; angiotensin-converting enzyme 2; inflammation; endothelial dysfunction
• ISSN: 2296-858X; 2296-858X
• DOI: 10.3389/fmed.2020.629413

The pandemic of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has become a global challenge to public health. While its typical clinical manifestations are respiratory disorders, emerging evidence of cardiovascular complications indicates the adverse interaction between SARS-CoV-2 infection and cardiovascular outcomes. Given that viral infection has emerged as an additional risk factor for atherosclerosis, in this paper, we attempt to clarify the susceptibility to new-onset atherosclerosis in individuals infected with SARS-CoV-2. Mechanistically, serving as functional receptors for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2) mediates SARS-CoV-2 infection of endothelial cells (ECs) directly, leading to endothelial dysfunction and dysregulation of the renin-angiotensin system (RAS). In addition, high expression of CD147, an alternative receptor, and activation of the NLRP3 inflammasome may also contribute to atherosclerosis in the context of COVID-19. More importantly, SARS-CoV-2 attacks the immune system, which results in excessive inflammation and perpetuates a vicious cycle of deteriorated endothelial dysfunction that further promotes inflammation. The alterations in the blood lipid profile induced by COVID-19 should not be ignored in assessing the predisposition toward atherosclerosis in victims of COVID-19. A better understanding of the underlying mechanisms of SARS-CoV-2 infection and the long-term monitoring of inflammatory factors and endothelial function should be considered in the follow-up of patients who have recovered from COVID-19 for early detection and prevention of atherosclerosis.