Department of Pharmaceutical and Pharmacological Sciences (DSF), University of Padova, 35131 Padova, Italy.
Department of Pharmaceutical and Pharmacological Sciences (DSF), University of Padova, 35131 Padova, Italy.
Med Hypotheses. 2020 Nov;144:110015. doi: 10.1016/j.mehy.2020.110015. Epub 2020 Jun 20.
Several risk factors are associated with a worse outcome for COVID-19 patients; the most recognized are demographic characteristics such as older age and male gender, and pre-existing cardiovascular conditions. About the latter, hypertension and coronary heart disease are among the most common comorbidities recorded in infected patients, together with type 2 diabetes mellitus (T2DM). Data from Istituto Superiore di Sanità (ISS, Italy) show that more than 68.3% of patients had hypertension, 28.2% ischemic heart disease, 22.5% atrial fibrillation, while 30.1% T2DM. Several authors suggested that cardiovascular diseases and diabetes mellitus are linked to endothelial dysfunction, and all of them are strictly related to aging. Considering the impact of the gender on the COVID-19 epidemic, even if confirmed cases from each nation are changing every day, epidemiological data clearly evidence that in men the infection causes worse outcomes compared to women. In Italy, up to 21 May, in the age range of 60-89 years, male deaths were 63.9% of total cases. The reason behind this difference between genders appears not clear; however, the diversity in sex-hormones and styles of life are believed to play a role in the patient's susceptibility to severe SARS-CoV-2 outcomes. It is known that the activation of endothelial estrogen receptors increases NO and decreases ROS, protecting the vascular system from angiotensin II-mediated vasoconstriction, inflammation, and ROS production. During the pandemic, joining forces is vital; thus, as people help doctors by limiting their displacements out of their houses avoiding hence the spread of the infection, doctors help patients to overcome severe SARS-CoV-2 infections by using multiple pharmacological approaches. In this context, the preservation of endothelial function and the mitigation of vascular inflammation are prominent targets, essential to reduce severe outcomes also in male older patients.
许多风险因素与 COVID-19 患者的预后不良有关；最被认可的是人口统计学特征，如年龄较大和男性，以及先前存在的心血管疾病。关于后者，高血压和冠心病是感染患者中最常见的合并症之一，此外还有 2 型糖尿病（T2DM）。意大利国家卫生研究所（ISS）的数据显示，超过 68.3%的患者患有高血压，28.2%患有缺血性心脏病，22.5%患有心房颤动，30.1%患有 T2DM。一些作者认为心血管疾病和糖尿病与血管内皮功能障碍有关，所有这些疾病都与衰老密切相关。考虑到性别对 COVID-19 流行的影响，尽管每个国家的确诊病例每天都在变化，但流行病学数据清楚地表明，在男性中，感染导致的后果比女性更严重。在意大利，截至 5 月 21 日，在 60-89 岁年龄组中，男性死亡人数占总病例的 63.9%。这种性别差异的原因尚不清楚；然而，性激素的多样性和生活方式被认为在患者对严重 SARS-CoV-2 结局的易感性中发挥作用。众所周知，内皮雌激素受体的激活增加了 NO 并减少了 ROS，从而保护血管系统免受血管紧张素 II 介导的血管收缩、炎症和 ROS 产生。在大流行期间，团结一致至关重要；因此，人们通过限制自己离开家来帮助医生，从而避免感染的传播，医生通过使用多种药理学方法帮助患者克服严重的 SARS-CoV-2 感染。在这种情况下，保护内皮功能和减轻血管炎症是突出的目标，对于减少老年男性严重结局也至关重要。
