Napoli Claudio, Tritto Isabella, Benincasa Giuditta, Mansueto Gelsomina, Ambrosio Giuseppe
Clinical Department of Internal Medicine and Specialistic Units, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Naples, Italy.
IRCCS SDN, Naples, Italy.
Ann Med Surg (Lond). 2020 Aug 5;57:236-243. doi: 10.1016/j.amsu.2020.07.054. eCollection 2020 Sep.
SARS-CoV-2 betacoronavirus is responsible for the Corona Virus Disease 2019 (COVID-19) which has relevant pathogenic implications for the cardiovascular system. Incidence and severity of COVID-19 are higher in the elderly population (65 years and older). This may be due to higher frequency of comorbidities, but increased frailty and immunosenescence linked with aging may also contribute. Moreover, in elderly individuals, SARS-CoV-2 may adopt different molecular strategies to strongly impact on cardiac aging that culminate in exacerbating a pro-inflammatory state (cytokine storm activation), which, in turn, may lead to pulmonary vascular endothelialitis, microangiopathy, diffuse thrombosis, myocarditis, heart failure, cardiac arrhythmias, and acute coronary syndromes. All these events are particularly relevant in elderly patients, and deserve targeted cardiovascular treatments and specific management of repurposed drugs against COVID-19. We discuss current evidence about the cardiovascular involvement during COVID-19, and elaborate on clinical implications in elderly patients.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）是2019冠状病毒病（COVID-19）的病原体，该病对心血管系统具有重要的致病影响。COVID-19在老年人群（65岁及以上）中的发病率和严重程度更高。这可能是由于合并症的发生率较高，但与衰老相关的身体虚弱和免疫衰老增加也可能起作用。此外，在老年人中，SARS-CoV-2可能采用不同的分子策略来强烈影响心脏衰老，最终加剧促炎状态（细胞因子风暴激活），这反过来可能导致肺血管内皮炎、微血管病、弥漫性血栓形成、心肌炎、心力衰竭、心律失常和急性冠状动脉综合征。所有这些事件在老年患者中尤为重要，值得针对心血管疾病进行治疗以及对用于治疗COVID-19的药物进行特定管理。我们讨论了关于COVID-19期间心血管受累的当前证据，并阐述了对老年患者的临床意义。
