Chidambaram Vignesh, Kumar Amudha, Sadaf Murrium I, Lu Emily, Al'Aref Subhi J, Tarun Tushar, Galiatsatos Panagis, Gulati Martha, Blumenthal Roger S, Leucker Thorsten M, Karakousis Petros C, Mehta Jawahar L
Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Division of Cardiology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois, USA.
JACC Adv. 2024 Jul 17;3(8):101107. doi: 10.1016/j.jacadv.2024.101107. eCollection 2024 Aug.
The incidence of atherosclerotic cardiovascular disease is increasing globally, especially in low- and middle-income countries, despite significant efforts to reduce traditional risk factors. Premature subclinical atherosclerosis has been documented in association with several viral infections. The magnitude of the recent COVID-19 pandemic has highlighted the need to understand the association between SARS-CoV-2 and atherosclerosis. This review examines various pathophysiological mechanisms, including endothelial dysfunction, platelet activation, and inflammatory and immune hyperactivation triggered by SARS-CoV-2 infection, with specific attention on their roles in initiating and promoting the progression of atherosclerotic lesions. Additionally, it addresses the various pathogenic mechanisms by which COVID-19 in the post-acute phase may contribute to the development of vascular disease. Understanding the overlap of these syndromes may enable novel therapeutic strategies. We further explore the need for guidelines for closer follow-up for the often-overlooked evidence of atherosclerotic cardiovascular disease among patients with recent COVID-19, particularly those with cardiometabolic risk factors.
尽管在降低传统危险因素方面付出了巨大努力，但全球范围内动脉粥样硬化性心血管疾病的发病率仍在上升，尤其是在低收入和中等收入国家。已有文献记载，过早的亚临床动脉粥样硬化与多种病毒感染有关。近期新冠疫情的规模凸显了了解严重急性呼吸综合征冠状病毒2（SARS-CoV-2）与动脉粥样硬化之间关联的必要性。本综述探讨了各种病理生理机制，包括SARS-CoV-2感染引发的内皮功能障碍、血小板活化以及炎症和免疫过度激活，并特别关注它们在启动和促进动脉粥样硬化病变进展中的作用。此外，还阐述了新冠病毒感染急性期后可能导致血管疾病发生的各种致病机制。了解这些综合征之间的重叠可能有助于制定新的治疗策略。我们进一步探讨了针对近期感染新冠病毒的患者，尤其是那些具有心脏代谢危险因素的患者中常被忽视的动脉粥样硬化性心血管疾病证据进行更密切随访的指南的必要性。
