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Potential Effects of Coronaviruses on the Cardiovascular SystemA Review

Educational Objective
To review the severe acute respiratory syndrome coronavirus 2 and its potential effects on the cardiovascular system.
1 Credit CME

Importance  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) has reached a pandemic level. Coronaviruses are known to affect the cardiovascular system. We review the basics of coronaviruses, with a focus on COVID-19, along with their effects on the cardiovascular system.

Observations  Coronavirus disease 2019 can cause a viral pneumonia with additional extrapulmonary manifestations and complications. A large proportion of patients have underlying cardiovascular disease and/or cardiac risk factors. Factors associated with mortality include male sex, advanced age, and presence of comorbidities including hypertension, diabetes mellitus, cardiovascular diseases, and cerebrovascular diseases. Acute cardiac injury determined by elevated high-sensitivity troponin levels is commonly observed in severe cases and is strongly associated with mortality. Acute respiratory distress syndrome is also strongly associated with mortality.

Conclusions and Relevance  Coronavirus disease 2019 is associated with a high inflammatory burden that can induce vascular inflammation, myocarditis, and cardiac arrhythmias. Extensive efforts are underway to find specific vaccines and antivirals against SARS-CoV-2. Meanwhile, cardiovascular risk factors and conditions should be judiciously controlled per evidence-based guidelines.

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Article Information

Corresponding Author: Mohammad Madjid, MD, MS, McGovern Medical School, Department of Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.246, Houston, TX 77030 (mmadjid@gmail.com).

Published Online: March 27, 2020. doi:10.1001/jamacardio.2020.1286

Accepted for Publication: March 21, 2020.

Conflict of Interest Disclosures: Dr Madjid has been a speaker and consultant to Sanofi Pasteur Inc. Dr Vardeny reports research support from the National Institutes of Health and consulting with Sanofi-Pasteur Inc. Dr Solomon has received research grants from Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, BMS, Celladon, Cytokinetics, Eidos, Gilead, GSK, Ionis, Lone Star Heart, Mesoblast, MyoKardia, National Institutes of Health/National Heart, Lung, and Blood Institute, Novartis, Sanofi Pasteur, and Theracos and has consulted for Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, BMS, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi-Sankyo, Gilead, GSK, Ironwood, Merck, Myokardia, Novartis, Roche, Sanofi-Pasteur, Takeda, Theracos, Quantum Genetics, Cardurion, AoBiome, Janssen, Cardiac Dimensions, Tenaya, Dinaqor, and Tremeau. No other disclosures were reported.

Additional Contributions: The authors thank Timothy M. Uyeki MD, MPH, MPP, US Centers for Disease Control and Prevention, Atlanta, Georgia, for valuable input regarding virus epidemiology and treatment strategies.

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