COVID-19 may directly infect Coronary Arteries leading to plaque Inflammation and CV Complications

A recent study published in Nature Cardiovascular Research has uncovered a direct mechanism linking SARS-CoV-2 infection to cardiovascular complications, shedding light on why COVID-19 can lead to heart problems in some individuals.

Researchers have found in a new study that SARS-CoV-2, the virus that causes COVID-19, can directly infect the arteries of the heart and cause the fatty plaque inside arteries to become highly inflamed, increasing the risk of heart attack and stroke. The findings may help explain why certain people who get COVID-19 have a greater chance of developing cardiovascular disease, or if they already have it, develop more heart-related complications.

The research, conducted by Chiara Giannarelli, MD, PhD, and her team at NYU Grossman School of Medicine in New York City, revealed that the SARS-CoV-2 virus can infiltrate atherosclerotic plaques in coronary arteries directly. This infiltration triggers an inflammatory response within the plaque, which may contribute to acute cardiovascular manifestations of COVID-19, such as myocardial infarction (heart attack).

The study found that SARS-CoV-2 infection targeted plaque macrophages, especially cholesterol-loaded primary macrophages, in coronary arteries. These infected macrophages then orchestrated an over-reactive inflammatory response. The virus displayed a stronger affinity for arterial lesions than adjacent perivascular fat.

The researchers used coronary autopsy specimens from eight individuals with confirmed COVID-19 and coronary artery disease. These individuals had multiple cardiovascular risk factors, and the study revealed that SARS-CoV-2 replicated in plaque macrophages in their coronary arteries.

The findings suggest that COVID-19 infection can create a highly inflammatory environment within arterial plaques, making it easier for plaque to grow, rupture, and block blood flow to vital organs like the heart and brain. This mechanism provides a molecular basis for understanding how SARS-CoV-2 infection can lead to acute cardiovascular events.

The study highlights the importance of addressing pre-existing heart conditions and the potential long-term effects of COVID-19. It also underscores the role of inflammation in cardiovascular disease.

While the study provides valuable insights, the researchers acknowledged the limitations of their small and relatively sick sample and cautioned against generalising the findings to healthier individuals or those affected by different viral strains.

In summary, this research reveals a direct link between SARS-CoV-2 infection and cardiovascular complications, emphasising the importance of understanding the virus's impact on the heart and the role of inflammation in cardiovascular disease.

Reference:

Nature Cardiovascular Research Eberhardt N, et al "SARS-CoV-2 infection triggers pro-atherogenic inflammatory responses in human coronary vessels" Nat Cardiovasc Res 2023; DOI: 10.1038/s44161-023-00336-5.