How SARS-CoV-2 contributes to heart attacks and strokes (2024)

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October 24, 2023

At a Glance

  • SARS-CoV-2 infected coronary arteries and increased inflammation in atherosclerotic plaques.
  • The findings suggest how COVID-19 could increase the risk of heart attack and stroke.
How SARS-CoV-2 contributes to heart attacks and strokes (1)

Foam cells, which accumulate within arteries to form plaques in atherosclerosis, proved particularly susceptible to infection with SARS-CoV-2. Kateryna Kon / Shutterstock

COVID-19 is known to increase the risk of heart attack and stroke. The intense inflammation that occurs throughout the body in severe cases likely contributes to this increased risk. But it’s not clear whether SARS-CoV-2, the virus that causes COVID-19, also affects blood vessels directly.

To find out, an NIH-funded research team, led by Dr. Chiara Giannarelli at New York University School of Medicine, analyzed coronary artery tissue samples from eight people who died of COVID-19 between May 2020 and May 2021. Results appeared in Nature Cardiovascular Research on September 28, 2023.

The team found SARS-CoV-2 viral RNA in coronary artery tissue from all patients. They found more viral RNA in the arterial walls than in the surrounding fat tissue. Many of the infected cells were macrophages, a type of white blood cell that ingests pathogens. Samples with more macrophages had more viral RNA.

Macrophages also help remove cholesterol from blood vessels. When macrophages become laden with cholesterol, theyare known as foam cells. Accumulation of foam cells within arteries forms plaques that are a hallmark of atherosclerosis. The team confirmed that SARS-CoV-2 could infect human macrophages and foam cells in a petri dish. The foam cells were much more susceptible to infection than the macrophages. This could explain why people with atherosclerosis are more vulnerable to COVID-19.

In both cell types, infection depended on a protein on the surface of the cells called neuropilin. Turning off the gene for neuropilin in these cells reduced infection. So did blocking the virus from binding to neuropilin.

Infection triggered several inflammatory pathways in macrophages and foam cells. The cells also released molecules that are known to contribute to heart attacks and strokes. In arterial plaques that had been surgically removed from patients, the researchers saw an inflammatory response to SARS-CoV-2 infection like that seen in the cultured cells.

The findings suggest that SARS-CoV-2 may increase the risk of heart attacks and stroke by infecting artery wall tissue, including associated macrophages. This provokes inflammation in atherosclerotic plaques, which could lead to heart attack or stroke.

“These results shed light onto a possible connection between preexisting heart issues and Long COVID symptoms,” Giannarelli says. “It appears that the immune cells most involved in atherosclerosis may serve as a reservoir for the virus, giving it the opportunity to persist in the body over time.”

“Since the early days of the pandemic, we have known that people who had COVID-19 have an increased risk for cardiovascular disease or stroke up to one year after infection,” says Dr. Michelle Olive of NIH’s National Heart, Lung, and Blood Institute. “We believe we have uncovered one of the reasons why.”

The authors plan to further investigate the potential link between infection of the arteries and Long COVID. They also aim to see if their results also hold true for newer SARS-CoV-2 variants.

—by Brian Doctrow, Ph.D.

Related Links

References:SARS-CoV-2 infection triggers pro-atherogenic inflammatory responses in human coronary vessels. Eberhardt N, Noval MG, Kaur R, Sajja S, Amadori L, Das D, Cilhoroz B, Stewart O, Fernandez DM, Shamailova R, Guillen AV, Jangra S, Schotsaert M, Gildea M, Newman JD, Faries P, Maldonado T, Rockman C, Rapkiewicz A, Stapleford KA, Narula N, Moore KJ, Giannarelli C. Nat Cardiovasc Res. 2023 Sep 28:2023.08.14.553245. doi: 10.1101/2023.08.14.553245. Preprint. PMID:37645908.

Funding:NIH’s National Heart, Lung, and Blood Institute (NHLBI), National Center for Advancing Translational Sciences (NCATS), National Institute of Allergy and Infectious Diseases (NIAID), and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); American Heart Association; Chan Zuckerberg Initiative; New York University.

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How SARS-CoV-2 contributes to heart attacks and strokes (2024)

FAQs

How SARS-CoV-2 contributes to heart attacks and strokes? ›

The results suggest that SARS-CoV-2 increases the inflammatory share of macrophages in the heart, leading to heart damage. This change appears to result from the immune response to lung injury rather than from viral infection of the heart itself.

Why are there so many heart attacks after COVID? ›

Inflammation is the main culprit, as it raises your risk of blood clots and prevents your body from getting rid of clots on its own. Blood clots also prevent oxygen from reaching your organs, including your heart. When this happens, you're at risk of having a heart attack.

How does COVID-19 heighten the risk of heart attack and stroke? ›

Turning off the gene for neuropilin in these cells reduced infection. So did blocking the virus from binding to neuropilin. Infection triggered several inflammatory pathways in macrophages and foam cells. The cells also released molecules that are known to contribute to heart attacks and strokes.

How does COVID-19 affect the heart? ›

Research shows COVID-19 infection can increase the risk for heart-related problems such as myocarditis, a rare inflammation of the heart, and an irregular heartbeat known as atrial fibrillation.

Can COVID cause AFib months later? ›

The study shows that the risk of atrial fibrillation and flutter was increased up to two months after infection. In the first month, the risk was twelve times greater than for people who did not suffer from COVID-19 infection.

What are long term cardiac complications of COVID? ›

Key Points
  • Cardiovascular complications are a common manifestation of acute and post-acute COVID-19 infection.
  • Complications include cardiomyopathy, myocardial infarction, arrhythmias, heart failure, and deep venous thrombosis.
  • Pathophysiology remains poorly defined and complex.
Mar 31, 2023

What are the chances of surviving COVID with heart disease? ›

Pre-existing CVD, in particular, has been implicated in aggravating pneumonia and elevating mortality [8]. The reported global lethality rate of COVID-19 stands at 1.0% [2], while a previous study of 72,314 cases demonstrated a much higher mortality rate of 10.5% for COVID-19 patients with pre-existing CVD [9].

Is the COVID shot linked to heart and brain conditions? ›

Covid vaccines from companies like Pfizer, Moderna and AstraZeneca were linked to rare occurrences of heart, brain and blood disorders, a recent peer-reviewed study found, though experts say the risks of developing Covid-19 greatly outweigh the risks of getting vaccinated.

Can COVID cause narrowing of the arteries? ›

There appears to be a bidirectional association between arterial stiffness/atherosclerosis and COVID‐19 severity. Preliminary studies have already documented the association of COVID‐19 with adverse functional and morphological changes in the arterial wall.

Why are heart attacks increasing? ›

Unhealthy habits like poor diet, reduced physical activity, increased alcohol consumption, and heightened tension have negatively impacted heart health.

Could COVID have damaged my heart? ›

Scientists have long known that COVID-19 increases the risk of heart attack, stroke, and Long COVID, and prior imaging research has shown that over 50% of people who get COVID-19 experience some inflammation or damage to the heart.

Will my heart rate go back to normal after COVID? ›

Many post-COVID patients may experience a rapid heart rate due to inactivity or prolonged illness. This will get better with regular exercise as they recover. Other patients have a rapid heart rate when standing.

Does COVID cause permanent brain damage? ›

Fortunately, most people who get COVID don't suffer damage to the brain. But some do, and even people who initially get just mild COVID symptoms are vulnerable. So COVID's potential to damage the brain is just one more reason to do everything we can to avoid getting this disease.

What is the most lingering symptom of Covid? ›

The most common symptoms of long COVID are:
  • extreme tiredness (fatigue)
  • feeling short of breath.
  • problems with your memory and concentration ("brain fog")
  • heart palpitations.
  • dizziness.
  • joint pain and muscle aches.

When does myocarditis present after COVID? ›

In a small number of patients, an abnormal inflammatory response can ensue within days to weeks after the infection and cause inflammation of the heart muscle (myocarditis) or the sac around the heart (pericarditis).

What are three long term complications of COVID-19? ›

Organ damage could play a role. People who had severe illness with COVID-19 might experience organ damage affecting the heart, kidneys, skin and brain. Inflammation and problems with the immune system can also happen. It isn't clear how long these effects might last.

Why are heart attacks on the rise? ›

Youth who lead modern lifestyles are more likely to suffer from heart attacks. Poor Food Choices: Fast food, processed foods, and sugary drinks are all too common, increasing the risk of obesity, cholesterol and other cardiovascular diseases.

Does myocarditis go away? ›

Most cases of myocarditis are self-resolving. Other cases recover several months after you receive treatment. In some cases, this condition can recur and can cause symptoms related to inflammation such as chest pain or shortness of breath.

Can cardiomyopathy be reversed? ›

There's usually no cure for cardiomyopathy, but the treatments can be effective at controlling symptoms and preventing complications. Some types of cardiomyopathy have specific treatments and early diagnosis is very important. Not everyone with cardiomyopathy will need treatment.

How do I know if my heart is failing? ›

Get to your doctor. You may have trouble breathing, an irregular heartbeat, swollen legs, neck veins that stick out, and sounds from fluid built up in your lungs. Your doctor will check for these and other signs of heart failure. A test called an echocardiogram is often the best test to diagnose your heart failure.

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