ABC | Volume 114, Nº5, May 2020

Review Article The Effect of Coronavirus Disease 2019 on Cardiovascular Diseases Lutfu Askin, 1 Okan Tanrıverdi, 1 Husna Sengul Askin 2 Adiyaman Universitesi Egitim ve Arastirma Hastanesi – Cardiology, 1 Adıyaman, Centry – Turkey Adiyaman Universitesi Egitim ve Arastirma Hastanesi – Infectious Disease, 2 Adıyaman, Centry – Turkey Abstract Coronavirus disease 2019 (COVID-19) is a global pandemic affecting the world, seen in more than 1,300,000 patients. COVID-19 acts through the angiotensin-converting enzyme 2 (ACE2) receptor. Cardiovascular comorbidities are more common with COVID-19, and nearly 10% of cases develop myocarditis (22% of critical patients). Further research is needed to continue or discontinue ACE inhibitors and angiotensin receptor blockers, which are essential in hypertension and heart failure in COVID-19. Intensive research is promising for the treatment and prevention of COVID-19. Introduction Coronavirus disease 2019 (COVID-19) has been characterized as a global pandemic. As of March 28, 2020, there were infected patients in 167 countries worldwide and more than 1,300,000 cases with approximately 69,780 deaths. 1 The outbreak originated in China, and the number of cases outside China has exceeded the number of cases in China. It is increasing steadily as of March 28, 2020. Furthermore, the number of deaths in Italy now exceeds three times the total number in China. COVID-19 interacts with the cardiovascular system and increases morbidity and mortality by causing myocardial dysfunction in patients with previous cardiovascular comorbidities. COVID-19 causes severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In its single-chain envelope structure, the RNA virus is the seventh known human coronavirus. SARS-CoV-2 differs from the coronaviruses that caused zoonotic severe acute respiratory syndrome coronavirus (SARS-CoV)² in 2002 and middle east respiratory syndrome coronavirus (MERS-CoV)³ in 2012. SARS-CoV-2 is thought to have 89% to 96% nucleotide similarity with bat coronaviruses and to be caused by bats, similar to other coronaviruses. 4 Like SARS-CoV-1 and MERS, SARS-CoV-2 can pass from bats to an intermediate host (possibly a Malayan pangolin sharing 91% nucleotide identity) and then to humans. 5 SARS-CoV-2 binds to the human angiotensin-converting enzyme 2 (ACE2) receptor (Figure 1) after activation of the spike protein by transmembrane protease, serine 2 (TMPRSS2). 6 ACE2 is mainly expressed in the lung (type II alveolar cells), 7 and this appears to be the dominant access site. ACE2 is highly released in the heart in cases of excessive activation of the renin-angiotensin system, such as hypertension (HT), congestive heart failure (CHF), and atherosclerosis. 8 In addition to its cardiac effects, ACE2 is expressed in the lung, intestinal epithelium, vascular endothelium, and kidneys, which is one of the causes of multiple organ failure in SARS-CoV-2 infection. 8,9 Evidence for the association of COVID-19 with morbidity and mortality is growing in cardiovascular diseases (CVD). In this review, we aimed to share up-to-date data on COVID-19, which spreads very rapidly. COVID-19 in CVD CVD was a common comorbidity in SARS and MERS infections before COVID-19. The prevalence of diabetes mellitus (DM) and CVD in SARS was 11% and 8%, respectively, and the presence of both comorbidities had a twelve-fold risk of death. 10 DM and HT were common in approximately 50% of MERS cases. 11 The presence of cardiovascular comorbidities also applies to COVID-19, and its importance increases in more severe cases. In Wuhan, 30% of infected patients (48% of survivors) had HT; 19% had DM (31% of survivors), and 8% had KVH (13% of survivors). 12 In a cohort of 138 patients with COVID-19, cardiovascular comorbidities were similarly Keywords Coronavirus; COVID 19; Cardiovascular Diseases/ complications; Comorbidity; Hypertension;Heart Failure; Myocarditis; Acute Respiratory Syndrome; Pandemic; Mortality; Hospitalization; Critical Care. Mailing Address: Lutfu Askin • Adiyaman Universitesi Egitim ve Arastirma Hastanesi – Cardiology - Adıyaman Eğitim Ve Araştırma Hastanesi Kardiyoloji Bölümü Adıyaman Centry 2230 – Turkey E-mail: lutfuaskin23@gmail.com Manuscript received April 02, 2020, revised manuscript April 06, 2020, accepted April 08, 2020 DOI: https://doi.org/10.36660/abc.20200273 Figure 1 – SARS-CoV-2 receptor interaction. 817