The pandemic has passed, the complications remain

The coronavirus is no longer dominating daily news headlines, but that doesn't mean it's no longer causing problems. The pandemic has passed, but the complications caused by this virus, which turned the world upside down, have remained. Locally, we can't say that there are no longer issues; authorities have reported dozens of deaths and thousands of infections in the past week.

Scientists have observed that severe cardiovascular problems can be triggered due to COVID-19, especially among older individuals with a buildup of fatty material in their blood vessels. A new study has shown that SARS-CoV-2, the virus that causes COVID-19, directly infects the arteries of the heart, as reported in National Geographic. Furthermore, the study found that the virus can survive and thrive inside the cells that form plaques-accumulations of fatty cells that narrow and stiffen the arteries, leading to atherosclerosis. If the plaque ruptures, it can block blood circulation and cause a heart attack or stroke. SARS-CoV-2 infection worsens the situation by inflaming the plaque and increasing the chances of it rupturing. This can explain the long-term cardiovascular effects observed in some, if not all, COVID-19 patients. It has already been noted that SARS-CoV-2 infects many organs outside of the respiratory system, but it hasn't been demonstrated before that it attacks the arteries directly. "No one has really looked at whether there's a direct effect of the virus on the arterial wall," says Chiara Giannarelli, a cardiologist at NYU Langone Health in New York, who led the study. Giannarelli noted that her team detected viral RNA, the genetic material of the virus, in the coronary arteries. "You wouldn't expect to see this a few months after recovering from COVID." More and more evidence now shows that SARS-CoV-2 is not just a respiratory virus but can also affect the heart and many other organ systems, says Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis. Al-Aly's research has shown that the risk of developing heart and cardiovascular diseases, including heart failure, stroke, irregular heartbeat, cardiac arrest, and blood clots, increases two to five times within a year of contracting COVID-19, even when the person was not hospitalized. "This important study directly links the SARS-CoV-2 virus to atherosclerotic plaque inflammation for the first time," says Charalambos Antoniades, head of the cardiovascular medicine department at the University of Oxford, UK. A recent study involving over 800,000 people, led by Fabio Angeli, a cardiologist at the University of Insubria in Varese, Italy, showed that COVID-19 patients develop high blood pressure twice as often as others. Even more concerning is that the risk of heart disease can increase in patients who only had mild COVID symptoms. "We've seen a patient who now has a defibrillator, and she didn't even have a severe illness," says Bernard Gersh, a cardiologist at the Mayo Clinic in Rochester, Minnesota. "The original finding of this study is that the virus was convincingly found in the coronary artery plaque," says Juan Carlos Kaski, a cardiovascular specialist at St George's, University of London, who was not involved in the study. The NYU team found that in the arteries, the virus predominantly colonized white blood cells called macrophages. Macrophages are immune cells that are mobilized to fight infection, but these same cells also absorb excess fat, including cholesterol from the blood. When macrophages load up too much fat, they turn into foamy cells, which can increase plaque formation. To confirm that the virus indeed infected and grew in blood vessel cells, scientists obtained arterial and plaque cells, including macrophages and foamy cells, from healthy volunteers. They then cultured these cells in Petri dishes and infected them with SARS-CoV-2. Giannarelli found that although the virus infected macrophages at a higher rate than other arterial cells, it did not replicate in them to form new infectious particles. However, when macrophages loaded up with cholesterol and turned into foamy cells, the virus was able to grow, reproduce, and survive longer. These results also confirm previous reports that measuring inflammation in the blood vessel wall can diagnose the extent of long-term cardiovascular complications after COVID-19, says Antoniades. This study analyzed only 27 samples from eight elderly patients who had preexisting coronary artery disease and were infected with the original strains of the virus. Therefore, the results of this study may not necessarily apply to younger individuals without coronary disease or to the new variants of the virus, which cause a milder illness, says Angeli. Experts recommend that COVID patients monitor any new incidents of shortness of breath on exertion, chest discomfort typically with exertion, palpitations, loss of consciousness, and discuss the possibility of heart disease with their doctor. The data is not encouraging, but the most important thing is to know what to do to truly take care of your health.