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Elucidating the COVID19 ACE2 Connection: What Does This Mean for Heart Health?


 



We’ve learned a lot about the SARS-CoV-2 virus since the emergence of COVID19 worldwide  in the early months of 2020. As cases continue to rise across the US and in certain parts of the world, it is wise to understand how this virus works. A deeper understanding of the mechanism of SARS-CoV-2 can help to provide better care for those who are suffering with this illness.

 

While clinical medicine and research continues to advance our knowledge of this virus and the way it interacts with a human host, the COVID19 crisis and our understanding of the virus is still evolving. When the majority of individuals think of COVID19, a viral respiratory illness immediately comes to mind, and this would be a largely accurate reflection. SARS-CoV-2, the new coronavirus responsible for the COVID19 crisis does indeed cause a respiratory illness that can be fatal, especially for those who are at high risk due to immune dysfunction and comorbidities like hypertension and diabetes. But how has this new coronavirus been able to wreak so much havoc in so many parts of the world so quickly? And what implications does it have for cardiovascular health both now and in the future?

 

The answer lies in the nature of this virus and the way that it goes about the replication process. 

 

SARS-CoV-2 belongs to the Coronaviridae family which encompasses alpha, beta, gamma, and deltacoronaviruses. Only alpha and betacoronaviruses infect mammals with 7 different coronaviruses known to be infectious to humans. SARS-CoV-2 is a single stranded RNA betacoronavirus capable of causing lower respiratory tract infections and acute respiratory distress syndrome which can be fatal [1]. In fact, it’s name is reminiscent of the SARS (Severe Acute Respiratory Syndrome) outbreak in late 2002 through 2004. These two viruses, SARS-CoV and SARS-CoV-2 (responsible for COVID19) actually share approximately an 80% genetic similarity [2].

 

Although they are extremely similar genetically, the difference between SARS and COVID19 lies in their transmission ability. The Ro, or basic reproductive number is the number of cases expected to generate directly from one case in a population that is susceptible to an infection. The Ro of SARS was calculated to be 1. At the time of this writing, the Ro of SARS-CoV-2 is 5.7 [3]. This means that COVID19 is almost 6 times more transmissible than the SARS of the early 2000s. It is no wonder then that it has infected so many countries so quickly.

 

Another similarity between both SARS-CoV and SARS-CoV-2 is that they both tend to use angiotensin converting enzyme 2, ACE2, to gain entrance into the cell. Angiotensin converting enzyme 2, is an enzyme attached to the cells of many organs, like the heart, kidneys, central nervous system, gut, and notably, the lungs. It catalyzes the conversion of angiotensin II, a vasoconstrictor, to angiotensin, a vasodilator.

 

SARS-CoV-2, responsible for COVID19, gains entry primarily into type II pneumocytes, lung cells responsible for the secretion of surfactant, through ACE2 receptors. The virus gains entry into the cell by way of ACE2 biding to the viral envelope protein spike (S) protein [4]. Unfortunately, once the S protein binds to ACE2, it is as if a lock has been opened and the virus enters the cell. What’s even more unfortunate is that when SARS-CoV-2 enters the cells via ACE2 membrane fusion, it down-regulates ACE2 causing increased pulmonary inflammation and coagulation due to the effects of unobstructed angiotensin II [5].

 

Those diagnosed with hypertension, cardiovascular disease, and older individuals already have a baseline ACE2 deficiency. A COVID19 infection greatly exacerbates this condition. In fact, while respiratory illness is the main clinical feature of a COVID19 infection, medical literature reports cardiac involvement. In up to 12% of all COVID19 cases, acute cardiac injury, observed by a significant elevation of cardiac troponins, is present [6]. Arrhythmia has also been associated with a COVID19 infection and those with cardiac involvement and COVID19 had poorer survival rates [7].

 

While it is highly probably that the vast majority of these individuals suffered from cardiovascular disorders prior to a COVID19 infection, the virus certainly exacerbated their frail  cardiovascular conditions.

 

So what does this mean for individuals with a compromised cardiovascular system?

 

Since a COVID19 infection has a greater chance to become severe in individuals with cardiovascular disease, vigilant care should be taken to prevent an infection when possible. Staying vigilant ensures that any cardiovascular problems will be found and addressed in a timely manner. While necessary precautions should be taken to prevent a COVID19 infection, a vigilant approach to caring for the cardiovascular system should include regular testing to ensure basic and optimal functioning.

 

AYUMETRIX offers an innovative, accurate, comprehensive, and affordable cardiac panel to monitor heart health and cardiovascular function. Blood sample can be easily self-collected at home by a simple finger prick and then mailed to laboratory for analysis. While the cardiac panel offers testing for essential cardiovascular markers like high density lipoprotein (HDL), low density lipoprotein (LDL), and cholesterol, important but often overlooked tests like insulin, hs- CRP and adrenal hormones are included as well, with good reason.

 

For example, COVID19 causes cytokine-induces insulin resistance [8] which, in turn, reduces cardiac efficiency. Insulin promotes glucose as the main source of energy for cardiac tissue and  reduces the amount of oxygen consumption of the heart thereby increasing efficiency [9]. Insulin testing is a much needed part of the picture of heart health.

 

Adrenal insufficiency has been shown to be directly associated with increased cardiovascular risk. Cortisol imbalance may lead to coronary heart disease, resulting in adverse coronary events (9). Reduced cortisol levels have been known to cause increased inflammation, which leads to increased secretion of hs-CRP. This makes it important to regularly test for cortisol levels to ensure hormone balance and adrenal function. Physicians and their patients should be aware of the increased cardiovascular risk due to adrenal insufficiency.

 

 

Maintaining cardiovascular health is essential, especially during the COVID19 crisis. For more information about cardiovascular health and innovative at home  testing visit ayumetrix.com or contact info@ayumetrix.com.

 

 

Candace Mathers, ND, MSAc

 

 

References

1.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154215/

2.    https://www.sciencedirect.com/science/article/pii/S2452014420301667

3.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264656/

4.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330865/

5.    https://pubmed.ncbi.nlm.nih.gov/32336612/

6.    https://pubmed.ncbi.nlm.nih.gov/32247212/

7.    https://pubmed.ncbi.nlm.nih.gov/32586839/

8.    https://pubmed.ncbi.nlm.nih.gov/32388331/

9.    https://pubmed.ncbi.nlm.nih.gov/29376070/

 


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