Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects host cells following binding with the cell surface ACE2 receptors, thereby leading to coronavirus disease 2019 (COVID-19). SARS-CoV-2 causes viral pneumonia with additional extrapulmonary manifestations and major complications, including acute myocardial injury, arrhythmia, and shock mainly in elderly patients. Furthermore, patients with existing cardiovascular comorbidities, such as hypertension and coronary heart disease, have a worse clinical outcome following contraction of the viral illness. A striking feature of COVID-19 pandemics is the high incidence of fatalities in advanced aged patients: this might be due to the prevalence of frailty and cardiovascular disease increase with age due to endothelial dysfunction and loss of endogenous cardioprotective mechanisms. Although experimental evidence on this topic is still at its infancy, the aim of this position paper is to hypothesize and discuss more suggestive cellular and molecular mechanisms whereby SARS-CoV-2 may lead to detrimental consequences to the cardiovascular system. We will focus on aging, cytokine storm, NLRP3/inflammasome, hypoxemia, and air pollution, which is an emerging cardiovascular risk factor associated with rapid urbanization and globalization. We will finally discuss the impact of clinically available CV drugs on the clinical course of COVID-19 patients. Understanding the role played by SARS-CoV2 on the CV system is indeed mandatory to get further insights into COVID-19 pathogenesis and to design a therapeutic strategy of cardio-protection for frail patients.

中文翻译：

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老年人与 COVID-19 相关的心血管发病率：意大利心血管研究学会的立场文件。

严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 与细胞表面 ACE2 受体结合后感染宿主细胞，从而导致 2019 冠状病毒病 (COVID-19)。SARS-CoV-2 引起病毒性肺炎，伴有额外的肺外表现和主要并发症，包括急性心肌损伤、心律失常和休克，主要发生在老年患者中。此外，患有高血压和冠心病等心血管合并症的患者在感染病毒性疾病后临床结果会更差。COVID-19大流行的一个显着特点是高龄患者的死亡率很高：这可能是由于内皮功能障碍和内源性心脏保护机制丧失导致虚弱和心血管疾病随着年龄的增长而增加。尽管有关该主题的实验证据仍处于起步阶段，但本立场文件的目的是假设和讨论更具启发性的细胞和分子机制，从而 SARS-CoV-2 可能对心血管系统造成有害后果。我们将重点关注衰老、细胞因子风暴、NLRP3/炎症小体、低氧血症和空气污染，这是与快速城市化和全球化相关的新兴心血管危险因素。我们最后将讨论临床可用的 CV 药物对 COVID-19 患者临床病程的影响。了解 SARS-CoV2 在 CV 系统中发挥的作用确实对于进一步了解 COVID-19 发病机制并为虚弱患者设计心脏保护治疗策略至关重要。