The Mutual Relationship among Cardiovascular Diseases and COVID-19: Focus on Micronutrients Imbalance

Abstract

Micronutrients are ions and vitamins humbly required by the human body. They play a main role in several physiological mechanisms and their imbalance is strongly associated with potentially-fatal complications. Micronutrient imbalance is associated with many cardiovascular diseases, such as arrythmias, heart failure, and ischemic heart disease. It has been also observed in coronavirus disease 2019 (COVID-19), particularly in most severe patients. The relationship between cardiovascular diseases and COVID-19 is mutual: the latter triggers cardiovascular disease onset and worsening while patients with previous cardiovascular disease may develop a more severe form of COVID-19. In addition to the well-known pathophysiological mechanisms binding COVID-19 and cardiovascular diseases together, increasing importance is being given to the impact of micronutrient alterations, often present during COVID-19 and able to affect the balance responsible for a good functioning of the cardiovascular system. In particular, hypokalemia, hypomagnesemia, hyponatremia, and hypocalcemia are strongly associated with worse outcome, while vitamin A and D deficiency are associated with thromboembolic events in COVID-19. Thus, considering how frequent the cardiovascular involvement is in patients with COVID-19, and how it majorly affects their prognosis, this manuscript provides a comprehensive review on the role of micronutrient imbalance in the interconnection between COVID-19 and cardiovascular diseases.

Role of Micronutrients and Gut Microbiota-Derived Metabolites in COVID-19 Recovery

“…The Na+-K+ ATPase pump processes this mineral [ 51 ], allowing it to regulate blood volume, blood pressure, acid–base balance, and osmosis processes, and it is also a regulator of nerve and muscle function [ 52 ]. Potassium is a cation located at 98% in the intracellular fluid, and only 2% remains outside it [ 53 ]. With a serum range of 3.6–5.5 mmol/L, it is involved in several physiological mechanisms, such as insulin secretion by binding to specific cell receptors, causing glucose insertion to transporter type 4 (GLUT4), which facilitates glucose absorption in insulin-dependant tissues [ 54 ].…”

“…On the other hand, acid–base disturbances typically result in diseases such as HBP, cardiomyopathy, heart failure, arrhythmias, and even imbalances in the coagulation cascade [ 53 , 57 ]. Sodium is also the most prevalent electrolyte disturbance in hospitalized patients [ 52 ].…”

“…The most severe patients affected by COVID-19 often present dehydration [ 53 ], diarrhea, and vomiting [ 82 ], which are potential factors for fluid distribution and electrolyte imbalance. Moreover, the main cardiovascular symptoms experienced by COVID-19 patients are heart palpitations and chest pain [ 83 ].…”

“…Due to the high prevalence of CVD with COVID-19, researchers found that both conditions are strongly related [ 53 ]. The relationship might be due to SARS-CoV-2’s main entrance to the human host being through the ACE2 receptor, which participates in the renin-angiotensin-aldosterone system (RAAS).…”

“…Moreover, RAAS is one of the principal causes of heart failure [ 87 ]. Therefore it is reasonable to admit that COVID-19 exacerbates and triggers early-onset CVD; likewise, patients with previous CVD may develop a more severe form of COVID-19; both scenarios significantly impact their post-COVID-19 syndrome recovery [ 53 ].…”