Intriguing Links Between Viral Infections, Heart Attacks, and Cardiometabolic Syndrome

Jonathan Vellinga, MD

Everyone knows that a healthy heart is a foundation for a healthy life. Because of its central role in keeping all other bodily systems functioning, disease of the cardiovascular system is the leading cause of death in America, according to the CDC. Beyond that, heart health plays a huge factor in one’s ability to recover from COVID-19; doctors are finding that coronavirus (once primarily thought to be a lung disease) is impacted by cardiovascular health and can drastically increase the risk of heart attacks.

In this article, we’ll explore the most common heart diseases, how viral infections can affect heart health, the link between viruses, disease, and heart attacks, and most importantly: prevention.

Intriguing Links Between Viral Infections, Heart Attacks, and Cardiometabolic Syndrome

Cardiometabolic Syndrome

Cardiometabolic syndrome (CMS) is a cluster of metabolic disorders that may include insulin resistance, impaired glucose tolerance, dyslipidemia, high blood pressure, and abdominal obesity (1). Each of these disorders creates an increased risk of plaque build-up in arteries. This build-up, otherwise known as atherosclerosis, along with other negative effects can lead to coronary heart disease, diabetes, heart attack, and stroke (2).

Atherosclerosis, Coronary Heart Disease, and Heart Attacks

Atherosclerosis in the blood vessels that supply blood to the heart is called coronary artery disease and is the most common cause of heart attacks (3). When the plaque that has built up along the lining of the artery ruptures, a blood clot forms, is carried away into the heart, and creates a blockage that restricts blood flow to the heart and body (3). While heart attacks can range from mild to life-threatening, the effects are always damaging, and at worst can cause cardiac arrest and death. Given that over 800,000 people experience heart attacks in the US each year (according to the CDC), the importance of preventing coronary heart disease and atherosclerosis whenever possible can’t be overstated. A large part of this prevention lies in protecting the health of vascular endothelium and endothelial glycocalyx.

The Endothelial Glycocalyx

A thin cell layer known as the endothelium lines the inside of all of our blood vessels, acting as a barrier between the blood vessel and the blood that fills it. Attached to the endothelium is a thin gel-like layer called the endothelial glycocalyx that acts as a protective physical barrier for the endothelium (4,5,6). A healthy endothelial glycocalyx (EGC) also regulates vascular tone and permeability, blood pressure and clotting, and acts as an arterial anti-adhesive (4,8). Additionally, the properties of the EGC inhibit inflammation, oxidation, and coagulation (7). This helps ensure that blood flows smoothly, maintaining homeostasis without forming plaque build-up. While it is a very complex system that interacts with its environment to maintain health, its complexity leads to delicacy, and a disruption to one part of the EGC can lead to loss or degradation of the whole (3,4).

The main source of damage to the endothelial glycocalyx is inflammation, caused by aging, infections, and high amounts of certain toxins, sugar, fat, or cholesterol in the blood (7,8). Damage to the EGC means not only a reduction in all the important regulation mentioned above, but also an increase in the risk of developing atherosclerosis and potentially coronary heart disease.

Viral infections, Inflammation, and Cardiometabolic Syndrome

Because the vascular endothelium plays such a critical role in regulation and in maintaining the barrier between the vascular and organ systems, any infection can have serious body-wide implications. Once the endothelium is infected, the body sends an immune response, leading to increased inflammation and permeability (9). Because inflammation is the main source of damage to the endothelial glycocalyx, the aft