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.
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 aftermath of viral infections contributes to vascular and pulmonary diseases which increase the risk of cardiometabolic syndrome and heart attacks, as shown above (9,10). One well-known example of this is the link between periodontal diseases, like gingivitis, and heart disease. Studies have even shown that children who have experienced viral infections have stiffened arteries and accelerated atherosclerosis, and there is speculation that these risk factors for cardiometabolic syndrome last into adulthood (11).
COVID-19 is currently being studied as a potential vascular infection. While it initially enters and attacks the lungs, the body-wide symptoms, including blood clots, heart attacks, and strokes, sparked research to determine if it is actually vascular in nature. This is corroborated by the discovery that the protein necessary for SARS-CoV-2 to activate is present in all cells, especially endothelial cells (12). It is suspected that when the virus enters the lungs and begins destroying tissue, blood vessels are opened and the infection then enters the vascular endothelium. The body responds with a local immune response, creating inflammation, and the infection and inflammation spread throughout the body. As we know, inflammation disrupts the epithelial glycocalyx’s ability to regulate, increasing the risk of any existing plaque rupturing, thus leading to the shockingly high number of heart attacks and strokes associated with what was thought to be a lung disease (12). While these patients may have had an underlying low risk of heart attack or stroke, the effects of coronavirus can and have drastically increased these odds (12).
Prevention and Treatment
Some of the best methods to protect against viral infections, avoid and treat the disorders of cardiometabolic syndrome, and prevent heart attacks come from lifestyle choices. While medication is often prescribed to help cardiometabolic disorders, exercise and a healthy diet and lifestyle are hugely important in prevention and recovery (1). For diseases like diabetes mellitus, diet and exercise have actually shown more favorable outcomes than oral medication (1). A healthy lifestyle also plays a part in avoiding and recovering from viral infections; you can learn more about it in this six-part series on how to keep your immune system healthy.
Another important factor to protect and prevent lies in maintaining your endothelial glycocalyx health. In the past fifteen years, over 20,000 studies have been done on the EGC, and its important role in overall health is being increasingly recognized (7). Though the endothelial glycocalyx is easily damaged, the body is able to repair the EGC over time. Specialized sulfated polysaccharides from seaweed have been found to be able to prevent and repair the damage to the ECG at an increased rate (7). These polysaccharides are available in supplement form in a product called Arterosil. Arterosil is a proprietary blend of compounds that can not only improve EGC function and arterial flexibility, but also reduce blood pressure, prevent endothelial inflammation, and slow or even reverse existing plaque build up on arterial walls (6).
Arterosil can help prevent and treat cardiometabolic syndrome and other disorders that lead to a high risk of heart attacks and may even be a potential option for preventing or treating serious complications from COVID-19. Since epithelial glycocalyx function declines with age, it is often recommended for people over the age of 45, and of course for those with a personal or family history of cardiometabolic syndrome or similar disorders.
If you would like to speak with one of our providers about taking steps to lower your risk of developing serious symptoms if you are exposed to COVID-19, or have any questions about Arterosil, cardiometabolic syndrome, viral infections, or any other topics addressed in this article, please give us a call. We are happy to assist and set up a consultation with you to discuss the best prevention and treatment methods.
Jonathan Vellinga, M.D. is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
Manouchehr Saljoughian, P. (2017, February 16). Cardiometabolic Syndrome: A Global Health Issue. Retrieved July 06, 2020, from https://www.uspharmacist.com/article/cardiometabolic-syndrome-a-global-health-issue
Srivastava A. K. (2012). Challenges in the treatment of cardiometabolic syndrome. Indian journal of pharmacology, 44(2), 155–156. https://doi.org/10.4103/0253-7613.93579
U.S. Department of Health and Human Services. Heart Attack. National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health-topics/heart-attack.
Kirk, E. P., & Klein, S. (2009). Pathogenesis and pathophysiology of the cardiometabolic syndrome. Journal of clinical hypertension (Greenwich, Conn.), 11(12), 761–765. https://doi.org/10.1111/j.1559-4572.2009.00054.x
Gaudette, S., Hughes, D., & Boller, M. (2020, February 18). The endothelial glycocalyx: Structure and function in health and critical illness. https://onlinelibrary.wiley.com/doi/abs/10.1111/vec.12925
Reitsma, S., Slaaf, D. W., Vink, H., van Zandvoort, M. A., & oude Egbrink, M. G. (2007). The endothelial glycocalyx: composition, functions, and visualization. Pflugers Archiv: European journal of physiology, 454(3), 345–359. https://doi.org/10.1007/s00424-007-0212-8
Calroy Health Sciences, LLC. (2020). Dr. Mark Houston: The Endothelial Glycocalyx and Cardiovascular Health Revolutionary Concepts and Treatment. Vimeo. https://vimeo.com/387454113/cc7b8487b7.
Rice, C. (2020). In "The Endothelial Glycocalyx: A New Key to Vascular Health?" Webinar. Scottsdale, AZ; Calroy Health Sciences.
Goodrum, F., & Bughio, F. (2015). Viral infection at the endothelium. Oncotarget, 6(29), 26541–26542. https://doi.org/10.18632/oncotarget.5246
Fong I. W. (2009). New perspectives of infections in cardiovascular disease. Current cardiology reviews, 5(2), 87–104. https://doi.org/10.2174/157340309788166679
Do Childhood Infections Cause Adult Cardiometabolic Disease? Medscape. (2015, November 24). https://www.medscape.com/viewarticle/853308_6.
Smith, D. (2020, June 30). Coronavirus May Be a Blood Vessel Disease, Which Explains Everything. https://elemental.medium.com/coronavirus-may-be-a-blood-vessel-disease-which-explains-everything-2c4032481ab2