Main common and specific virus mechanisms and complications related to the increased risk of atherosclerosis
| Infectious agent | Main mechanisms and pathways involved | Main CV complications |
|---|---|---|
| HIV | - Presence in the atherosclerotic lesion - Systemic inflammation/oxidative stress - Immunity (CD4+ cell depletion) - Opportunistic infections | - AMI - High prevalence of traditional CVD risk factors - Carotid atherosclerosis - Carotid stiffness - HF - Myocardial fibrosis - T2D - cART-related adverse cardiometabolic effects |
| HSV-1 and -2 | - Presence in the atherosclerotic lesion - Systemic inflammation/oxidative stress - Endothelial dysfunction - Apoptosis - Procoagulant effects | - CV mortality - CAD - AMI - Stroke - Carotid atherosclerosis |
| CMV | - Presence in the atherosclerotic lesion - Systemic inflammation/oxidative stress - Host immune response - Endothelial dysfunction - Lipid dysregulation and lipid deposition, vascular SMC proliferation and migration - Procoagulant effects and increased prothrombotic risk | - Carotid atherosclerosis - CAD - AMI - Stroke - T2D |
| HCV | - Presence in the endothelial cells and atherosclerotic lesion - Systemic and local arterial inflammation/oxidative stress - Host immune response - Liver iron deposition - Metabolic disarrangement - Cryoglobulinemia | - CV mortality - Carotid atherosclerosis - CAD - Dysrhythmias - HF - AMI - Cerebrovascular disease - Myocarditis and Cardiomyopathies - T2D |
| Influenza | - Presence in the endothelial cells and atherosclerotic lesions - Systemic and local arterial inflammation/oxidative stress - Hypercoagulability - Fever, tachycardia, hypoxia-induced injury | - CV mortality - AMI - T2D |
| SARS-CoV-2 | - Direct viral entry through ACE2 receptor (e.g., cardiomyocytes, fibroblasts, endothelial cells) - Systemic inflammation/cytokine storm - Hypercoagulability, thrombosis - Local inflammation (myocardial inflammation-myocarditis, cardiac fibrosis, myocyte apoptosis) - Plaque destabilization - Stress, anxiety, psycho-emotional status - Hypoxia-induced injury (myocardial oxygen demand/supply mismatch) - Endothelial dysfunction - Catecholamine stress response | - HF - Ventricular hypertrophy - Ventricular dilation - AMI - Fibrosis - Myocarditis - T2D |
CAD: coronary artery disease; AMI: acute myocardial infarction; ACE: angiotensin-converting enzyme; cART: combined antiretroviral therapy; HF: heart failure