key: cord-0826554-fv1pb7kc authors: Ren, Jun title: Cardiovascular medicine in the era of COVID-19 pandemics date: 2021-12-30 journal: Cardiol Plus DOI: 10.4103/2470-7511.334404 sha: a98dd9d0043bb34932fdadf221f4bf36fe352017 doc_id: 826554 cord_uid: fv1pb7kc nan S evere acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) or COVID-19 pandemics has remained a riding factor globally for the past 2 years and has dramatically impacted daily cardiovascular practice and research. [1] [2] [3] Reminiscent of outbreaks of infectious diseases over the decades including SARS-CoV-1, Zika virus, Ebola, and Chikungunya virus, COVID-19 infection caught us off guard and has contributed to variation in clinical manifestations of acute coronary syndrome (ACS), ischemic and nonischemic myocardial injury, and hypertension, with fewer individuals receiving the primary percutaneous coronary intervention and less in-hospital care for myocardial infarction (MI). Moving forward into 2022, a number of trends and challenges have caught the attention of physicians and scientists in this era of COVID-19. It is thus pertinent to launch clinical guidelines and preventive measures for cardiovascular procedures in patients afflicted with COVID-19. One of the major impacts that COVID-19 has embarked on medicine is the severe cardiovascular complications in COVID-19 patients. Cardiovascular symptoms associated with severe COVID-19 encompass heart failure, coronary artery disease, various cardiomyopathies, hypertension, and cerebrovascular disease/stroke. In this context, our issue tackles on some of the burning issues in cardiovascular medicine related to COVID-19. [3] [4] [5] In the first article, Zhao (Beijing Anzhen Hospital) and Smith (University of Chapel Hill) evaluated the current patient care standard for ACS, a severe stage of ischemic heart disease with high risk of death. From the clinical perspective in general care offered to ACS patients by the health system and medical providers seems to correlate with the likelihood of desired Cardiology Plus ¦ Volume 6 ¦ Issue 4 ¦ October-December 2021 Ren : Cardiovascular medicine and COVID-19 various aspects of STEMI management during the COVID-19. [8] In the fourth article, Jia and Sowers from the University of Missouri Columbia summarized the recent epidemiological findings of hypertension in COVID-19 patients and emphasized the essential role for angiotensin-converting enzyme-2 (ACE-2), a receptor for SARS-CoV-2, and viral entry into cells. Epidemiological data have revealed that hypertension is a frequent comorbidity and an independent prognostic risk factor in COVID-19 patients. They discussed the possible contribution of endothelial dysfunction, inflammation, and arterial stiffness in the prevalence of hypertension and cardiovascular disease in COVID-19 patients. They also commented on therapeutic strategies for managing hypertension in COVID-19 patients, with particular focus on ACE inhibitors, angiotensin receptor blockers, and calcium channel blockers. [9] In the fifth article, Li et al. from the University of Manitoba provided insights into the complex interplay between inflammation and myocardial ischemia-reperfusion (I/R), a major cause of death. I/R is commonly associated with pro-inflammatory responses to augment postischemic injury and remodeling. Myocardial ischemia injury and acute MI remain the leading causes of death in patients with cardiovascular diseases. [10] [11] [12] Interestingly, certain pro-inflammatory factors, including tumor necrosis factor-alpha, IL-1, IL-6, melanocyte-stimulating hormone-inhibiting factor, and D-dopachrome tautomerase may in fact improve the cell survival and compensate energy deprivation in acute I/R. To this end, selective targeting of pro-inflammatory factors is expected to display disparate therapeutic outcomes in the treatment of heart attack. [13] In the sixth article, Pan et al. from Zhongshan Hospital Fudan University summarized the evidence that argued for and against coronary artery fistula closure and offered a balanced view of the pros and cons for coronary artery fistula closure in patients with different types of coronary artery fistula. [14] In the last article, Zhao et al. from Stanford University assessed macrophage polarization into M1 and M2 phenotypes in ischemic brain following stroke. These authors employed in vivo and in vitro techniques to examine whether distinctive M1 and M2 types truly exist or not and evaluated their effects on brain injury evoked by stroke. [15] Although our society, physicians, and scientists have admirably responded to COVID-19 pandemic, many issues still exist to compromise the timely and target therapy for COVID-19-related cardiovascular diseases including health-care barriers, early detection, and preventative management for individual risk factors. Loss of human life and socioeconomic contact during the COVID-19 pandemic should be deemed as a warning whistle for our society, physicians, and scientists, or our descendants will suffer again in future. Although our theme issue has shed some insights toward cardiovascular medicine in this COVID-19 pandemic, we have failed in a large part identifying the specific target (s) or drug (s) on COVID-19-associated cardiovascular anomalies. This reflects the overall challenge and difficulty in the mechanism behind COVID-19 pathology. We hope that this theme issue will serve as a little step toward launching better intervention regimens for COVID-19-associated cardiovascular anomalies. Jun Ren is an Editorial Board member of Cardiology Plus. The article was subject to the journal's standard procedures, with peer review handled independently of this Editorial Board member and their research groups. COVID-19: The impact on cardiovascular system Task Force for the Management of COVID-19 of the European Society of Cardiology. European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: Part 1-epidemiology, pathophysiology, and diagnosis Task Force for the Management of COVID-19 of the European Society of Cardiology. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: Part 2-care pathways, treatment, and follow-up Obesity cardiomyopathy: Evidence, mechanisms, and therapeutic implications SARS-CoV-2 and cardiovascular complications: From molecular mechanisms to pharmaceutical management Quality of care for patients with acute coronary syndrome COVID-19-induced cardiovascular damage differs from other prevalent viruses Challenges in management of ST elevation myocardial infarction during COVID-19 pandemic Management of hypertension in patients with COVID-19: Implication of angiotensin-converting enzyme 2 Editorial: New therapetic approaches in the management of ischemia reperfusion injury and cardiometabolic diseases: Opportunities and challenges Ren: Cardiovascular medicine and COVID-19 Targeting autophagy for the therapeutic application of histone deacetylase inhibitors in ischemia/ reperfusion heart injury Bridging the gap, facing the challenge-the 26(th) Great Wall International Congress of Cardiology Cardiac protective effects of proinflammatory cytokines during ischemiareperfusion Coronary artery fistula: To close or not close, that is the question Revisit the concept of M1 versus M2 phenotypes of BV2 microglia and test their effects on stroke outcome in mice