MOLECULAR AND EPIGENETIC MECHANISMS OF COVID-19-RELATED CARDIOVASCULAR COMPLICATIONS: MULTIOMICS BIOMARKERS AND PRECISION MEDICINE APPROACHES
DOI:
https://doi.org/10.22159/ijap.2025v17i6.55425Keywords:
COVID-19, SARS-CoV-2, Cardiovascular disease, Myocardial injury, Endothelial dysfunction, Cytokine storm, ACE2 receptor, Epigenetic reprogramming, Multiomics integration, BiomarkersAbstract
COVID-19 has emerged as a significant precipitant of acute cardiovascular complications, collectively termed COVID-19-associated acute cardiovascular syndrome. Approximately one-third of hospitalized patients experience myocardial injury, with elevated cardiac troponins correlating with disease severity and mortality. The pathogenesis involves direct viral invasion of cardiomyocytes and endothelial cells via the ACE2 receptor, immune-mediated inflammation (notably cytokine storm), endothelial dysfunction, and prothrombotic states. These mechanisms are further modulated by genetic and epigenetic factors, including DNA methylation changes and host genetic polymorphisms, which influence individual susceptibility to cardiac complications. Multiomics integration—encompassing microRNA expression, exosomal biomarkers, glycomic profiling, and genomic data—has enabled the identification of novel molecular signatures for risk stratification and therapeutic targeting. For instance, specific miRNA signatures have been shown to predict responsiveness to anti-inflammatory therapies, offering the potential to personalize treatment strategies based on individual molecular profiles. Classic biomarkers such as high-sensitivity troponins, NT-proBNP, and myoglobin, alongside emerging molecular and epigenetic markers, provide valuable insights into the mechanisms linking SARS-CoV-2 infection to myocardial injury, arrhythmia, and long-term cardiovascular sequelae. This review synthesizes current evidence on the molecular, genetic, and epigenetic underpinnings of COVID-19-related cardiovascular disease, highlighting the promise of precision medicine approaches for early diagnosis, prognostication, and targeted intervention in post-COVID-19 cardiovascular risk management.
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