SARS-CoV-2 Infection and Cardioncology: From Cardiometabolic Risk Factors to Outcomes in Cancer Patients

SIMPLE SUMMARY: The coronavirus disease-2019 (COVID-19) pandemic has significantly changed the management and treatment of some diseases, including cancer, in order to reduce the risk of viral contamination in particularly vulnerable patients. SARS-CoV-2 infection leads to secondary hemophagocytic lymphohistiocytosis (sHLH), which is a multiorgan hyperinflammatory condition based on the hyperactivation of cytotoxic T lymphocytes, macrophages, and natural killer cells, leading to multiorgan failure (including myocarditis, venous thromboembolism, and acute respiratory distress syndrome) and consequently to death. We highlight the major cardiovascular and coagulative complications of COVID-19 with particular reference to cancer patients by analyzing the retrospective clinical studies currently available. Discussions on the harmful or beneficial effects of anticancer therapies as well as on the type of tumor during SARS-CoV-2 infection have been made, with the addition of practical recommendations for the risk reduction of coagulation dysfunctions, myocarditis, venous thromboembolism, and mortality in cancer patients. ABSTRACT: The coronavirus disease-2019 (COVID-19) is a highly transmissible viral illness caused by SARS-CoV-2, which has been defined by the World Health Organization as a pandemic, considering its remarkable transmission speed worldwide. SARS-CoV-2 interacts with angiotensin-converting enzyme 2 and TMPRSS2, which is a serine protease both expressed in lungs, the gastro-intestinal tract, and cardiac myocytes. Patients with COVID-19 experienced adverse cardiac events (hypertension, venous thromboembolism, arrhythmia, myocardial injury, fulminant myocarditis), and patients with previous cardiovascular disease have a higher risk of death. Cancer patients are extremely vulnerable with a high risk of viral infection and more negative prognosis than healthy people, and the magnitude of effects depends on the type of cancer, recent chemotherapy, radiotherapy, or surgery and other concomitant comorbidities (diabetes, cardiovascular diseases, metabolic syndrome). Patients with active cancer or those treated with cardiotoxic therapies may have heart damages exacerbated by SARS-CoV-2 infection than non-cancer patients. We highlight the cardiovascular side effects of COVID-19 focusing on the main outcomes in cancer patients in updated perspective and retrospective studies. We focus on the main cardio-metabolic risk factors in non-cancer and cancer patients and provide recommendations aimed to reduce cardiovascular events, morbidity, and mortality.