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The role of the endothelium in long COVID

Leonardo Tamariz1, Lina A Shehadeh2, Elizabeth Bast3

  • 1Department of Public Health Sciences, Miller School of Medicine at the University of Miami, Miami, FL, United States of America; GRECC, Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Miami, FL, United States of America.

Vascular Pharmacology
|May 15, 2026
PubMed

Insights

SARS-CoV2 infection elevates cardiovascular risk via endothelial dysfunction and inflammation. Vitamin C and L-arginine show promise in improving endothelial function in long COVID patients.

Area of Science:

  • Cardiovascular Medicine
  • Infectious Diseases
  • Vascular Biology

Background:

  • SARS-CoV-2 infection is linked to increased cardiovascular event risk.
  • Key mechanisms include systemic inflammation, dysautonomia, endothelial dysfunction, and prothrombotic states.
  • The endothelium's role is critical, alongside dysautonomia and mast cell activation.

Purpose of the Study:

  • To explore the mechanisms linking SARS-CoV-2 to cardiovascular risk.
  • To identify methods for detecting endothelial dysfunction.
  • To review potential treatments for endothelial dysfunction in long COVID.

Main Methods:

  • Review of existing literature on SARS-CoV-2 and cardiovascular complications.
  • Discussion of endothelial cell activation by SARS-CoV-2.
  • Identification of flow-mediated dilation as a key diagnostic method.
  • Summary of randomized trials for endothelial dysfunction treatments.

Main Results:

  • SARS-CoV-2 induces a pro-inflammatory and pro-thrombotic endothelial phenotype.
  • This can lead to microcirculatory dysfunction and reduced tissue oxygen delivery.
  • Flow-mediated dilation is a primary method for assessing endothelial dysfunction.
  • Antihypertensives, statins, beta-blockers, supplements, and lifestyle changes are established treatments.
  • Limited studies suggest Vitamin C and L-arginine may improve flow-mediated dilation in long COVID.

Conclusions:

  • Endothelial dysfunction is a significant contributor to cardiovascular risk post-SARS-CoV-2.
  • Microcirculatory changes and impaired vasodilation are key consequences.
  • Further research into supplements like Vitamin C and L-arginine for long COVID is warranted.

Keywords:
EndotheliumLong COVIDPharmacology

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