Official journal of the Slovak Society of Cardiology,
Slovak Society of Hypertension and Slovak Association for Cardiac Arrhythmias

Cardiology Letters 2025, 34(5):270-282

Endothelial dysfunction as a key pathomechanism of long COVID: a potential therapeutic target

Angelika Púzserová1, Peter Bališ1, Silvia Dobrodenková2, Enikő Potocká3, Miroslava Kvandová1
1 Ústav normálnej a patologickej fyziológie, Centrum experimentálnej medicíny, Slovenská akadémia vied, v. v. i., Bratislava, Slovakia
2 Travel Health Clinic, Bratislava, Slovakia

Long COVID (LC) refers to the spectrum of long-term health consequences caused by SARS-CoV-2 infection. It includes persistent or new symptoms lasting months to years after the initial infection. Multiple organ systems can be affected, including the cardiovascular system. The pathophysiology of LC is complex and multifactorial, involving viral persistence, immune system dysregulation, endothelial dysfunction, oxidative stress, gut dysbiosis, coagulation disorders, inflammatory processes, and other factors. The endothelium, a key regulator of vascular homeostasis, plays a central role in LC pathophysiology. Endothelial dysfunction leads to altered vascular permeability, inflammation, and coagulation abnormalities, and is considered one of the main mechanisms behind persistent symptoms and multi-organ complications in LC patients. Markers of endothelial activation and damage, such as P-selectin, ICAM-1, VCAM-1, and syndecan-1, may serve as potential diagnostic biomarkers for LC and indicators of cardiovascular risk. Moreover, persistent oxidative stress and inflammation drive ongoing symptoms and impaired vascular function. Current therapies mainly target viral replication and inflammation, while novel strategies focusing on endothelial dysfunction offer promising potential to prevent cardiovascular and multi-organ sequelae in LC. Further research into endothelial dysfunction mechanisms, biomarker identification, and suitable experimental models is essential to improve diagnosis, enable personalized treatments, and reduce LC's public health impact.

Keywords: biomarkers; COVID-19; endothelial dysfunction; endothelium; long COVID; SARS-CoV-2

Published: May 1, 2025  Show citation

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Púzserová A, Bališ P, Dobrodenková S, Potocká E, Kvandová M. Endothelial dysfunction as a key pathomechanism of long COVID: a potential therapeutic target. Cardiology Letters. 2025;34(5-6):270-282.
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