Thus, it appears that having an actual underlying CVD is a major risk factor for death, not simply due to tissue expression of ACE2, although ACE2 upregulation is associated with heart failure or ischaemic cardiomyopathy (see [52] and references therein), and ACE2 elevation occurred in cardiomyocytes of patients with heart disease compared with healthy controls [53]. Here, ACE2 is linked to heart failure.