Recent articles published in medical journals or the public media, discuss the emerging link between COVID-19 and cardiovascular diseases surge, and the factors that have driven this phenomenon over the last year since the beginning of the pandemic.
Respiratory symptoms often dominate the clinical presentation of COVID-19, yet, the SARS-CoV-2 infection is also responsible for a variety of potentially severe cardiovascular manifestations. In fact, evidence accumulated over the last year indicates that SARS-COV-2 often infects and damages heart tissue directly.
Nature Reviews Cardiology
In a recent review published in Nature Reviews Cardiology Nishiga et al. emphasize 3 major points related to the mechanisms behind this phenomenon:
1) The interaction between the viral spike (S) protein and angiotensin-converting enzyme 2 is likely to be involved in the cardiovascular manifestations of COVID-19;
2) The presence of underlying cardiovascular comorbidities in patients with COVID-19 is associated with high mortality; and
3) COVID-19 can cause cardiovascular disorders, including myocardial injury, arrhythmias, acute coronary syndrome and venous thromboembolism.
JAMA Cardiology published a prospective observational cohort study of 100 patients, identified from the University Hospital Frankfurt COVID-19 Registry, and recently recovered from COVID-19 infection.
In this study, the cardiovascular magnetic resonance (CMR) revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), independent of pre-existing conditions.
Canadian Journal of Cardiology
A review by Marouane Boukhris et al., published in the Canadian Journal of Cardiology indicates that several cardiovascular manifestations have been observed in COVID-19 patients, including myocardial injury, myocarditis, ACS, pulmonary embolism, stroke, arrhythmias, heart failure, and cardiogenic shock.
The authors of this article also discuss several factors that may contribute to the cardiovascular consequences of COVID-19. This includes the adrenergic drive, systemic inflammatory milieu and cytokine-release syndrome caused by SARS-CoV-2, direct viral infection of myocardial and endothelial cells, hypoxia due to respiratory failure and electrolytic imbalances.
Moreover, a recent systematic literature review and meta-analysis, published in Heart, BMJ, concluded that cardiovascular disease (CVD) and its risk factors (hypertension and diabetes) were closely related to fatal outcomes in COVID-19 for patients across all ages. Although young patients had lower prevalence rates of cardiovascular comorbidities than elderly patients, relative risk of fatal outcome in young patients with hypertension, diabetes and CVD was higher than in elderly patients.
In a recent Healthline news entitled “Why heart disease deaths rose during covid-19 surge”, Dr. Laurence M. Epstein, a professor of cardiology at the Zucker School of Medicine at Hofstra/Northwell, concluded that there are two major factors regarding COVID-19’s impact on deaths from heart disease.
“We know that COVID-19 is a systemic disease, and not only did people who had underlying cardiovascular disease were more likely to get infected, their outcomes were worse,” Epstein said “The other thing was, we’re realizing that this extensive sort of vasculopathy, where issues related to blood clotting, became a big issue.”
American Heart Association and TIME magazine
Heart disease remains the leading cause of death worldwide, according to the American Heart Association, and experts warn that the broad influence of the COVID-19 pandemic will likely continue to extend that ranking for years to come. They also predict the global burden of cardiovascular disease will grow exponentially over the next few years as the long-term effects of the current COVID-19 pandemic evolve.
“The extraordinary circumstances of dealing with COVID-19 have changed the way we live, including adopting unhealthy behaviors that are known to increase the risk of heart disease and stroke. Unhealthy eating habits, increased consumption of alcohol, lack of physical activity and the mental toll of quarantine isolation and even fear of contracting the virus all can adversely impact a person’s risk for cardiovascular health”, said Salim S. Virani, M.D., Ph.D., FAHA.
In the U.S., about 655,000 people die of heart disease each year. According to Jeffrey Kluger, “Take a nation that already eats too much, drinks too much, exercises too little and fails too often to show up for regular checkups, put them in lockdown for a year or more, and those behaviors–all of which are drivers of cardiovascular disease–will only get worse”.
Yet, the good news buried in the bad is that some of these cardiovascular dangers associated with COVID-19 can be controlled. Healthier lifestyle choices can help mitigate heart-disease risks.
Moreover, in this more optimistic direction, and regarding the American Heart Association (AHA) goals and strategies, prevention strategies that target modification of psychological well-being may be a potential avenue for AHA to reach its goal of improving Americans’ cardiovascular health.
And, last but not least, psychological stress across the lifespan should be considered during cardiovascular risk assessment.