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COVID-19 Risk Factors – Cardiovascular Disease

There are certain factors that put particular groups of people at higher risk of experiencing severe disease if infected by SARS CoV-2. Click here for an overview.

The association between non-communicable disorders (NCDs) and more severe COVID-19 symptoms is consistent worldwide; those with underlying NCDs are more vulnerable to experiencing severe complications following infection with SARS CoV-2. 

Some of the most prevalent NCDs include type 2 diabetes, hypertension, cardiovascular disease, chronic lung conditions, chronic kidney disease, chronic liver disease, and cancer

This article covers cardiovascular disease.

Cardiovascular disease: cause or consequence of COVID-19?

Many patients who have been hospitalised with severe or chronic COVID-19 have had hypertension or another type of cardiovascular disease (CVD). CVD is associated with chronic low-grade inflammation. Long-term inflammation can lead to an exhausted immune state, which is less able to respond to, or fight, any new challenges, such as exposure to a novel infectious agent.

Autopsy results from patients who have died with or from the disease show evidence of myocarditis, confirmed by the presence of unusual inflammatory cells in the heart. It is thought that the extent of myocardial injury might serve as a useful prognostic tool, with more pronounced myocarditis indicative of a worse prognosis. 

Furthermore, individuals hospitalised with COVID-19 often show biomarkers of cardiac injury in their blood. However, it is important to note that even those who have no pre-existing history of CVD are testing positive for circulating cardiac inflammatory markers; suggesting that SARS CoV-2 is also putting pressure on the heart muscles of those with no known heart issues.

Why would a respiratory infection trigger CVD?

Respiratory infections, including COVID-19 are triggers for CVD because they make it harder for the heart to work.

  • COVID-19 causes systemic inflammation, which is more robust in patients with severe or critical disease. It is well established that inflammation can lead to the development or exacerbation of heart conditions; for example, perpetual inflammation can damage the heart muscle and exhaust the immune system. Therefore, the main contributory factors leading to cardiac failure in COVID-19 patients are thought to be a compromised heart and a dysfunctional immune system, caused by virus-induced inflammatory events. 
  • Heart failure can occur when your heart muscle doesn’t pump blood as efficiently as normal. When combined with arrhythmia, which is commonly seen in vulnerable individuals infected with SARS CoV-2, it puts pressure on the heart and affects how well it functions. 
  • There are recent findings that suggest that blood clotting events which are a characteristic of COVID-19 disease progression, are also responsible for some of the cardiovascular events observed in individuals who have died from the infection. This is supported by evidence suggesting that individuals who are on blood-thinning medication have significantly improved survival rates compared to those who are not on medication. 

Unanswered questions and treatment options

The novel status of COVID-19 means that a lot of questions remain unanswered. Including, but not limited to, the association between the virus and CVD. 

Currently there is no cure for COVID-19; treatment focuses on managing the complications that arise as a result of infection. This means that those who present with symptoms of CVD may be treated with medications such as statins, beta blockers and anti-platelet agents. The heavy involvement of inflammatory events suggests that there may be a role for anti-inflammatory therapies in the management of COVID-19.

I have CVD, what should I do?

Make sure you continue to take any prescribed medications and ensure you have a good supply. One of the most important things you can do to lower the risk of serious complications is to manage your overall health, making it as good as possible. Exercise regularly and stay active. Ensure that your diet is balanced and healthy; eat a diet rich in unsaturated fats, such as fish, olives, avocados, nuts and seeds, to lower cholesterol levels.

Having a pre-existing heart condition does make you higher risk for COVID-19-related complications. Therefore, it is imperative that you take the necessary social distancing steps to minimise your exposure to the virus. 

Sources:

  • Fogarty, Helen, et al. “COVID19 Coagulopathy in Caucasian Patients.” British Journal of Haematology, vol. 189, no. 6, 24 Apr. 2020, pp. 1044–1049., doi:10.1111/bjh.16749.
  • Klok, F.a., et al. “Incidence of Thrombotic Complications in Critically Ill ICU Patients with COVID-19.” Thrombosis Research, vol. 191, 10 Apr. 2020, pp. 145–147., doi:10.1016/j.thromres.2020.04.013.
  • Madjid, Mohammad, et al. “Potential Effects of Coronaviruses on the Cardiovascular System.” JAMA Cardiology, 27 Mar. 2020, doi:10.1001/jamacardio.2020.1286.
  • “People Who Are at Higher Risk for Severe Illness.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 14 May 2020, www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html.
  • Ruparelia, Neil, et al. “Inflammatory Processes in Cardiovascular Disease: a Route to Targeted Therapies.” Nature Reviews Cardiology, vol. 14, no. 3, 1 Dec. 2016, pp. 133–144., doi:10.1038/nrcardio.2016.185.
  • Wang, Lun, et al. “Cardiovascular Impairment in COVID-19: Learning From Current Options for Cardiovascular Anti-Inflammatory Therapy.” Frontiers in Cardiovascular Medicine, vol. 7, 30 Apr. 2020, p. 78., doi:10.3389/fcvm.2020.00078.