Public health experts began researching the link between heart disease and COVID-19 early on in the pandemic, and the picture has become more clear as we settle into year three of the pandemic. According to an early bulletin released by the American College of Cardiology (ACC) on March 6, 2020, people who have underlying cardiovascular disease have a higher mortality rate with COVID-19 (10.5 percent) than people who have an underlying chronic respiratory disease (6.3 percent). Early pandemic data from the UK Office for National Statistics, published on April 16, 2020, showed that 91 percent of those who died of COVID-19 in England and Wales in March 2020 had at least one underlying condition, with heart disease among the most common (14 percent). Another early review, published on October 6, 2020, in the American Journal of the Medical Sciences, found that the COVID-19 mortality rate for people with underlying cardiovascular disease was between 10.5 and nearly 14 percent. That number jumped to between 35 percent and almost 87 percent for people who had underlying coronary artery disease. The researchers blame the increased risk of COVID-19 complications in cardiovascular disease to an abundance of a receptor that serves as a gateway for the virus to jump into the lungs and heart. Following a winter surge fueled by the highly contagious omicron variants, most Americans have now been infected with COVID-19 at some point during the pandemic, the CDC reports. Experts expect new variants to continue to emerge for the foreseeable future. Each variant could have a slightly different effect on the body — research suggests the original BA.1 omicron variant, which is quickly being displaced in the United States by the BA.2 subvariant, CDC data show — causes a milder infection than previous variants, including delta. A study published in April 2022, in the journal The Lancet found that compared with delta, omicron infection was associated with a two-thirds lower chance of hospitalization for COVID-19. But these variants more easily evade vaccines, so it’s still very important for high-risk people, like those with existing heart disease, to protect themselves from infection and understand the risks. “COVID-19 causes a severe inflammatory response in the body, and inflammation is the biggest cause of heart attacks,” says Dr. Madjid. Inflammation can cause otherwise benign plaque buildup in the arteries to swell, leading to blood clots, heart attack, and stroke, he explains. A massive study that included more than 11 million people, published in February 2022 in the journal Nature Medicine, investigated the long-term cardiovascular outcomes of people who had been infected with COVID-19. The researchers followed people for a year after infection and found that their risk of developing cardiovascular disease after being infected with COVID-19 extended well beyond the roughly two weeks a person is actively infected with the virus. The researchers found that even in patients who weren’t hospitalized, COVID-19 infection increased risk of cerebrovascular disorders like stroke, heart disease, pericarditis, myocarditis, heart failure, and blood clots 30 days or longer after infection. The risk of any heart complication within one year of infection was 63 percent for those who had had COVID-19 compared with those who had not. The researchers identified an additional 45 cardiovascular events per 1,000 people who had tested positive. The results were in line with what preliminary research had suggested early on in the pandemic. An earlier study, published July 27, 2020, in JAMA Cardiology, included 100 people who had recently recovered from COVID-19, and found cardiac involvement in 78 percent of patients and ongoing myocardial inflammation in 60 percent of patients. A small study published in September 2020, also in JAMA Cardiology, analyzed heart images of 26 competitive college athletes who had recovered from COVID-19. Twelve of the athletes reported a mild case of COVID-19, while the rest were asymptomatic. The researchers found that 15 percent had signs on the images that were consistent with myocarditis.
Heart Disease and COVID-19: How to Stay Safe and Healthy
If you have heart disease, it’s particularly important to take special care to stay healthy and avoid getting infected with COVID-19. The following tips may help you avoid getting sick and prevent medical emergencies.
Don’t Delay Getting Care for Heart Issues
If you’re experiencing warning signs of a heart attack or stroke, you should call 911 immediately, says the American Heart Association (AHA). People who have heart disease need to pay extra attention to symptoms such as shortness of breath, chest pain, or irregular heartbeat, says Waqar Khan, MD, a cardiologist at Lone Star Heart and Vascular Center in Tomball, Texas. In the early months of the pandemic, some people may have delayed getting care out of fear of contracting the coronavirus, and this may have led to an increase in deaths. A study published in July 2020 in JAMA analyzed data from New York City in March and April of that year, when the city was overwhelmed with COVID-19 cases, and found that death rates from heart disease rose by nearly 400 percent during that time. In addition to possible nonrespiratory manifestations of COVID-19, the study authors suggested that delayed access to healthcare may have played a role in the spike. RELATED: Pandemic Caused Heart Disease Deaths to Spike Sharply in States Most Affected According to the COVID Tracking Project, COVID-19 hospitalizations in the United States are falling, but new variants may bring additional waves. Even when hospitals are experiencing high volumes from COVID-19, systems are in place to ensure that people with medical emergencies unrelated to COVID-19 can get the care they need with minimal risk of being exposed to the coronavirus.
Take Your Heart Medication
It’s always important to keep up with any heart medication your doctor has prescribed, and even more so when you are at risk of COVID-19 exposure. The CDC recommends having at least a 30-day supply of heart medication on hand. “By taking your medication, you can better protect your heart, which can help protect you against complications of COVID-19 if you do get it,” says Madjid.
Do Not Take Unproven Drugs to Treat COVID-19
In June 2020, the FDA withdrew its emergency use authorization for hydroxychloroquine, a malaria drug, to treat COVID-19. The agency cited heart rhythm problems, which cardiovascular groups including the AHA, the ACC, and the Heart Rhythm Society (HRS) expressed concern over early on. In addition, the results of a National Institutes of Health clinical trial, published in November 2020 in JAMA, determined that hydroxychloroquine is not an effective treatment for COVID-19. A Brazilian clinical trial published by JAMA in April 2021, also concluded that patients hospitalized with COVID-19 who took either hydroxychloroquine or a combination of two other antivirals, lopinavir and ritonavir, did not recover any better than those who did not receive the drugs. A study conducted by researchers at the University of Chicago, published September 15, 2020, in JAMA, found that azithromycin, a type of antibiotic, increases a patient’s risk of cardiac arrest if taken with other drugs that regulate electrical functioning of the heart.
Get Vaccinated — Not Just for COVID-19
According to CDC data, more than 100 million people in the United States have received a COVID-19 booster since August 2021. In late March 2022, the FDA authorized a second booster dose of either the Moderna (Spikevax) or Pfizer-BioNTech vaccines for people older than 50 and for people older than 12 who have specific conditions that make them extremely immunocompromised. People should wait until four months after their first booster to get a second, and early data has shown that antibodies from the first booster appear to wane after three and six months, according to the AHA. Companies like Moderna are also working to create additional boosters that trigger immunity against multiple variants, including omicron. “Individuals eligible for COVID vaccination who are not yet fully immunized are urged to get the series of vaccines at least up through the first booster. People who are eligible for the second booster should call their clinical care office to discuss the need for a second booster,” said the AHA’s volunteer president, Donald M. Lloyd-Jones, MD, in a statement following the second booster’s authorization. An earlier statement written by five heart-health experts, published by the AHA in January 2021, encouraged everyone to get vaccinated for COVID-19 as soon as they are eligible — in particular people with cardiovascular risk factors and heart disease, and those who had survived heart attack and stroke, “because they are at much greater risk from the virus than they are from the vaccine.” Although research has shown that current vaccines are less protective against infection with omicron variants, they still protect against severe disease and hospitalization. A study published in April 2022 in the Lancet found that among those who received two doses of a COVID-19 vaccine, the hospitalization rate for an omicron infection was 0.24, much lower than the rate for those who were unvaccinated or had received only one dose. Vaccine-induced myocarditis, a rare condition that causes inflammation of the heart muscle, and pericarditis, inflammation of the lining of the heart, have been the subjects of lots of research over the past year. Some cases have been reported, mostly in males younger than 30, according to the CDC. But the agency still recommends that everyone over age 5 get fully vaccinated and boosted for COVID-19. A British study published in December 2021 in Nature Medicine included around 38 million vaccinated people. Researchers found that a COVID-19 infection is more likely than vaccination to cause rare cardiovascular complications such as myocarditis, pericarditis, and irregular heartbeat. While vaccination was responsible for an additional 1 to 10 cases of myocarditis per one million people, infection with COVID-19 was responsible for an extra 40 cases per one million people. It’s a good idea to keep up-to-date on other vaccinations as well, especially as mask mandates are being loosened. The CDC recommends that people with heart disease get vaccinated for influenza every year, because they are at risk of developing serious complications from the flu, such as heart attacks and stroke. The agency also recommends that people who have heart disease stay up-to-date with pneumococcal vaccination to protect against pneumococcal diseases such as pneumonia, meningitis, and bloodstream infections.
Consider Masking Up to Protect Yourself
The CDC recommends that high-risk people continue to wear masks indoors despite the lifting of mask mandates in most of the country. The omicron variants currently circulating in the United States are more contagious than delta and can spread more quickly and with less exposure time than previous variants, the CDC reports. Data published by the CDC in February 2022 found that a well-fitting N95 or KN95 mask reduced a person’s chances of catching COVID-19 by 83 percent. A surgical mask lowered risk by 66 percent, and a cloth mask cut risk by 56 percent. Speak to your healthcare provider for guidance on masks if you’re not sure when, where, or how to wear one.
Get Updates and Information From Credible Sources
The internet has become flooded with information regarding vaccines and masks, along with other claims about COVID-19. But it’s important to remember that not everything you read is fact. Madjid stresses the importance of getting information directly from primary sources, such as the CDC, the World Health Organization, the U.S. Food and Drug Administration (FDA), or other government agencies, as well as news organizations that credit these agencies in their reporting.
