Heart risk factors, not heart disease itself, may increase risk of death from COVID-19


Seeking to clarify links between pre-existing heart disease and COVID-19, a study of critically ill patients found that their risk of dying from COVID-19 may stem not directly from heart disease, but from factors within it. contribute.

According to the Centers for Disease Control and Prevention, people with heart disease have been and continue to be at higher risk of developing a severe form of COVID-19. The new study, published Tuesday in Circulation: quality and cardiovascular resultssuggests that cardiovascular risk factors, such as being older and whether or not a person smokes, were major contributors to serious illness, rather than heart disease itself.

COVID-19 is known to cause organ damage through uncontrolled inflammation. Inflammation is also common in people with heart disease and stroke, and is associated with smoking and other cardiovascular disease risk factors such as high blood pressure and diabetes.

To understand the links, the researchers looked at the records of 5,133 critically ill COVID-19 patients who were part of a collaborative study called STOP-COVID. The patients came from 68 hospitals across the United States and were admitted to intensive care between March 1 and July 1, 2020.

Of these, 1,174 had pre-existing cardiovascular disease, defined in the study as including coronary artery disease (plaque in the arteries of the heart), heart failure (where the heart fails to pump effectively) or atrial fibrillation (a type of irregular heartbeat).

Having pre-existing cardiovascular disease initially appeared to be a risk factor for death within 28 days of hospital admission with COVID, said lead author Dr. Salim Hayek. He is an assistant professor at the University of Michigan in Ann Arbor, where he is director of the Frankel Cardiovascular Center.

But when the researchers separated out items associated with cardiovascular disease, such as age, high blood pressure and diabetes, the link between cardiovascular disease itself and death from COVID seemed statistically insignificant.

The researchers found that the most important risk factors for death were, in order, age, body mass index (a measure of obesity), race and ethnicity, and smoking history.

The findings suggest that the increased risk of death in the heart patients studied is less that they have plaque-lined arteries, and more that they have risk factors contributing to COVID-19 hyperinflammation, said Hayek. He acknowledged, however, that because the study included few people with heart transplants or serious cardiovascular disease, such as advanced heart failure, the researchers could not draw conclusions about them.

In a second part of their analysis, the researchers looked at a biomarker of heart damage called troponin. Troponin is commonly used as a test to find out if someone has had a heart attack. But, Hayek said, it can also indicate stress on the cardiovascular system or heart injury as the body fights a COVID-19 infection.

Among the 2,741 patients for whom troponin levels were available, “heart injury was a strong predictor of poor outcome,” Hayek said, whether or not the patient had cardiovascular disease. The higher the level of troponin, the more likely a patient is to die. “Essentially what we’re seeing here is that cardiac injury is a surrogate marker for COVID-19 disease severity,” he said.

In summary, Hayek said, the first part of the study “emphasizes that it’s not about pre-existing heart disease. And the second part emphasizes that heart damage is linked to worse outcomes.” Together, this suggests that cardiac injury is likely related to the stress of acute COVID-19 disease rather than a sign of new cardiovascular disease complications.

He said the study highlights that severe COVID-19 is a hyperinflammatory process — and that inflammatory processes linked to cardiovascular risk also put people at risk of having severe COVID.

The study doesn’t mean someone with existing cardiovascular disease can ignore the problem, Hayek said. Instead, people need to think about these shared risk factors.

Dr. Tracy Y. Wang, professor of medicine in cardiology at Duke University in Durham, North Carolina, agreed.

People with heart disease are still at a higher risk of dying from COVID-19, said Wang, who was not involved in the research. But the study helps clarify what is hurting people.

“It’s not so much that they had heart disease before,” she said. “It’s about their overall health that makes them more at risk. So I think that distinction is really interesting.”

The association between heart damage and death “seems a bit obvious,” she said. Severe COVID-19 causes damage everywhere, not just in the heart. “Patients who die tend to have more organ strokes, so to speak,” she said. Troponin levels would be just one more marker that they are sick.

She noted that “a good portion of these patients never had troponin measured,” making it harder to draw conclusions.

But she said the results, overall, offered a bit of a bright spot for patients.

“It means all hope is not lost even if you’ve had heart disease before,” she said. These findings suggest that if researchers can learn to limit levels of heart damage, “then we have a much better chance of patients surviving their ICU stay and hopefully having a better quality of life.” and better longevity after that as well.”

Whether or not they’ve been diagnosed with heart disease, people could view the findings as a way to inspire self-care, Wang said. “If you can practice good preventative therapy – seeing a doctor regularly, controlling your diabetes, aiming for a healthy weight, aiming for an active lifestyle – the combination of all of these things should not only limit your risk of developing heart disease, it would also help reduce the severity of your illness and your risk of side effects, even if you were to get COVID-19.”

Hayek said he hopes the research will lead to a better understanding of the fundamental links between heart disease, inflammation and infectious disease, perhaps to unravel better markers that all conditions could share.

“Because there is an overlap between inflammation and cardiovascular disease, understanding the link in a mechanistic way will be useful not only for this pandemic, but for all serious infectious diseases to which patients with heart disease are exposed,” did he declare.


Study finds link between COVID and new-onset atrial fibrillation


More information:
Alexi Vasbinder et al, Relationship between pre-existing cardiovascular disease and death and cardiovascular outcomes in critically ill patients with COVID-19, Circulation: quality and cardiovascular results (2022). DOI: 10.1161/CIRCOUTCOMES.122.008942

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Quote: Heart risk factors, not heart disease itself, may increase risk of death from COVID-19 (October 4, 2022) Retrieved October 4, 2022 from https://medicalxpress.com/news/2022-10 -heart-factors-disease-odds-covid-.html

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