Cardiac risk factors, not heart disease itself, may increase the chance of dying from COVID-19

In an effort to clarify the link between pre-existing heart disease and COVID-19, a study of critically ill patients found that the risk of death from COVID-19 may not be directly related to heart disease, but to factors that contribute to it.

According to the Centers for Disease Control and Prevention, people with heart disease have been and continue to be at greater risk of developing severe COVID-19. A new study published Tuesday in the Circulation: cardiovascular quality and outcomesassumes cardiovascular risk factors– such as older age and whether a person smoked – were the main causes of serious illness, not 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 linked to smoking and others Cardiovascular disease risk factors such as high blood pressure and diabetes.

To understand the connection, researchers reviewed the records of 5,133 severe COVID-19 patients who participated in a collaborative study called STOP-COVID. Patients came from 68 US hospitals and were admitted to the ICU between March 1 and July 1, 2020.

Of these, 1,174 already had cardiovascular disease, defined in the study as ischemic heart disease (plaques in the arteries of the heart), heart failure (where the heart cannot pump effectively), or atrial fibrillation (a type of irregular heartbeat).

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

But when the researchers separated out things associated with cardiovascular disease, such as age, high blood pressure and diabetes, the association between cardiovascular disease itself and death from COVID was found to be statistically insignificant.

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

The results show that the increased risk of death among the heart disease patients studied has less to do with having arteries lined with plaque and more to do with having risk factors that contribute to the hyperinflammation of COVID-19, Hayek said. He acknowledged, however, that because the study had few people with heart transplants or severe cardiovascular disease, such as advanced heart failureresearchers could not draw conclusions about them.

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

Among the 2,741 patients for whom troponin levels were available, “cardiac injury was a strong predictor of poor outcome,” Hayek said — regardless of whether the patient had cardiovascular disease. The higher the troponin level, the more likely the patient will die. “Essentially, what we’re seeing here is that cardiac injury is a surrogate marker for the severity of the disease with COVID-19,” he said.

Summing up, Hayek said the first part of the study “emphasizes that it’s not pre-existing heart disease. The second part emphasizes that cardiac trauma is associated with worse outcomes.” Taken together, this suggests that the heart damage is likely related to the stress of acute COVID-19 disease rather than a sign of new complications of cardiovascular disease.

He said the study highlights that severe COVID-19 is a hyper-inflammatory process, and that inflammatory processes associated with cardiovascular risk also put people at risk for severe COVID.

The study does not mean that a person with existing cardiovascular disease can ignore the problem, Hayek said. Instead, people need to think about common 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 greater risk of dying from COVID-19, said Wang, who was not involved in the study. But research helps to find out what harms people.

“It’s not so much that they’ve had heart disease before,” she said. “It’s about general health that makes them a higher risk. So this difference, I think, is very interesting.”

The link between heart damage and death “seems a bit simple,” she said. A severe form of COVID-19 affects everywhere, not just the heart. “Patients who die tend to have more hits to the organs, so to speak,” she said. Troponin levels would be another marker that they are sick.

She noted that “a large proportion of these patients never had their troponin measured,” making it more difficult to draw conclusions.

But she said the findings, overall, offered patients some silver linings.

“This means that all hope is not lost, even if you have had heart disease before,” she said. These results suggest that if researchers can learn how to limit the level of damage to the heart, “we will have a much better chance of patients surviving their ICU stay and hopefully having a better quality of life and longer life afterward.” .

Whether or not they’ve been diagnosed with heart disease, people can think of the results as a way to inspire self-care, Wang said. “If you can practice good preventative care — see your doctor regularly, keep your diabetes under control, aim for a healthy weight, aim for an active lifestyle — the combination of all these things should not only limit your risk of developing heart disease, but it will also help reduce the severity of your disease.” and reduce the risk of adverse outcomes even if you contract COVID-19.”

Hayek said he hopes the research will lead to a better understanding of the underlying links between heart disease, inflammation and infectious diseases, possibly to identify better markers that may be common to all diseases.

“Because there is an overlap between inflammation and cardiovascular disease, understanding the mechanistic link will have implications not only for this pandemic, but also for any severe infectious disease to which patients with heart disease exposed,” he said.

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