The Journal of the American College of Cardiology (JACC) has issued a three-part focus seminar on COVID-19 in 2020 to address the complex relationship between COVID-19 and the heart.
The series includes a paper discussing a new COVID-19-related cardiometabolic syndrome composed of four drivers—abnormal adiposity (excess body fat), dysglycemia (abnormality in blood sugar stability), dyslipidemia (abnormal level of cholesterol and other fats in the blood) and hypertension (high blood pressure). Researchers give recommendations for these patients, especially those with diabetes, for preventing heart disease while navigating the COVID-19 pandemic. Recommendations include pharmacotherapy and lifestyle changes, such as diet and exercise routines, be adopted and maintained within social distancing guidelines. Researchers said that disruptions in work and school routines and the convenience of ordering in food during social distancing and stay at home orders can negatively impact health habits. Patients should receive healthy lifestyle instructions.
“The role of healthy lifestyles and pharmacotherapy targeting metabolic drivers to reduce cardiovascular risk is well-established,” said Jeffrey I Mechanick, lead author of the study and professor of medicine and medical director of the Marie-Josee and Henry R Kravis Center for Cardiovascular Health at Mount Sinai Heart, New York, USA. “However, lessons learned from the COVID-19 pandemic support shorter-term benefits of these interventions, similar to observed benefits on acute cardiovascular disease outcomes.”
A further study addresses the global concerns COVID-19 has raised for the health and safety of vulnerable populations, including heart disease patients. According to the paper, most people infected experience mild symptoms and recover, but the elderly and people with comorbidities are more susceptible to infection and serious illness and complications, with development of acute respiratory distress syndrome and microthrombi in the lungs, heart and kidneys appearing to be the drivers of fatal disease. Researchers said that the long-term risk of serious illness for survivors of severe cases of COVID-19 remain uncertain, but early observations are concerning.
“It is plausible to assume that COVID-19 survivors will be more vulnerable to long-term cardiac morbidity,” said Sean P Pinney, MD, lead author of the study and a professor of medicine, cardiology, at the University of Chicago, Chicago, USA. “Longitudinal follow-up with multi-modal imaging and physiological testing will be important to describe the full extent of acquired COVID-19 heart disease.”
In a third paper, researchers explore the underlying mechanisms producing cardiovascular damage among hospitalised patients with severe COVID-19 infection, including that of thromboembolic disease and arrhythmia. According to researchers, myocardial injury occurs in about one-quarter of hospitalised COVID-19 patients and is associated with a greater need for mechanical ventilator support and higher hospital mortality.
“Myocardial injury results in detectable increases in serum troponin, varying degrees of ventricular dysfunction and relatively frequent cardiac arrhythmias,” Pinney, one of the study authors, said. “Whether these effects are simply associated with poor patient outcomes, including death, or directly contribute to patient mortality is as yet uncertain.”