COVID-19 and the heart: New studies provide an in-depth look

The studies, published in the Journal of the American College of Cardiology (JACC), address the complex relationship between COVID-19 and the heart, and add to previous research that showed the disease can cause heart problems for survivors.
 
While originally thought to be a virus primarily affecting the lungs, the researchers say it is now clear coronavirus can also impact and cause damage to the heart, with a higher risk of complications for patients who already have, or are at increased risk of, heart disease.
 
According to the authors of one of the papers, which discusses the underlying mechanisms that produce cardiovascular damage among those hospitalised with severe COVID-19 infection, myocardial injury occurs in about one-quarter of this patient cohort.
 
These patients also generally have a greater need for mechanical ventilator support, and are associated with higher hospital mortality.
 
‘Myocardial injury results in detectable increases in serum troponin, varying degrees of ventricular dysfunction and relatively frequent cardiac arrhythmias,’ co-author Professor Sean Pinney, from the University of Chicago, said.
 
‘Whether these effects are simply associated with poor patient outcomes, including death, or directly contribute to patient mortality is as yet uncertain.’
 
A separate paper contained in the JACC series focuses on a new COVID-related cardiometabolic syndrome and examines four key 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 – in the context of COVID-19.
 
‘Epidemiological or mechanistic associations of CMBCD [cardiometabolic-based chronic disease] with coronavirus disease 2019 substantiate a postulated coronavirus disease-related cardiometabolic syndrome [CIRCS],’ the researchers state.
 
Professor Jason Kovacic, cardiologist and executive director of the Victor Chang Cardiac Research Institute, told the ABC the paper combines overlapping risk factors into a unifying theory around cardiometabolic health and poor COVID-19 outcomes.
 
‘It seems that those four factors really do intersect and interact across COVID-19 … to cause worse outcomes,’ he said, adding that people with COVID-19 and metabolic and cardiovascular dysfunction are more likely to experience blood clotting and poor immune function.
 
Professor Kovacic also said obesity can make it more difficult for someone to breathe if they are required to go on a ventilator.
 
‘They tend to have worse lung function [and] really high glucose levels when they wind up in the ICU [intensive care unit], and all of this adds together to cause more problems,’ he said.
 
The paper provides recommendations for vulnerable patients, especially those with diabetes, to help prevent heart disease while navigating the COVID-19 pandemic, including pharmacotherapy and lifestyle changes, such as diet and exercise routines.
 
‘The role of healthy lifestyles and pharmacotherapy targeting metabolic drivers to reduce cardiovascular risk is well established,’ lead author Professor Jeffrey Mechanick from Mount Sinai Heart said.
 
‘However, lessons learned from the COVID-19 pandemic support shorter-term benefits of these interventions, similar to observed benefits on acute cardiovascular disease outcomes.’
 
Aside from the threat posed by coronavirus itself, disruptions in work and school routines, and the convenience of ordering in food during social distancing and stay-at-home orders can negatively affect health habits, the researchers added.
 
The third paper builds on existing evidence that shows the elderly and people with comorbidities are more susceptible to infection, serious illness and complications associated with COVID-19.
 
According to the paper, while most infected people experience mild symptoms and recover, the long-term risk of serious illness for survivors of severe cases of COVID-19 remains uncertain – but early observations are concerning.
 
‘It is plausible to assume that COVID-19 survivors will be more vulnerable to long-term cardiac morbidity,’ Professor Pinney said.
 
‘Longitudinal follow-up with multi-modal imaging and physiological testing will be important to describe the full extent of acquired COVID-19 heart disease.’
 
The development of acute respiratory distress syndrome and microthrombi in the lungs, heart and kidneys appear to be the main drivers of fatal disease, the researchers added.
 
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