As I write this, the COVID-19 coronavirus—a virus similar to seasonal influenza but on a per capita basis more lethal—is sweeping the United States, with the full extent of its harm still being assessed. However, those of us living in North America do have the advantage of learning from how the pandemic emerged in China in January 2020 and its direct cardiovascular effects.
Here’s what cardiologists on the frontline report, according to a clinical bulletin issued in mid-March 2020 by the American College of Cardiology:
•The majority of those actually hospitalized for the disease—by definition, the most serious cases—have one or more underlying chronic diseases, with 31 percent having hypertension and 14.5 percent having cardiovascular disease. (Some epidemiologists believe that one of the receptors involved in this virus is also associated with cardiovascular disease, but at the moment that’s only a theory.)
•10.5 percent of case fatalities occurred in patients with cardiovascular disease and 6 percent in patients with hypertension.
•Another 10 percent of those hospitalized for the virus also had diabetes, which as we learned in Chapter 9 is a common comorbidity of heart disease.
Bottom line: A good portion, perhaps as much as one-third, of cardiovascular patients in the United States are likely to get COVID-19 at some point. Those with cardiac injury from a previous event or an inherited heart condition appear to be particularly at risk. Even if you think that you currently don’t have a cardiovascular disease but are at risk based on the information presented in this book, you should immediately consult your physician.
To be clear, COVID-19 could be with us for many more months. Not all coronaviruses are seasonal, and it will probably be a year or more before a vaccine is available.
How exactly COVID-19 affects the heart is not known yet, but likely it follows the same pattern of other viral infections that inflame the lungs and compromise oxygen intake. The good news, based on the preliminary data gathered in China as well as in Italy, is that most patients after recovering from COVID-19 will have normal heart function.
While it is still too early to say how to best treat cardiovascular patients who get COVID-19, a judicious use of high-intensity statins may be called for. Again, check with your physician or cardiologist, particularly in regards to the potential effect of high-statin usage on liver function.
Finally, this is a good time to remind all cardiovascular patients to a get a flu shot every fall before the start of flu season. A little over a majority of cardiovascular patients do get a flu shot, but that should be more on the order of 90 perecnt. While there is no vaccine yet for COVID-19, it’s important to keep in mind that seasonal influenza to date has been far more deadlier over the past 12 months than COVID-19.
—Harold L. Karpman, MD, Los Angeles, March 2020