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Heart disease risk after COVID

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In December 2020, a week before cardiologist Stuart Katz was scheduled to receive his first COVID-19 vaccine, he developed a fever. He suffered from coughing, body aches and chills for the next two weeks. After months of helping others survive the pandemic, Katz, who works at New York University, was experiencing COVID-19 firsthand.

On Christmas Day, Katz’s acute illness finally subsided. But many of the symptoms lingered, including those related to his heart, the organ he’d built a career on: his two steps up his heart beats at 120 beats per minute. , I can’t breathe. Over the next few months, he began to feel better and is now back to his normal routine of walking and cycling, but reports of the effects of COVID-19 on his cardiovascular system prompted him to I became concerned about my long-term health. “I ask myself, ‘Are you really done?'” says Katz.

In one study this year, researchers used US Department of Veterans Affairs (VA) records to estimate how often COVID-19 causes cardiovascular problems.They found that one year after being infected with the coronavirus SARS-CoV-2, people with the disease were at risk for 20 cardiovascular diseases, including potentially devastating problems such as heart attack and stroke. found that they faced a significant increase. Researchers say these complications can occur Even people who appear to have fully recovered from minor infections may.

Some small studies echo these findings, while others have found a lower incidence of complications. -Being infected with CoV-2, clinicians are wondering whether the pandemic will be followed by cardiovascular aftershocks. Meanwhile, researchers are trying to understand who is most at risk for these heart-related problems, how long the risk persists, and what causes these symptoms.

This is a huge gap in a critical area of ​​public health, Katz said. “We don’t know if this will change the lifetime trajectory of heart attack or stroke or other cardiac event risk. We don’t know.” I’m looking at the answers you’ve revealed.

How many people are at risk?

Physicians have reported cardiovascular problems related to COVID-19 throughout the pandemic, but concerns about the problem surged after the results of a VA study were published earlier this year. An analysis by Ziyad Al-Aly, an epidemiologist at Washington University in St. Louis, Missouri, and his colleagues is the most extensive effort to characterize what happens to the heart and circulatory system after the acute phase of COVID-19. is one of Researchers compared his more than 150,000 veterans who recovered from acute COVID-19 to uninfected colleagues and pre-pandemic controls.

People admitted to intensive care units with acute infections had a significantly higher risk of developing cardiovascular problems in the following year (see Cardiac Concerns). Some conditions, such as swollen hearts and blood clots in the lungs, jumped the risk by at least 20 times compared to uninfected peers. But even those who were not hospitalized had an increased risk of various diseases, including an 8% increase in heart attack and a 247% increase in heart inflammation.

Nature; Source: “Long-Term Cardiovascular Outcomes of COVID-19,” Xie, Yan et al. natural medicine roll. 28.3 (2022): 583-590. doi:10.1038/s41591-022-01689-3

For Al-Aly, the study adds to growing evidence that bouts of COVID-19 can permanently alter the health of some people. Such changes are classified as acute sequelae of COVID-19, which covers problems that occur after initial infection. This obstacle includes A persistent condition known as long COVIDa term with many definitions.

Studies have shown that the coronavirus is associated with a wide range of persistent problems. such as diabetes, permanent lung damage and even brain damage. Similar to these conditions, Al-Aly says cardiovascular problems that occur after SARS-CoV-2 infection can reduce a person’s quality of life in the long run. There are treatments for these problems, but “they are not curable conditions,” he adds.

Despite its size, the VA study has caveats, the researchers said. This study is observational, meant to reuse data collected for other purposes. In other words, it is a possible way to introduce bias. For example, the study only considered veterans, so the data are skewed towards white males. Eric Topol, a genomicist at Scripps Research in La Jolla, California, said: He believes more research is needed before scientists can truly quantify how often cardiovascular problems occur.

Daniel Tancredi, a medical statistician at the University of California, Davis, points to another potential source of bias. One of the control groups in the VA study was not included in the study unless he had been free of SARS-CoV-2 for more than a year. There may be physiological differences that make the control group less likely to get the disease, and this may also affect susceptibility to cardiovascular problems. We believe it is well designed and likely to have minimal bias. “I can’t say these numbers are exactly right, but they’re definitely within a rough range,” he says. He hopes future prospective studies will refine his Al-Aly estimates.

Several other studies point in the same direction. For example, data from the UK health system show that people hospitalized with COVID-19 are about as likely as non-infected people to face significant cardiovascular problems within eight months of hospitalization. was three times higher. A second study found that four months after infection, people infected with COVID-19 had an approximately 2.5-fold increased risk of congestive heart failure compared to uninfected people.

Sarah Wolfe Hanson, a health modeler at the University of Washington Institute for Health Metrics and Evaluation in Seattle, used Al-Aly data to estimate the number of heart attacks and strokes associated with COVID-19. . Her unpublished research shows that post-COVID-19 complications will cause 12,000 additional strokes and 44,000 additional heart attacks in the United States in 2020, and 18,000 strokes and 66,000 in 2021. Suggesting that it spiked into a heart attack on the subject. This means that COVID-19 increased heart attack rates by about 8% and stroke rates by about 2%. “It’s chill,” says Wolfe Hanson.

As an indirect effect of the COVID-19 pandemic, missed medical appointments, stress, and the sedentary nature of being isolated at home may have further increased the cardiovascular burden of many people. is high, scientists suggest.

However, these numbers do not match what some researchers have seen in the clinic. In a small study of 52 people, Gerry McCann, a cardiologist at the University of Leicester in the UK, and his colleagues found that people who recovered after being hospitalized with COVID-19 were more likely to have heart disease than others. found to be no higher than A group of people who have similar underlying diseases but are not infected. Although this trial was orders of magnitude smaller than his Al-Aly trial, McCann and his colleagues are working on a larger trial with about 1,200 participants. The results have not yet been published, but McCann said, “The more data we have, the less impression we have about, for example, the extent of myocardial damage or heart problems.”

Despite an incomplete picture of the cardiovascular impact of COVID-19, doctors recommend caution. A panel of experts convened by the American College of Cardiology recommends that people infected with COVID-19 be screened for cardiovascular problems if they have risk factors, such as being older or having a weakened immune system. I am advising my doctor.

How are researchers gathering more information?

Answers to many questions about the long-term effects of COVID-19 may come from a large study called the Researching COVID to Enhance Recovery (RECOVER) project. usa. The study includes long-term COVID participants, infected and recovered people, and those who have never been infected. “It’s registered for life,” says Katz, the trial’s principal investigator. He and his colleagues plan to study children, adults, pregnant people, and infants born during the trial.

Most RECOVER participants complete a health questionnaire and undergo non-invasive testing. Researchers aim to collect additional information about about 20% of participants. For example, a small tube is temporarily inserted into an adult’s heart to obtain local measurements of indicators such as blood pressure and oxygen levels. In a few years, scientists hope to complete a catalog of long-term symptoms of COVID and begin to understand who develops them and why they occur.

In the UK, McCann heads a cardiovascular working group for a similar project called Posthospital COVID-19 Research (PHOSP-COVID). This multicentre study focuses on people hospitalized with COVID-19, looking at the prevalence of persistent symptoms, who are most at risk, and how the virus causes long-lasting health problems. It is intended to clarify So far, the group found that only about a quarter of hospitalized people felt he had fully recovered from the infection a year later. The team then identified immune markers associated with her worst cases of COVID over the long term.

How do viruses harm the heart?

The effects of COVID-19 on the heart may be related to key proteins that the virus uses to enter cells. It binds to a protein called ACE2 that is found on the surface of dozens of human cells. This gives “access and permission to enter nearly every cell in the body,” he says, Al-Aly.

Many cardiovascular problems likely start when the virus invades the endothelial cells that line blood vessels, says Topol. Blood clots form naturally and heal damage caused while the body is clearing an infection. A study based on more than 500,000 COVID-19 cases found that infected people were at greater risk of developing blood clots two weeks after infection than people infected with the flu. was found to be 167% higher. Robert Harrington, a cardiologist at Stanford University in California, says that even after an initial infection, plaque can accumulate where the immune response has damaged the lining of blood vessels, narrowing them. This can lead to problems such as heart attacks and strokes, even months after the initial wound heals. There is,” says Harrington.

SARS-CoV-2 can also leave fingerprints on the immune system. When Akiko Iwasaki, an immunologist at Yale University in New Haven, Connecticut, and her colleagues characterized antibodies in people hospitalized during the acute phase of COVID-19, they found large numbers of antibodies against human tissues. rice field. Iwasaki said that when SARS-CoV-2 boosts someone’s immune system, it can inadvertently activate immune cells—cells that stay quiet when the immune system is not overdriven—to attack the body. I think that there is a nature. These immune cells can damage many organs, including the heart.

Damage to blood vessels can exacerbate attacks on the immune system. “You can think of this damage as accumulating over time,” says Iwasaki. If the cardiovascular system is sufficiently attacked, it can lead to serious consequences such as stroke and heart attack.

What about reinfection and new variants?

Vaccinations, reinfections, and the omicron variant of SARS-CoV-2 have all raised new questions about the cardiovascular impact of the virus. A paper by Al-Aly and his colleagues published in May suggests that vaccination reduces, but does not eliminate, the risk of developing these long-term problems.

Hanson also modeled whether reinfection exacerbates risk and whether relatively mild but widespread Omicron variants have similar dramatic effects on the cardiovascular system as other variants. enthusiastic to do “We’re eating the Omicron case follow-up data bit by bit,” she says.

This article is reprinted with permission. first published August 2, 2022.

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