More than 7.4 million people in the UK are living with Heart or Circulatory Disease (Cardiovascular Disease – CVD), a great number of whom take a mixture of medications to attenuate symptoms, prevent progression and reduce the risk of adverse events.
We know that the coronavirus and its associated disease, COVID-19, is primarily a respiratory condition and that one of the at risk groups are those with pre-existing conditions, including heart disease.
So, what do those with CVD need to know about COVID-19 and the potential risks associated with their current health?
Early studies have estimated that those with CVD are 5-times more likely to have complications and more severe reactions to COVID-19, and the advice around the world is for those individuals to shield themselves from the disease through social distancing and/or self-isolation.
As we learn more about COVID-19 it is becoming clearer that this pathology is not only a respiratory one but in fact affects multiple organs, including the heart. Studies of those who sadly passed away from the disease showed changes in typical heart scan results, and more specifically, inflammatory cells infiltrating the myocardium (heart muscle).
The most likely cause of COVID-19 related heart issues is due to the known effect of the virus on a pathway known as RAS/ACE2. This is one of the key systems and chemical cascades involved in regulating blood pressure and this, in combination with ‘immune overdrive’ (cytokine storm), can cause issues with existing cardiovascular disease.
However, whilst it is important that we do not disregard the increased risks of COVID-19 infection in a CVD population, there are several studies that have shown that individuals with CVD mostly make a full recovery and the survival rate is still around 89%.
Lastly, there have been news stories debating whether individuals with CVD medication, particularly ACE inhibitors and ARBs (angiotensin-II receptor blockers), should continue to take their medication or whether it predisposes them to a greater risk of COVID-19. The studies in which this question was first posed were found to be mostly flawed in design. Better studies since have shown that there seems to be no increased risk of cardiovascular medication (notably aspirin, ACEi and ARBs) on severity and prevalence of COVID-19. This has led to several leading medical bodies around the world to advise cardiologists and patients to continue their usual medication prescription. Evidence seems to suggest that withdrawal from treatment may actually lead to a higher number of CVD complications. It must be noted that research is still ongoing at this stage and absence of evidence does not equate to evidence of absence effect, so guidelines will be continuously updated as research develops.
Summary of current advice for those with CVD to protect against COVID-19:
- Continue to take your medication as normal unless told otherwise by your cardiologist.
- Wash your hands regularly for at least 20 seconds.
- Maintain and maximise your cardiovascular health through regular exercise and a balanced nutritional intake.
- Follow the government guidelines in your local area with regards to social distancing, use of PPE and self-isolation.
- If you develop symptoms such as fever and a dry cough which progresses to chest pain and breathing difficulties immediately seek medical help, call NHS 111 or in an emergency call 999.
- BHF CVD Statistics January 20202 https://www.bhf.org.uk/what-we-do/our-research/heart-statistics
- ESC Guidelines on COVOD-19 and CVD – ESC Guidance April 2020
- Kuster et al (2020) – ESC Statement on ACEi and ARBs
- Mancia et al (2020) – RAAS Inhibitors and COVID-19