JACC Series Looks at COVID-19 and CVD, Myocardial Injury, Arrhythmias and Cardiometabolic Syndrome

Since the emergence of the COVID-19 pandemic, the impact of the virus on the heart has become more prevalent, with clinicians acting in real time to effectively help cardiovascular disease patients and those at higher risk who contract coronavirus. The Journal of the American College of Cardiology published a three-part focus seminar Oct. 19 on COVID-19 in 2020 to address the complex relationship between COVID-19 and the heart.

Coronavirus Historical Perspective, Disease Mechanisms, and Clinical Outcomes

According to a paper by Sean P. Pinney, MD, FACC, et al., most people infected with COVID-19 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," explains Pinney, lead author of the study and a professor of medicine, cardiology, at the University of Chicago. "Longitudinal follow-up with multi-modal imaging and physiological testing will be important to describe the full extent of acquired COVID-19 heart disease."

Coronavirus and CVD, Myocardial Injury and Arrhythmia

A separate paper by Gennaro Giustino, MD, et al., discusses the underlying mechanisms producing cardiovascular damage among hospitalized patients with severe COVID-19 infection, including that of thromboembolic disease and arrhythmia. According to researchers, myocardial injury occurs in about one-quarter of hospitalized 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," said Pinney, one of the study authors. "Whether these effects are simply associated with poor patient outcomes, including death, or directly contribute to patient mortality is as yet uncertain."

Coronavirus and Cardiometabolic Syndrome

A new COVID-19-related cardiometabolic syndrome composed of four drivers – abnormal adiposity, dysglycemia, dyslipidemia and hypertension – is discussed in a paper by Jeffrey I. Mechanick, MD, et al. Researchers give recommendations for these patients, especially those with diabetes, for preventing cardiovascular 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. The researchers add 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. They note that patients should receive "simple" healthy lifestyle instructions.

"The role of healthy lifestyles and pharmacotherapy targeting metabolic drivers to reduce cardiovascular risk is well-established," explains Mechanick, lead author of the study and a professor of medicine and medical director of the Marie-Josee and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart. "However, lessons learned from the COVID-19 pandemic support shorter-term benefits of these interventions, similar to observed benefits on acute cardiovascular disease outcomes."

Clinical Topics: COVID-19 Hub

Keywords: COVID-19, Cardiovascular Diseases, Adiposity, Coronavirus, Coronavirus Infections, Troponin, Hospital Mortality, Respiratory Distress Syndrome, Risk Factors, severe acute respiratory syndrome coronavirus 2, Pandemics, Obesity

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