COVID-19 and Cardiovascular Disease

Study Questions:

What is the association between COVID-19 and morbidity and mortality from cardiovascular disease?

Methods:

The investigators review and summarize the rapidly evolving data regarding evidence linking COVID-19 with increased morbidity and mortality from cardiovascular disease.

Results:

COVID-19 is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which invades cells through the angiotensin-converting enzyme 2 (ACE2) receptor. Among those with COVID-19, there is a higher prevalence of cardiovascular disease and >7% of patients suffer myocardial injury from the infection (22% of the critically ill). Myocardial injury is present in more than a quarter of critical cases and presents in two patterns: acute myocardial injury and dysfunction on presentation and myocardial injury that develops as illness severity intensifies.

Conclusions:

The authors concluded that cardiovascular comorbidities are common in patients with COVID-19 and such patients are at higher risk of morbidity and mortality.

Perspective:

This review suggests that cardiovascular comorbidities are common in patients with COVID-19 and such patients are at higher risk of morbidity and mortality. At this time, nearly all major societies have recommended against either adding or stopping ACE inhibitors, angiotensin-receptor blockers, or other renin–angiotensin–aldosterone system antagonists in this setting, unless done on clinical grounds independently of COVID-19, due to the lack of evidence currently available on their potential benefit or harm. Of note, COVID-19 also poses a challenge for heart transplantation, impacting donor selection, immunosuppression, and post-transplant management. Finally, on the bright side, there are a number of promising treatments and vaccines under investigation, but none with proven clinical efficacy at this time.

Keywords: Acute Coronary Syndrome, Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Antagonists, Comorbidity, Coronavirus, COVID-19, Critical Illness, Heart Failure, Heart Transplantation, SARS Virus, Secondary Prevention, Severe Acute Respiratory Syndrome


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