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.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant, Interventions and ACS

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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