During the first two years of the pandemic, from March 2020 to March 2022, there were about 90,000 more deaths from cardiovascular disease in the United States than expected for that period.
The majority of these occurred in people aged 65 and older, the age group at greatest risk for cardiovascular complications. However, heart-related deaths also increased dramatically among younger people. In fact, one study found that the sharpest increase in heart attack deaths during this period was among young people between the ages of 25 and 44.
Some of these cardiovascular-related deaths may have occurred due to difficulties in accessing health care at the height of the pandemic. But doctors and researchers now have little doubt that the coronavirus itself was a contributing factor. In addition to complications that can occur during the acute phase of COVID-19, there appears to be an increased risk of heart attack, stroke, and other problems in the first year after infection. Experts are now trying to figure out why.
“There’s a very unique relationship between this virus and the cardiovascular system,” said Dr. Susan Chen, chair of cardiovascular health and population sciences at Cedars-Sinai University, who led the study on heart attack deaths. said. “What’s the connection? That’s the million dollar question.”
Immediate effects of the new coronavirus on the heart
Cardiologists’ leading theory about how the coronavirus damages the heart and causes cardiovascular events is that it stimulates widespread inflammation.
“We know that inflammation itself increases cardiovascular risk,” says cardiologist Dr. Luke Ruffin, co-director of the Blood Pressure Disorders Center at the Cleveland Clinic. “We know that infections, especially severe COVID-19 infections, cause inflammation. So is that the mechanism for the increased risk? Maybe.”
Part of the immune system’s response to infection or injury is to release proteins that cause inflammation and blood clotting. In people who have plaque buildup in their arteries, inflammation can break down the plaque and form blood clots, which can lead to heart attacks and strokes. For this reason, experts say people who already have plaque in their arteries, such as many smokers and people with high blood pressure or high cholesterol levels, are also at highest risk of a heart attack from the coronavirus.
In some cases, these proteins can cause blood clots to form even if no plaque is already present. According to Dr. Chen, if there is enough inflammation within a blood vessel and the cells within it are stimulated, blood clots can form spontaneously. In this way, young people without plaques “can still have a heart attack under the right conditions,” she added.
Long-term effects of the new coronavirus on the heart
Even after recovering from coronavirus, cardiovascular complications remain a possibility. A large 2022 study that tracked the medical records of 691,455 patients in the United States found that they were at significantly higher risk of developing virtually all heart-related conditions in the year following coronavirus infection. . According to the study, they were 1.5 times more likely to have a stroke, almost twice as likely to have a heart attack, and 1.6 to 2.4 times more likely to develop various types of arrhythmia.
“Early on, we saw the effects of COVID-19 on the cardiovascular system,” said Dr. K., a cardiologist and associate professor of clinical medicine at the Perelman School of Medicine at the University of Pennsylvania, who was not involved in the study. Dr. Helen Glassberg said. “But now we are seeing long-term effects on people who have previously been infected with coronavirus.”
Some of these symptoms may be caused by the lasting effects of an infection. The coronavirus has also been linked to the development of risk factors for heart disease, particularly high blood pressure, so other illnesses may also develop. A recent study found that nearly 21% of people hospitalized with COVID-19 and 11% of people who had mild infections who were not hospitalized developed high blood pressure in the following months. .
Experts don’t know exactly how the new coronavirus causes high blood pressure. There may be something biological going on, but the general stress of the pandemic is also probably playing a role, Dr. Ruffin said.
How vaccines reduce risk
Studies show vaccinated people are about 40 to 60 percent less likely to have a heart attack or stroke after contracting coronavirus than unvaccinated people. . This may be because vaccinated people are less likely to develop severe COVID-19 infection, thereby lowering their risk for many of these heart-related problems. Alternatively, a vaccine could help protect the cardiovascular system itself, for example by reducing the inflammatory effects of the coronavirus.
There is a small risk of developing myocarditis (inflammation of the heart muscle) in the weeks after receiving the mRNA coronavirus vaccine made by Pfizer-BioNTech or Moderna. However, the risk of myocarditis after coronavirus infection is much higher. A U.S. Centers for Disease Control and Prevention study found that men ages 12 to 29, who are at highest risk for vaccine complications, were 4 to 8 more likely to develop myocarditis after a coronavirus infection than three weeks after vaccination. It is reported to be twice as high. of vaccines. For men over 30, the risk of myocarditis from coronavirus was 28 times higher than from the vaccine.
“It’s important to understand that this vaccine-related event is real, but the risk to the heart is much greater with the coronavirus than with the vaccine,” Dr. Glassberg said.
How to manage risk
If you have recently had Covid and have cardiovascular symptoms such as chest pain or shortness of breath, or if you are at increased risk of heart disease, you should contact your doctor and tell them.
“I ask all my patients, ‘Have you had COVID-19 since your last visit?'” Dr. Glassberg said. “My antennae are on those guys. I’m going to look into their blood pressure some more. I’m making sure they’re actively controlling their cholesterol.”
If you have no risk factors and are not showing symptoms, all you need to do is tell your doctor that you have been infected with the coronavirus at your next annual checkup. In the meantime, be sure to practice heart-healthy behaviors like exercising regularly and eating well.
