Heart disease — already the top killer of men and women in the U.S. — may be particularly worrisome in the era of the new coronavirus.
As of April 20, five of the top 10 chronic health problems suffered by people who have died of COVID-19 in New York — the U.S. epicenter of the crisis — involved cardiovascular disease, the state's health department reported.
The No. 1 cormobidity was high blood pressure. Hyperlipidemia, or high cholesterol, was in third place, followed by coronary artery disease. Atrial fibrillation and stroke also made the grim list.
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But there’s still a lot of uncertainty about what the virus means for people with heart conditions, said Dr. Andrew Freeman, a cardiologist at National Jewish Health in Denver, Colorado, and a member of the American College of Cardiology’s COVID-19 Response Work Group.
“By and large, I would say that if you have multiple chronic health conditions, or you have obesity or a sedentary lifestyle, it’s possible that you could be at higher risk,” Freeman told TODAY.
“But we’re also seeing young relatively healthy people getting sick and even dying from this. So I don’t think we have a clear sense just yet of what makes somebody higher risk or not.”
At the same time, doctors worry that people who are having symptoms of a heart attack or stroke are actively avoiding calling 911 because they’re afraid to go to the hospital during the pandemic.
Here are answers to some of the most commonly asked questions heart patients may have:
What are the possible consequences of COVID-19 on the heart?
Although the disease is dominated by respiratory symptoms, some patients also may have severe cardiovascular damage, the American College of Cardiology, the American Heart Association and the Heart Failure Society of America said in a joint statement last month.
People with the severe form of the illness can develop myocarditis, an inflammation of the heart muscle. Viral illnesses can destabilize plaque in the arteries, potentially resulting in a blockage and a heart attack. Studies of COVID-19 patients have found some developed arrhythmia or had acute onset heart failure, heart attack and cardiac arrest after a coronavirus infection.
Why would higher blood pressure be a risk factor for severe COVID-19?
It’s not exactly clear, Freeman said.
“High blood pressure does put a bit more strain on the heart and then there are drugs that people take for blood pressure — we don’t know if that increases or decreases susceptibility,” he noted.
“The question I ask is: Is it hypertension or is it that hypertension has a lifestyle associated with it, where people are eating poorly and are under more stress and that’s what’s doing it? I don’t know if we know the answer.”
Which heart conditions are most affected by the coronavirus?
Again, doctors don’t have a clear answer. Bottom line: Any virus that puts more demand on the body can impact heart conditions, Freeman said.
If people with atrial fibrillation get acutely ill with an infection, their heart rate control could be very poor, leading to bouts of rapid AFib, which often requires hospitalization.
A disease that puts more demand on the heart can make angina worse or could even precipitate a heart attack. A heart failure patient may have limited reserves to deal with the higher levels of stress or demand on the body.
“So people who have underlying, relatively severe health conditions who are suddenly afflicted with a severe form of the virus could be in greater jeopardy than somebody who doesn’t have those,” Freeman said. “But we don’t have enough data to say any of this stuff definitively.”
Should people delay getting stents, heart bypass surgery and other procedures?
That depends on whether the patient is stable and the procedure can be safely postponed. It’s not always an easy "yes" or "no" decision, so patients should have a discussion with their doctor about what’s best, Freeman said.
If elective heart procedures and routine tests can be safely postponed, they probably should be, he noted. Follow-up visits can often be done through telemedicine.
Is there any reason to avoid the hospital if you have chest pains or other symptoms?
No, the American College of Cardiology urged patients experiencing a heart attack or stroke to call 911, noting that hospitals are still treating those emergencies and taking “the utmost precautions” to prevent the spread of the virus.
Fearing COVID-19, "patients experiencing a heart attack or stroke are delaying their essential care, causing a new public health crisis,” said Dr. Martha Gulati, a cardiologist at the University of Arizona College of Medicine and editor-in-chief of ACC's CardioSmart initiative.
“The faster a patient is treated, the higher the outcome of survival and lower the risk for complications. No patient should delay their care.”
What should heart patients do to minimize their risk?
Freeman advised the basics, including frequent hand washing, staying at home and wearing a mask in public.
This is also the time to focus on healthy habits: “Lifestyle has an enormous effect of boosting and bolstering the immune system,” he said.
Here are his tips:
- Eat a diet rich in produce: “If you go to the grocery stores in most major cities now, the shelves are often empty but the produce section is surprisingly full,” Freeman noted. “Use that to your advantage and eat lots of fruits and vegetables, which have an immune-enhancing effect.”
- Exercise: It protects against heart disease and high blood pressure, and bolsters the immune system. Exercise away from people if you’re outdoors.
- Get enough sleep and find a way to relieve stress: Both are good for the heart and overall health, including the immune system.
- Connect with others (but do it remotely): “People with the most support in life tend to do the best in a variety of health conditions,” Freeman said.