COVID-19 and heart disease
It seems elderly people with coronary heart
disease or hypertension are more susceptible to
COVID-19 and to develop more severe symptoms.
Do you agree? Why is this the case?
Strict adherence to the regime of social distancing,
frequent washing of hands, and staying at home.
Ensure full compliance with medications.
The data coming out from the Chinese experience
suggests that patients aged between 60 – 80+ years
with coronavirus infections are at a significantly
higher risk of death than younger patients. The
presence of concomitant medical problems, such
as cardiovascular diseases, diabetes, chronic
respiratory disease, hypertension, and cancer, seems
to compound the risk of the disease being fatal. It’s
reasonable to postulate that the elderly have more
concomitant medical problems and, therefore, their
internal ability to mount a strong defence as well as to
recover from such an infection is impaired. Should patients with heart problems get
vaccinated against the flu?
Patients who have had a transplant or pregnant
women with heart disease are at extremely high
risk. Can you explain why and which risks they’re
exposed to? There are early postulations that treatment with ACE
inhibitors or angiotensin receptor blockers (ARB)
might increase the risk of severe COVID-19 infection.
However, these remain conjectures at this point and
have not been scientifically proven.
Patients who have had a transplant are in a state of
“drug induced immunosuppression.” This is necessary
to prevent the transplanted organ from being rejected.
In this state, their innate immunological ability to
mount an effective response to any form of infection is
less than optimal, and they are at high risk of infection.
The data on pregnant patients and their
risk for adverse outcomes in the event of a
coronavirus infection are less clear. However,
since pregnancy results in a “physiological state of
immunosuppression,” it’s fair to surmise that pregnant
women may also be predisposed to a higher risk of
illness and morbidity.
Patients with heart problems should get an influenza
vaccination. Medical studies show that getting
a flu vaccination reduces the risk of developing
complications related to the flu as well as a possible
reduction in the risk of having a heart attack.
There are preliminary reports suggesting that
angiotensin-converting enzyme inhibitors and
angiotensin receptor blockers might increase
the risk of severe COVID-19. Is there sufficient
evidence to support this link?
Who needs these medications and what are their
benefits? Should people keep taking them?
These medications are used by patients with
hypertension, diabetes, and heart disease. The
European Society of Cardiology in a statement
published on March 13, 2020 strongly recommends
that physicians and patients should continue
treatment with their usual antihypertensive therapy
because there is no clinical or scientific evidence to
suggest that treatment with ACE inhibitors or ARB
should be discontinued because of COVID-19. n
The data on
pregnant
patients and
their risk
for adverse
outcomes in
the event of
a coronavirus
infection are less
clear.
Are there other heart problems that appear
to increase the odds of COVID-19 infection or
negative outcomes?
The data shows that patients with existing coronary
artery disease and heart failure seem more
predisposed to a negative outcome from a COVID-19
infection.
What’s your advice for patients with heart
problems who want to lower their risk of COVID-19
infection?
GlobalHealthAndTravel.com
Dr Azlan Hussin is a senior
consultant cardiologist at the
National Heart Institute (IJN) in
Kuala Lumpur.
MAY 2020
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