Should You Step Up Your Heart Health if You Had COVID?

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's, Sydell and Arnold Miller, Family Heart, Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy.

Stanley Hazen, MD, PhD:

My name is Stanley Hazen. I'm the Co-section Head of Preventive Cardiology and Cardiac Rehabilitation at the Cleveland Clinic. One of the things that we've noticed clinically over the last few years is that there's a surprising increase in the number of heart attacks and strokes that are happening to younger people. And part of this brought us to the interest in trying to study what the impact of COVID is on cardiac health. Early on, we saw that patients who experienced COVID and were hospitalized for COVID had a higher incidence of thrombotic events in the hospital like heart attack and stroke. We looked at the data set and saw that in individuals who just had a PCR positive COVID test, there was at least a two-fold increased risk for heart attack, stroke or death over the ensuing period of follow-up. Another thing that we looked at is what is the impact of severity of disease on the risk for a heart attack, stroke or death following COVID infection?

We used severe COVID as defined by being hospitalized for COVID. We found that patients who had severe COVID were at even higher risk. The severity of the COVID infection seems to result in a long-lasting effect on long-term cardiac risk. So these results suggest to us that we need to reappraise the use of incorporating COVID history, especially severe COVID infection into risk assessment in patients because we traditionally use a coronary artery disease risk equivalence as a threshold for changing our preventive recommendations in terms of escalating preventive efforts and patients who have a CAD risk equivalent. And what do I mean by escalating preventive efforts? So we lower our LDL cholesterol goals, we recommend low-dose aspirin, as long as it's not contraindicated, and just become more globally aggressive with monitoring blood pressure control, diabetes control and all of the traditional cardiovascular risk factors in patients who have documented coronary artery disease or coronary artery risk equivalent.

So altogether, what's the take-home message? I think we need to consider COVID infection, particularly severe COVID infection as a risk factor for heart disease. And with over a billion people worldwide having experienced a COVID infection to date, I think it's reasonable to expect that cardiac risks worldwide are going to increase since the onset of the COVID pandemic. And I think that also it's important to consider that patients who've had severe COVID should be considered to be at higher risk long-term. Particularly middle-aged patients who've had severe COVID are at higher risk long-term for developing a heart attack, stroke or dying.

I'm often asked, what's the impact of vaccination? We know that vaccination for COVID lowers risk for susceptibility to infection with COVID as well as severe COVID infection and hospitalization from COVID or mortality from COVID. For all of these reasons, we suspect that vaccination should lower the risk for post-COVID cardiovascular disease risk.

What is interesting is that early on, some of the safety studies that were done with the first vaccines did show that following vaccination within six months, one could see a lower risk for thrombotic events like heart attack, stroke, pulmonary embolism, venous thromboembolism and lower extremity DVTs.

You may be asking, how do I use this information to take care of myself? Well, I think one thing that's important to remember is heart disease is the number one killer worldwide. Whether it's Third World countries or industrial countries, United States, Europe, heart disease is the number one killer. All the cancers combined don't compare to heart disease. And what we now know is that from these studies and other studies, COVID is a risk factor for heart disease. So now more than ever is a reasonable time to talk to your doctor and ask, can I do something more to help lower my cardiac risk?

That may be not just checking your blood pressure and making sure your cholesterol is okay and testing for diabetes, but also if you had severe COVID, let your doctor know so that more aggressive preventive efforts can be considered. I personally, in Preventive Cardiology Clinic, am taking this into account and escalating preventive efforts in patients who had severe COVID. That includes the lowering of LDL goals. That might actually mean the initiation of a statin or a cholesterol lowering drug or dose escalation of the statin to achieve a lower LDL goal. We routinely do that in patients who are at higher risk.

There's every reason to believe since lower LDL cholesterols lead to lower cardiac event risk that long-term, this will be a beneficial thing. Same thing with initiation of low-dose aspirin. We know that in patients with severe COVID based on these studies, that there's heightened risk for thrombotic events. So one thing that's worth considering is to discuss with your physician whether or not taking low-dose enteric-coated aspirin is reasonable for you because there appears to be a heightened risk for thrombotic events like heart attack and stroke in patients who experience severe COVID, that is COVID that resulted in hospitalization. Now with any medication, there can be adverse side effects. So all of these decisions should be done in conjunction with discussion with your physician.

Announcer:

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