Amid this evolving time of the novel coronavirus - COVID-19, officially named SARS-CoV-2, pandemic the new information is rapidly changing; the Centers for Disease Control (CDC) is constantly updating its guidance for health care providers.
Among the patients who are at the highest risk for developing severe illness, per the CDC, from this virus are those patients with heart disease, diabetes mellitus, lung disease and who are older in age, based on early data available from China. The specific effects on the cardiovascular (CV) systems are unknown at this time.
It is known that the normal influenza season has an increase in mortality among the CV population as well as an increase in ischemic heart disease and myocardial infarction admissions during this season annually, with a more deleterious effect on those patients over the age of 65 years. It is suggested that the increase in acute inflammatory state of CV patients while infected with influenza can cause atherosclerotic plaque destabilization; hence, higher rates of acute coronary syndrome and myocardial infarction are seen in this high-risk patient population. If COVID-19 demonstrates a similar impact on high-risk CV patients, this heightened inflammatory state could increase cardiovascular mortality.
The American Heart Association (AHA) issued a statement this week advising patients on angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) or renin angiotensin aldosterone system (RAAS) antagonists to not stop these drugs in efforts to prevent infections with COVID-19.
The joint statement with the Heart Failure Society of America (HFSA) and American College of Cardiology (ACC) did reference animal experiments suggesting the ACE2 receptor may be the port of entry for this virus; however, no human experiments have confirmed this finding.
Additionally, Dr. Bob Harrington the AHA president, stated that “... there are no experimental or clinical data demonstrating beneficial or adverse outcomes with background use of ACE inhibitors, ARBs or other RAAS antagonists in COVID-19 or among COVID-19 patients with a history of cardiovascular disease treated with such agents.”
This joint statement calls for more research regarding these "theoretical concerns and findings of cardiovascular involvement with COVID-19," and rapidly.
Nguyen, J; Yang W; Ito, K; Matte, TD; Shaman, J; Patrick L. Kinney, PL. Seasonal Influenza Infections and Cardiovascular Disease Mortality. JAMA Cardiol. 2016 Jun 1; 1(3): 274–281.
Kytömaa S, Hegde S, Claggett B, et al. Association of influenza-like illness activity with hospitalizations for heart failure: the atherosclerosis risk in communities study. JAMA Cardiol 2019;4:363-9.