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Heart Disease and COVID-19: Answers From a Cardiologist

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R. Todd Hurst, MD, FACC, FASE - Blogs
By R. Todd Hurst, MD, FACCBoard-certified cardiologistApril 06, 2020

As COVID-19 continues its devastating spread across the country and the world, we are learning new information daily that is important for those with heart disease who want to stay healthy. 

Of course, following social isolation guidelines and proper hygiene techniques is essential to maintaining your health during this pandemic.  However, if you have heart disease or have a loved one with heart disease, there are additional things to consider. 

Now, in particular, is not the time to take on additional risk, such as needing to go to an emergency room.  Not only are hospitals possibly where acquiring COVID-19 is more likely, the healthcare systems in many parts of the world are overwhelmed. With limited resources, they have to alter the care typically used for those with emergency heart conditions. 

Here are the questions my patients are asking me about their heart health and how they can lower their risk from COVID-19.

Should I continue to take my ACE inhibitor or ARB?

ACE inhibitors (such as lisinopril and benazepril) and ARBs (such as losartan and valsartan) are common medications used to treat high blood pressure and heart failure.  Early in the COVID-19 pandemic, there was some concern that these medications may lead to an increased risk for serious or fatal COVID-19 infection. However, at least ten national and international societies have noted that there is no evidence that ACE inhibitors and ARBs lead to worse outcomes and have made the recommendation that patients should continue these medications.  In fact, there is ongoing research to explore the intriguing possibility that ACE inhibitors and ARBs may be helpful in those who are seriously ill from COVID-19. The important point is that while we don’t have any evidence that these medications affect COVID-19, we do know that stopping them can increase the risk of uncontrolled high blood pressure, possible stroke, or heart failure. As noted, especially now is not the time to increase your likelihood of having an emergency medical condition.

Should I still take my statin?

There has been no evidence that statins are associated with worse outcomes in viral illness, and in fact, there is some evidence that statins may decrease heart problems during a viral illness. We also have several studies that show an increased risk of heart attacks after statins are stopped. My strong advice to my patients is to continue their statin medications unless there is a compelling reason not to, like adverse effects, which are infrequent. I am not, however, recommending routine lab testing to follow cholesterol levels currently both not to expose my patients to needless risk of COVID-19 infection and to minimize the strain on our healthcare resources.

Why are those with heart disease, high blood pressure, and diabetes at higher risk of severe illness and death with COVID-19?

The reasons aren’t clear, but additional data continues to support the association of heart disease with worse outcomes from COVID-19 infection. It is clear that heart conditions, high blood pressure, and diabetes are common in those who are seriously ill with COVID-19. However, these conditions are common in an older population also.  Whether having heart disease leads to worse outcomes from COVID-19, or simply reflects an older and more vulnerable group of people isn’t clear yet.

There is increasing evidence of direct heart involvement in about 20% of patients with COVID-19. Inflammation of the heart, heart attack, heart failure, and life-threatening heart rhythm problems have all been reported, and the patients with heart involvement tend to do particularly poorly. 

The takeaway point is that if you have heart disease, high blood pressure, or diabetes, it is vital to follow infection avoidance guidelines strictly.

For your health and ours, follow the social isolation guidelines. Wash your hands. Take your medications. Take care of your heart, and stay well.

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About the Author
R. Todd Hurst, MD, FACC

R. Todd Hurst, MD, FACC, FASE, is a board-certified cardiologist, director of the Center for Cardiovascular Health at Banner – University Medicine Heart Institute, and associate professor of medicine at the University of Arizona. He has written more than 50 publications in peer-reviewed journals and regularly speaks nationally and internationally at medical meetings, primarily on the prevention of heart disease.

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