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Big causes of heart failure in COVID-19 patients include obesity, hypertension

Poor heart health may be key driver for worsening rates of heart failure during pandemic

Key contributors of heart failure in COVID-19 patients will likely be due to pre-existing risk factors, such as obesity and hypertension, that portend worse outcomes with the virus, reports a new Northwestern Medicine Viewpoint.

Currently, a leading concern is that the virus directly attacks the heart leading to inflammation or myocarditis with the potential to cause lasting damage to the heart muscle, the authors said. 

“But that direct attack to the heart, or myocarditis, causing clinically significant heart dysfunction and heart failure has only been observed in a minority of people infected with COVID-19,” said senior study author Dr. Sadiya Khan, assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine cardiologist. “What remains unclear is if findings of myocarditis on imaging tests with minimal or without symptoms will have long-lasting health effects.” 

The paper synthesized data from six papers investigating the relationship between COVID-19 and heart effects.

The paper was published today, Sept. 30, in the Journal of the American Medical Association.

“I want to reframe the discussion to the bigger burden of poor heart health, which affects far more people with COVID-19,” Khan said. “People with obesity or hypertension are more likely to get COVID-19, are more likely to have a severe case and are more likely to have cardiovascular complications even without direct heart injury or myocarditis.”

“It may be the virus amplifies the poor heart health that already exists and was worsening in the U.S. population,” Khan said. “It is known the virus can prompt the release of inflammatory molecules throughout the body. This may affect the heart indirectly, especially in people with risk factors, like obesity and hypertension. These people are already at risk for heart failure, especially heart failure with preserved ejection fraction, the most common type of heart failure today.”

Some health experts have warned that exercising might be dangerous for former COVID-19 patients who developed myocarditis. 

“We don’t want to see people at low risk stop exercising out of fear,” Khan said. “We’ve already seen the collateral damage of the pandemic leading to avoidance of hospitals for patients who may be experiencing heart attacks or strokes.”

Patients who had COVID-19 will need to be monitored long term for symptoms of heart failure, said first author Dr. Priya Mehta Freaney, cardiovascular disease fellow at Northwestern Medicine. “This is especially critical for those who experienced lung injury and may have cardiovascular complications related to chronic pulmonary disease following recovery from COVID-19,” she noted. 

“The pandemic emphasizes once again, the urgency with which we need to change how we are approaching overall health,” Khan said. “Before the pandemic even started, we have been seeing worsening trends with higher numbers of people, especially under age 65 years dying from heart failure. We are losing ground in the battle against heart failure, in large part, due to growing rates of obesity and diabetes and poor control of high blood pressure. And the disparities in heart failure are clear and have been amplified during COVID-19.” 

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