18 Time February 15/February 22, 2021
PulmonologisTs, emergency resPonders
and intensive-care teams have been the point of
the medical spear in battling the COVID-19 pan-
demic in the U.S. over the past 12 months, but be-
fore long, expect another group of specialists to be
more engaged than ever:
cardiologists. Take a nation
that already eats too much,
drinks too much, exer-
cises too little and fails too
often to show up for regular
checkups, put them in lock-
down for a year or more,
and those behaviors—all of
which are drivers of cardio-
vascular disease—will only
get worse.
In a recent survey in
the journal Circulation,
the American Heart Asso-
ciation (AHA) predicted
a surge of cardiovascular
death and disease in the
months and years to come
as a lagging indicator of
the lifestyle changes forced
upon the world by the pan-
demic. “We don’t have a lot
of well-vetted data up to
the minute on the cardio-
vascular impact of COVID
because we are living
through the pandemic now,” says Dr. Mitch Elkind,
president of the AHA and a professor of neurology
and epidemiology at Columbia University. “That
new data will come in the next year or two, but we
are anticipating that the pandemic will have a sig-
nificant impact.”
SARS-CoV-2, the ViRuS that causes COVID-19,
does on occasion infect and damage heart tissue
directly. One study published over the summer in
JAMA Cardiology, for example, found that of a sam-
ple group of 100 people who had recovered from
COVID-19, 78 had some inflammation of myocar-
dial tissue or other damage such as scarring. In an-
other JAMA Cardiology study, researchers reported
finding SARS-CoV-2 in the heart tissue of 61.5%
of 39 patients who had died due to COVID-19. The
sample groups in both studies were small, and in
the overwhelming number of cases of corona virus
death, heart failure is not the proximate cause. But
FRONTIERS OF MEDICINE
COVID-19 may lead to
a heart-disease surge
By Jeffrey Kluger
there’s a related truth: the pandemic seems to be
leading people into developing the very lifestyle
factors that cause heart disease over the long term.
Consider a September 2020 study in JAMA that
showed that alcohol consumption had increased
14% in a sample group of 1,540 adults during the
pandemic. Or the study (from the same month) in
Psychiatry of 3,052 adults showing a decrease in
physical activity in 32.3% of adults who were pre-
viously physically active. Or the survey conducted
by the COVID Symptom Study (again, from Sep-
tember 2020) showing that
31% of adults had reported
snacking more during
lockdowns.
It’s not just eating,
drinking and sitting still
that can be killers. Elkind
and the AHA also cite
emotional stress caused by
economic hardship, and
depression as the isolation
of quarantining drags on.
When hospitals and doc-
tors’ offices are seen as viral
hot zones, people are less
likely to show up for rou-
tine monitoring of hyper-
tension, cholesterol levels
and other chronic condi-
tions that can have a car-
diovascular impact. Acute
cardiac events too are
being ignored. “We know
people have delayed get-
ting care for heart attacks
and strokes, which can
lead to poorer outcomes,”
said Dr. Salim Virani, who chaired the commit-
tee that wrote up the AHA’s statistical update, in a
statement.
In the U.S., about 655,000 people die of heart
disease each year, according to the U.S. Cen-
ters for Disease Control and Prevention, a figure
that outpaces the 360,000 reported to have died
of COVID-19 in 2020. But those statistics don’t
tell the whole story. Elkind estimates as many as
500,000 additional U.S. deaths in the past year
due to people not getting prompt medical help for
severe or emergency medical conditions, many of
which were cardiovascular in nature.
The good news buried in the bad is that some of
the cardiovascular dangers associated with COVID-
19 can be controlled. Just as masks mitigate COVID-
19 transmission, so can healthier lifestyle choices
mitigate heart-disease risks. A pandemic is a fero-
cious challenge, but at least some aspects of it can—
with effort — be surmountable. •TheBrief Health
‘We’re less
likely to be
active. We’re
likely to
have worse
eating
habits.’
DR. MITCH ELKIND,
president of the
American Heart
Association