Cardiovascular complications in patients who have had COVID-19 are now well described in many scientific papers, but until now, scientists have only assumed how long-term these consequences can be. In addition, such studies were carried out mainly among those who had a severe illness. And now it turned out that the virus is capable of destroying the vascular system in the body for a long time after the patient has recovered. At least for a year after the illness. And the development of complications is not related to whether the person was seriously or lightly ill.
The scientists analyzed the US Department of Veterans Affairs’ national health databases of 153,760 COVID-19 survivors and compared them to two control groups of 5.6 million and 5.8 million each. The first one contained information about people who did not have covid during the pandemic; in the second – data on patients before the pandemic, from 2017. The average age of study participants was 63 years. Those who died within a month of covid were not taken into account.
It turned out that 30 days after infection, those who recovered from COVID-19 increased the risk of cardiovascular disease in several categories, including cerebrovascular disorders, arrhythmias, coronary and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease. These risks even applied to those who were not hospitalized and had an overall mild illness, although they were still lower in the latter than in those who were seriously ill.
In general, patients after covid a month later had a 1.52-fold increased risk of stroke, 1.49-fold increased risk of transient ischemic attack, 1.71-fold atrial fibrillation (atrial fibrillation), 1.84-fold increased risk of sinus tachycardia and ventricular arrhythmias, 1.53 times – sinus bradycardia, 1.80 times – atrial flutter, 1.85 times – pericarditis, 5.38 times – myocarditis, 1.72 times – acute coronary disease, 1.63 times – myocardial infarction, 1.52 times – angina pectoris, 1.72 times – heart failure, 2.45 times – cardiac arrest, 2.93 times – pulmonary embolism, 2.09 times – deep vein thrombosis, 1.95 times – thrombosis of superficial veins.
At the same time, the risks of cardiovascular events persisted one year after the acute stage of infection. The risks depended on the severity of the disease. Thus, those who were ill easily received an increase in the risk of myocardial infarction by only 9%, while those who were hospitalized – 4.3 times, and those who underwent intensive care – 7.9 times. Strokes, respectively: by 24%, 3 times, 4.3 times. Myocarditis: 3.5 times, 12 times, 34 times. Thrombosis – by 77%, 6.5 times, 15 times. Arrhythmias – by 35%, 3.9 times, 8 times.
“Our results suggest a significant risk of cardiovascular disease in acute COVID-19 survivors up to a year after illness. Therefore, careful and long-term monitoring of patients who have had a coronavirus infection is necessary, ”the authors conclude.
Today it is no longer a secret that coronavirus infection leads to vascular damage, which causes a disruption in the normal functioning of the vascular system and a shift in blood parameters, which, among other things, provokes platelet activation. In the future, this leads to intense intravascular thrombosis. If a blood clot clogs a vessel that feeds the heart, myocardial infarction occurs. If the brain is an ischemic stroke. An analysis of all cases of coronavirus infection in Sweden last year showed that the risk of heart attack and stroke in the first two weeks from the onset of the disease increases by almost 7 times. Now, as we can see, much more long-term consequences of exposure to the virus are also known.
According to Sergey Boytsov, General Director of the National Medical Research Center for Cardiology of the Ministry of Health of Russia, chief freelance specialist cardiologist of the Ministry of Health of Russia of the Central, Ural, Siberian and Far Eastern Federal Districts, Russia has a high level of prevalence and mortality from heart and vascular diseases (40 million people suffer from arterial hypertension, coronary heart disease – 8 million, chronic heart failure – up to 8% of the population). “People with cardiovascular disease have a higher risk of severe and fatal covid. At the same time, patients with heart and vascular diseases die both in the acute period of covid and after recovery. Post-covid observations show that mortality increases significantly. Microthromboses appear in all vessels, myocardial damage develops (not necessarily myocarditis, rather, multicomponent myocardial damage). We found that troponin levels (the main marker of myocarditis) increased in 6% of patients after covid. COVID-19 exacerbates the course of heart failure, which provokes thromboembolism. As with influenza, the risk of acute coronary syndrome and acute myocardial infarction increases in post-COVID. It is not surprising, because the basis of atherosclerosis, which leads to them, is inflammation of the vessels. It should also be taken into account that during the lockdown, many gained weight, some abused alcohol. In general, the number of people exposed to stress has increased. Against the background of the overload of the health care system, the system of preventive and dispensary observations suffered. As a result, the number of myocardial infarctions increased by about 6% worldwide, people were afraid to go to an ambulance, they were afraid to be hospitalized, ”says Sergey Boytsov.
Nana Pogosova, Deputy Director for Scientific and Analytical Work and Preventive Cardiology of the National Medical Research Center for Cardiology of the Russian Ministry of Health, emphasizes that if patients with COVID-19 have arterial hypertension, the risk of death is 2.5 times higher, and if coronary heart disease is present, it is 5 times higher times: “We observed patients in post-COVID, took an analysis from them for a marker of heart muscle, which shows heart failure even before the onset of its symptoms: every third in 3-7 months it was elevated.”
Cardiac complications after COVID-19 are very diverse, so experts even introduced the term “Acute COVID-19 – Associated Cardiovascular Syndrome”. Experts note that, despite the fact that the elderly, people with obesity or diabetes mellitus (that is, those who are subject to traditional risk factors for cardiovascular disease), the SARS virus is a particularly vulnerable group of patients for the development of complications after covid. -CoV-2 can provoke acute myocardial injury, the development mechanisms of which are poorly understood. There are no data that would explain the selectivity of damage to organs, in particular, the cardiovascular system, even in young people. It is possible that viral load matters: the higher it is, the higher the likelihood of acute myocardial damage, but this is still only a hypothesis.
Since July 1, Russia has introduced an in-depth medical examination for those who have had covid, the purpose of which is to detect the damage that the virus has caused to the body in time. Assistance is available free of charge. As the professor of the Department of Faculty Therapy and Occupational Diseases of the Federal State Budgetary Educational Institution of Higher Education “MGMSU named after A.I. Evdokimova” of the Ministry of Health of Russia Olga Ostroumova, in-depth medical examination takes place in two stages: “The first includes general and biochemical blood tests, measurement of saturation – blood oxygen saturation, a six-minute walk test, spirometry, in which the volume of inhaled and exhaled air is estimated, as well as chest X-ray cells. A therapist is required. For those who have recovered from the moderate and severe form of COVID-19, an analysis is added to determine the concentration of D-dimer in the blood, which helps to identify signs of thrombosis. At the second stage of medical examination, the doctor may refer the patient for additional studies: echocardiography, computed tomography of the lungs, duplex scanning of the veins of the lower extremities, depending on the patient’s condition.
The expert recalls that a medical examination can be completed even if the person was not included in the database of patients with coronavirus and was treated independently. Particular vigilance should be shown to those who have pain or burning in the chest, increased blood pressure, increased pulse. In this case, experts advise not to delay contacting a doctor.