Heart Health & COVID-19: Prevention, Infection, & Vaccination

Welcome to American Heart Month, yet another Heart Month during the COVID-19 pandemic. About a year ago, I made a video describing some of the interactions between COVID-19 and cardiovascular health.

There have been some changes, certainly in our ability to help ward off or fight COVID-19, certainly in our ability to vaccinate, and it seems like a good time to revisit the topic. I'm going to break this into three parts:

1. The way our underlying cardiovascular health impacts our experience should we contract COVID. It's a pretty dramatic thing, and we'll talk about that in a few different ways.
2. The second is looking at the impact that COVID-19 has on our cardiovascular health. Again, not trivial. This virus has a predilection for getting into our respiratory and our vascular tissues, and it really has long-lasting and significant effects in those tissues.
3. The third area is to think a little bit about prevention. We'll talk about vaccination. We'll talk about some of the concerns that have been raised about vaccination and heart health, as well as some of the potential benefits of vaccination, particularly when compared to acute infection.

Watch the video below or read on for the full recap. 

Underlying Cardiovascular Health & COVID-19

So, let's go back to the beginning. Underlying cardiovascular health has a lot to do with predicting the outcome one has should you become infected with COVID.

There was a recent article in one of the British medical journals that described what's happened across the world in different countries and looked at death rates relative to different types of factors that had influence.

It turns out that two of the strongest ones were age, which you might expect, and older people definitely have higher rates of more severe illness and death, but a huge one turns out to be body mass index or weight.

The heavier you are as a population of people, the higher the death rates have been. In the United States, we're among the heaviest people in the world.

Our body mass index per capita is very high. Right now in February, as we close in on something like 900,000 deaths from COVID-19, it turns out that if we look at the past year and a half or so, and if we had said our population actually was at average body mass index for the world, our death rates would've been lower. It's projected that about 150,000 people who died from COVID-19 would not have died.

So somewhere between 15 and 20% of the death in the United States due to COVID-19 has been because of obesity, diabetes, underlying heart disease, hyperlipidemia, hypertension.

Underlying heart disease and its risk factors, obesity, in particular, has been a cause of death in about 20% of the COVID-19 cases.

So what do we do with that?

This is absolutely not an intention to shame people who are obese. I think it's more important that we recognize that there are so many factors that play into obesity.

There are genetic factors, but there are also cultural and societal factors, there are economic factors, there are political factors, there are factors in medicine that play into this, and we need to address those.

We need to work hard against obesity, hypertension, heart disease, to lower the rate of dying from those things, but also to improve the outcomes in situations like we see with COVID-19.

So again, the underlying cardiovascular health of the patient has a direct impact on their experience should they contract COVID-19, and anything we are able to do, now and in the future, with regard to exercise; eating a diet that is low in refined carbohydrates and high in protein and produce; getting a good night's sleep; and taking care of ourselves emotionally will have a dramatic impact on our likelihood of having bad outcomes with COVID, as well as overall cardiovascular outcomes.

We strongly encourage continuing to pay attention to that and let us help you if we can.

Impact of COVID-19 Infection on Cardiovascular Health

The second thing is thinking about the impact of COVID-19 on our cardiovascular system.

The SARS-CoV-2 virus enters the body through receptors that are in the respiratory tissue and in the vascular tree. If we've been vaccinated or had prior exposure to COVID, when we get the next infection, a lot of us will be able to hold the infection in our respiratory tissues, and basically, we get a bad cold.

It's if the virus is able to get into the deeper tissues is where we start seeing problems with pneumonia, and problems with cardiovascular disease is a much, much higher risk.

So if the virus only is in our respiratory tissues, the inflammation that happens and the damage that happens is in our upper airways, in our sore throats, in our bronchi.

But if it gets down into the lungs and we develop pneumonia, we start seeing problems with inflammatory reactions there, changes in pressures where the heart's pumping into the chest, higher risk for putting clots into the lung.

And if it gets into the vascular tissues themselves, we get inflammation in the lining of our blood vessels, causing clotting in our veins, clotting in our arteries, loss of structural integrity of the heart, heart failure, aneurysms. We can get difficulty with rhythm disturbances.

So a lot of different effects, both with acute COVID-19 and also in post-acute COVID-19, where we have people who, during their recovery, develop new symptoms — breathlessness, palpitations, lightheadedness, and are found to have difficulty with heart rhythm or structural integrity of the heart, valve problems.

It's really important if you do get acute COVID that, during your illness, you're paying attention for symptoms — heart problems, chest pain, palpitations, lightheadedness, shortness of breath —  that seem out of proportion to that bad cold idea. And be in communication with your doc about that, so we can assess and help evaluate that concern.

Similarly, in the weeks following, as you're trying to get your recovery online and get back to your regular life and exercise, if you're having those symptoms — palpitations, lightheadedness, shortness of breath — we'd love to know about that, so we can, again, evaluate and look and assess for evidence of damage to the heart and vascular structures and help you through that.

COVID Vaccination & Heart Health

Finally, let's talk a little bit about prevention and about concerns, particularly around vaccination.

Concerns have been raised about the risk of vaccination. This was seen in two primary forms with regard to cardiovascular health.

J&J Clotting

The Johnson & Johnson vaccine was found to cause a clotting problem in the veins and arteries in the head. It was mostly confined to young women, and thankfully rare, perhaps one in 6 million doses or so, something on that order.

This was a catastrophic problem when it occurred, and in our own practice, we were tending to advise the Johnson and Johnson vaccine for those other than young women because of that concern. Thankfully rare, and not seen with the mRNA vaccines.

Myocarditis & Pericarditis

The other cardiovascular risk that's been associated with vaccination has been inflammation of the heart muscle and the sac around the heart — myocarditis and pericarditis.

This was occurring mostly in young men, again, happening fairly infrequently. Something on the order of 2,500 cases that have been reported, about half of them confirmed, but 500 million doses of the vaccine given.

So an uncommon event, and something that, in most cases, could be managed outside of a hospital, and most people had a full recovery.

These are scary things, and you would never want a vaccine to cause these sorts of events.

But if you look at the likelihood of clotting, strokes, clotting in the veins, draining the head, clotting in the rest of the body, difficulty with arterial clots in the lungs, related to acute COVID, the risk is far higher than if you look at the risk of getting vaccinated.

And similarly, if you look at the rates of inflammation around the heart — pericarditis and myocarditis — they are much higher if you get the virus than if you get the vaccine.

Omicron particularly is so contagious that it's believed that by the time we end the Omicron wave, most people in this country will either have been vaccinated or had an Omicron infection. It is such a contagious thing.

So given that infection is so much higher risk than vaccination, it is certainly our recommendation that you get vaccinated and boosted as you're able, and would not recommend purposely going out of your way to get a COVID infection.

I would actually actively recommend taking steps to not become infected. It's a reminder that prevention on both fronts is important.

COVID & Heart Health: Wrapping it Up

Going back to the beginning of our talk today, underlying cardiovascular health plays a huge role in determining our outcomes with regard to COVID.

Exercising; sleeping; eating that plant-heavy, low carbohydrate, low processed food diet; and taking care of ourselves emotionally are very important.

Letting go of the cigarettes, letting go of the excessive alcohol, not poisoning ourselves, is very important, not just in determining our COVID outcomes, but of course, in determining our own long-term outcomes with regard to heart disease and cancers.

It's a reminder that also prevention by way of vaccination, prevention by way of avoiding infection, plays a huge role also in giving us better outcomes until we have an immune defense that's good enough to keep that infection being a relatively minor event in our lives.

So I wish you good heart health. I encourage you to continue to protect yourselves as we get through this Omicron wave. And if we can be helpful to you in terms of either primary prevention and helping you achieve those health goals, or helping you manage acute COVID or dealing with the sequelae, we'd love to be of service to you. Take good care.