Well into the pandemic’s fourth year, how profound a toll COVID-19 has taken on heart health is only starting to emerge.
“We are seeing effects on the heart and the vascular system that really outnumber, unfortunately, effects on other organ systems,” said Dr. Susan Cheng, a cardiologist at Cedars-Sinai Medical Center in Los Angeles.
For up to a year after a case of COVID-19, people may be at increased risk of developing a new heart-related problem, anything from blood clots and irregular heartbeats to a heart attack –- even if they initially seem to recover just fine.
Among the unknowns: Who’s most likely to experience these aftereffects? Are they reversible — or a warning sign of more heart disease later in life?
Heart disease has long been the top killer in the U.S. and the world. But in the U.S., heart-related death rates had fallen to record lows in 2019, just before the pandemic struck.
COVID-19 erased a decade of that progress.
Heart attack-caused deaths rose during every virus surge. Worse, young people aren’t supposed to have heart attacks but Cheng’s research documented a nearly 30% increase in heart attack deaths among 25- to 44-year-olds in the pandemic’s first two years.
An ominous sign the trouble may continue: High blood pressure is one of the biggest risks for heart disease and “people’s blood pressure has actually measurably gone up over the course of the pandemic,” she said.
Some of these patients have what’s known as long COVID, the catchall term for dozens of symptoms that often include fatigue and brain fog. The National Institutes of Health is beginning small studies of a few possible treatments for certain long COVID symptoms, including a heartbeat problem.
But Cheng said patients and doctors alike need to know that sometimes, cardiovascular trouble is the first or main symptom of damage the coronavirus left behind.
Blood flow jumps when people move around and subsides during rest. But some long COVID patients don’t get enough of a drop during rest because the fight-or-flight system that controls stress reactions stays activated.
Some also have trouble with the lining of their small blood vessels not dilating and constricting properly to move blood through, she added.
How big is the post-COVID heart risk?
To find out, Washington University’s Dr. Ziyad Al-Aly analyzed medical records from a massive Veterans Administration database. People who’d survived COVID-19 early in the pandemic were more likely to experience abnormal heartbeats, blood clots, chest pain and palpitations, even heart attacks and strokes up to a year later compared to the uninfected.
Based on those findings, Al-Aly estimated 4 of every 100 people need care for some kind of heart-related symptom in the year after recovering from COVID-19.
Per person, that’s a small risk. But he said the pandemic’s sheer enormity means it added up to millions left with at least some cardiovascular symptom. While a reinfection might still cause trouble, Al-Aly’s now studying whether that overall risk dropped thanks to vaccination and milder coronavirus strains.
More recent research confirms the need to better understand and address these cardiac aftershocks.
An analysis this spring of a large U.S. insurance database found long COVID patients were about twice as likely to seek care for cardiovascular problems including blood clots, abnormal heartbeats or stroke in the year after infection, compared to similar patients who’d avoided COVID-19.