Heart Problems After COVID-19, An Uncertain Threat

Some doctors wonder if heart risks may appear months after contracting COVID-19, but it’s still too early to establish a cause-and-effect relationship.

“A cardiovascular clinical follow-up is essential for all people with a COVID-19 infection, even benign,” the French Academy of Medicine, the consensus body in this field in France, declared earlier this week.

COVID-19 and cardiovascular disease have a “dangerous relationship,” he said, citing several recent studies.

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It was already known that patients suffering from cardiovascular diseases have a higher risk of developing a more severe form of COVID. This is in part because the virus, SARS-CoV-2, binds to a “receptor” – the enzyme ACE2 – that is especially present on blood vessel cells.

But what about cardiovascular effects in the general population? And, if proven, can they occur long after infection?

The question thus joins other broader uncertainties surrounding persistent COVID, a long-standing set of symptoms that are not yet well understood or defined.

“Until now, (long-lasting) cardiovascular consequences were detected only in hospitalized patients, in small series and with a short follow-up time,” says the Academy.

But extensive research, carried out in the United States and published in February by the journal Nature, opens the door to new approaches.

Their results “point to a significant increase in cardiovascular disease worldwide” following the COVID pandemic.

150,000 veterans

The study measured the frequency of cardiovascular problems in the year following COVID-19 infection in more than 150,000 US Army veterans and compared it with that of other veterans who were not infected.

“After 30 days post-infection, individuals with COVID-19 are at increased risk of cardiovascular disorders,” the study concludes, citing heart attacks, heart inflammation, or strokes.

This risk “exists even in individuals who were not hospitalized” for COVID-19, the document indicates. But in these cases, the risk is lower.

The research was praised by many scientists, mainly because it was carried out with a large number of patients and over a long period of time. However, some experts are more skeptical.

It is “very difficult to draw relevant conclusions” from this study, said British statistician James Doidge. According to him, there are too many methodological biases.

One is obvious: American veterans, as numerous as they may be, are a very homogeneous population, made up mostly of elderly men.

Therefore, the sample is not necessarily representative, although the study authors have tried to correct for these statistical biases.

This correction is still insufficient for Doidge, who pointed to another problem: the study does not clearly distinguish how long after infection heart problems occur.

Like the flu?

Because depending on whether the problems appear a little more than a month after the illness or almost a year later, the context will be different.

According to James Doidge, the study does not do enough to differentiate “long-term complications from those associated with the acute phase of the disease.”

In any case, the work “has the merit of existing,” French cardiologist Florian Zores told AFP.

He, too, pointed to several flaws, but believes the study supports hypotheses already considered likely by many cardiologists in light of the profile of SARS-CoV-2, which, like other viruses, can cause long-lasting inflammation.

“Inflammation has long been known to be a cardiovascular risk factor,” Zores said. “In fact, the same thing happens with the flu,” she adds.

The specialist recalled that in the 1920s, cardiovascular pathologies increased as a result of the 1918 flu pandemic.

Is there a specificity that makes the coronavirus even more dangerous in this regard? Current studies do not allow it to be confirmed and Florian Zores doubts that “there is a big difference” with respect to the flu.

But the question does not necessarily change much in terms of public health. As long as this risk exists, the cardiologist considers it dangerous to allow the coronavirus to circulate freely, given its high contagion capacity.

AFP is a major global information agency that offers fast, verified and comprehensive coverage.

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