COVID-19 continues to rage, but so does cardiovascular disease

While the nation watches the number of cases of COVID-19 increase, level off or decline, cardiovascular disease is still the leading cause of death in the U.S.

“During the height of the COVID-19 pandemic there were periods where coronavirus exceeded heart disease as a cause of death,” says Richard Becker, MD, director of the UC Heart, Lung and Vascular Institute and professor in the UC College of Medicine.

“The medical community doesn’t want chronic conditions of any kind to take a backseat, but COVID-19 has been so powerful and overwhelming that is what is happening,” says Becker, also a UC Health cardiologist. “As the number of cases of COVID-19 has come down, cardiovascular disease has assumed its number one spot as it has for decades. Whether there will be added long-term cardiovascular effects from COVID-19 is not known, but its known effects on the heart and blood vessels raises a very concerning possibility. Measures to follow survivors of COVID-19 will be needed.”

Physicians are hoping to call attention to the dangers still posed by heart disease during February, which is American Heart Month. The first Friday of the month is designated National Wear Red Day by Go Red for Women and the American Heart Association to call attention to the risk heart disease presents for women. Heart disease has traditionally been the top killer of American women and men.

In 2019, before COVID-19 emerged, the nation recorded 659,041 deaths from heart disease, according to the Centers for Disease Control and Prevention. Statisticians at the CDC say early statistics suggest COVID-19 was the third leading cause of death in 2020.

Regular exercise routines may have to change in the midst of the COVID-19 pandemic.

“People that have been used to performing their daily fitness activities in gyms are now wondering if that is safe in the midst of COVID-19,” says Becker. “Fitness centers and gyms are doing their best to keep people safe but not everyone is comfortable. Based on what we know of COVID and the way it is transmitted, a person walking outdoors near a track that is close to them or in a nearby park should have no problem.

“Those walking outdoors can bring a mask with them though exercising can be more challenging and it may be less intense,” says Becker. “Individuals who have stationary bikes or treadmills at home can work with virtual trainers or streaming services to continue their exercise routines.”

Becker says heart disease can be kept at bay with regular, moderate intensity exercise, at least 40 minutes a day, along with maintaining a proper diet such as one that is more plant-based or Mediterranean in nature, and getting seven to eight hours of sleep nightly. If you smoke, quitting can also improve heart health, he says. Avoiding second-hand smoke is equally important, but often overlooked.

Becker says preventive screenings for cardiovascular disease is still recommended with physicians and thanks to telehealth it can be done virtually. Individuals can also be taught to monitor their blood pressure at home and keep a log of the results; programs allow patients to download the results and send it to a physician for review.

Becker says he is seeing a growing number of patients who have recovered from COVID-19 and wish to resume their fitness routines. He advises patients with mild to moderate COVID-19 symptoms to resume but slowly.  The National Heart, Lung and Blood Institute also offers some advice.

“Based on everything we know about COVID-19 some individuals will have no symptoms or mild symptoms,” says Becker. “Our recommendation has been a gradual return to activity but for individuals who had more serious cases of COVID with hospitalization, we have developed a return-to-activity program designed by our cardiopulmonary rehabilitation and recovery specialists.” 

“For a person recovering from serious COVID, reconditioning is a long process,” says Becker.  “It’s something that should be done in consultation with physicians, physical therapists, occupational therapists and dieticians. The reconditioning program should be personalized and based on information available through the American Heart Association and the American College of Cardiology and other organizations who have taken a thoughtful approach to returning to activity after COVID-19. 

“This infection can affect the heart,” says Becker. “Inflammation of the heart muscle has been seen in several individuals including those with mild COVID-19 symptoms. We need to slowly recondition the heart, lungs and muscles.” We have also seen patients with either low or high blood pressure following COVID-19. Close monitoring and careful titration of medications are necessary to assure optimal blood pressure.”

Read Dr. Becker's latest position paper on care for COVID-19 patients in the Journal of Thrombosis and Thrombolysis.

Ischemic heart disease, also commonly known as coronary heart disease, can be among the most visible signs of cardiovascular trouble. According to the American Heart Association symptoms can include:

• Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes or goes away and comes back.
• Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath with or without chest discomfort.
• Other signs such as breaking out in a cold sweat, nausea or lightheadedness.
• As with men, women’s most common heart attack symptom is chest pain or discomfort.

But women are more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

Featured image of a bicyclist with a mask is courtesy of Unsplash.