It’s not just the lungs. Mounting evidence shows that COVID-19 can invade the heart or spark so much inflammation during the immune response that it weakens the critical organ, raising the risk of heart attacks, strokes and other cardiac chaos.
A U.K. study published this month found patients with COVID-19 were four times likelier to develop major cardiovascular disease in the acute phase of their infection than those uninfected. Even after the worst of their illness was over, they were 40% likelier to experience cardiac problems than the control group.
“The findings indicate that patients with COVID-19 should be monitored for at least a year after recovering from the acute illness to diagnose cardiovascular complications of the infection, which form part of long COVID,” said Ian C.K. Wong, a study author and professor of pharmacy at the University of Hong Kong.
The research comes on top of a massive study of U.S. veterans last year that found those infected by the coronavirus were at greater risk of heart attack, stroke, blood clots, irregular heartbeats and myocarditis, which is the inflammation of the heart muscle.
“It’s truly not only a respiratory disease. In some patients, they can develop heart problems as a result of [coronavirus] infection,” said Ziyad Al-Aly, chief of research and development service at the Department of Veterans Affairs’ health care system in St. Louis and a clinical epidemiologist at Washington University, also in the Missouri city.
Doctors hypothesize the virus can infect the heart cells by unlocking key cell receptors, creating an invasion of the organ. In other cases, inflammation from the immune response may cause collateral damage in the heart.
The phenomenon is similar to one found in certain influenza patients who have a greater risk of heart attack for two weeks to a month after their illness.
“We know that this is not just a COVID-specific phenomenon,” said William Schaffner, an infectious disease specialist at Vanderbilt University.
Panagis Galiatsatos, an assistant professor at Johns Hopkins School of Medicine who sees patients, said COVID-19 problems can occur in active COVID infections and long COVID, the blanket term for long-term effects such as brain fog, dizziness and changes in smell or taste in people who’ve recovered from an infection.
He said in some long COVID patients, the virus causes a debilitating phenomenon akin to postural orthostatic tachycardia syndrome, or POTS, in which people who stand up feel lightheadedness, fainting and rapid heartbeat.
In active cases, the virus has the ability to bind to the ACE2 receptor on cells in the lungs and heart and cause myocarditis.
“We have seen this often in patients, which results in a type of heart failure,” Dr. Galiatsatos said.
In some people, the body’s own immune response to the virus invader causes havoc. An elevated release of proteins known as cytokines can result in a cytokine storm, sparking inflammation and damaging key organs such as the heart.
Researchers at Cedars-Sinai in Los Angeles say reported heart attacks increased after the first year of the pandemic and surged with spikes in the coronavirus, including omicron, with higher relative increases in cardiac problems among younger adults.
Heart attacks rose 14% in the first year of the pandemic compared with the year before, an uptick that reversed a decadeslong improvement in avoiding cardiac deaths. The problem has persisted, even during surges in newer variants that were thought to be milder than earlier strains.
The problem was found across all age groups, but the highest relative rise was among younger adults — an increase of 29.9% for those ages 25-44, 19.6% for ages 45-64 and 13.7% for 65 and older.
“We found that the young-aged females and males were hit hardest. We also showed that this trend persisted through the early months of the omicron outbreak,” said Dr. Yee Hui Yeo, a Cedars-Sinai physician-scientist and first author of the study.
Actuaries in Australia recently reported that heart attacks were 17% higher than normal over the first eight months of 2022 as the island nation grappled with surges in the virus following strict lockdowns earlier in the pandemic.
This all comes on top of a high-profile study published in early 2022 that compared over 150,000 COVID-19 survivors in the Department of Veterans Affairs health care database to large control groups.
Even those without underlying health conditions or had relatively mild infections that did not require hospitalization found themselves at elevated risk, the researchers said.
Heart disease occurred in 4% more patients who had COVID-19 than those who did not, which would translate to 3 million people in the U.S. with cardiac complications because of COVID-19.
Dr. Al-Aly, who was involved in the study, advised to keep the spinoff risks from COVID-19 in perspective. Of 100 people you know who get the virus, “maybe 95% are gonna be just fine,” he said.
But he said clinicians should be on the lookout for cardiac issues and symptoms in those who’ve been infected.
“I think we should be cognizant of heart risks,” he said. “Getting that diagnosis early and treating those persons early is better than leaving it untreated for several years.”
The Centers for Disease Control and Prevention told The Washington Times, “People with COVID-19 appear to have a higher occurrence of a number of heart-related conditions in the months following infection compared to those who did not have COVID-19. CDC is continuing to track the impact of COVID-19 and post-COVID conditions across multiple organ systems, including the heart.”
Doctors told The Washington Times that risks are more pronounced in the unvaccinated vs. vaccinated, so getting updated boosters should be considered smart for your heart. Only about 15% of eligible Americans have gotten the latest booster shot.
“There are so many people who have not taken advantage of the bivalent vaccine. If you’re worried about heart disease as a consequence of COVID, how about running to the pharmacy for 15 minutes and no money, because it’s free, and getting your booster?” Dr. Schaffner said.
Officials have documented reports of myocarditis in those who’ve received the COVID-19 vaccines, particularly in young men.
Doctors said it’s important to recognize that vaccine injury can be serious, though there is less risk compared with COVID-19 itself.
One study published in Nature estimated there were about 10 extra myocarditis cases per 1 million people who received two doses of an mRNA vaccine vs. 40 incidents of myocarditis per million among those who got infected by the virus.
Scientists have found that most of the people who get myocarditis from the vaccine recover.
“If it occurs, it is transient and not life-threatening. However, COVID-related myocarditis is more common and more of a health concern,” Dr. Galiatsatos said. “The vaccines may play a role in preventing COVID-19-related myocarditis, so it is a great therapy to assist in overall heart care.”