Andrene Chung | COVID-19 and cardiovascular diseases
The dramatic global spread of the coronavirus disease (COVID-19) has created severe human, social and economic disruption across all continents and devastation of some healthcare systems. This is related not only to the rapid spread and highly transmissible nature of the virus, but also to the serious impacts the disease has on vulnerable populations. While we are still learning about the virus, several leading global health organisations have reiterated that, based on currently available data, older adults and people of any age who have serious underlying medical conditions seem to be at higher risk for severe illness from COVID-19.
Cardiovascular diseases (CVDs) is an umbrella term for a group of diseases of the heart and blood vessels, including heart disease and stroke. Anyone with a heart condition is considered to be at high risk of for more severe complications of COVID-19. The American College of Cardiology recently reported that the fatality rate of a COVID-19 patient is highest if the patient has an underlying CVD. Of these, hypertension seems to confer the greatest risk.
This is quite concerning as CVDs are the leading cause of death globally and they account for 30 per cent of deaths in Jamaicans. Prevalence of high blood pressure, which is a main factor for CVD and stroke, has been reported to be 33.8 patients in Jamaicans over 15 years old.
COVID-19 could affect CVD patients in a myriad of ways. While the virus acts by attacking the lungs, this could affect the heart, especially a diseased heart, which has to work harder to get oxygenated blood throughout the body when the lungs aren’t working at full potential. Additionally, persons with underlying heart conditions may have a weakened immune system reducing the body’s immune response when exposed to the virus. If there is fatty build-up known as plaque in the arteries, evidence indicates that viral illnesses can destabilise these plaques, causing them to rupture or break apart, increasing the risk of blockage of arteries in the heart which may lead to heart attack.
According to studies out of Wuhan, China, some persons with COVID-19 have developed myocardial injury, the death of heart cells, for reasons other than a heart attack, and others showed signs of heart damage. This suggests that the virus may attack the heart directly. To invade the lungs, the virus attaches to a protein in the cells in the lungs, a protein which is also found in heart muscle and in blood vessels.
With these stark findings, and as we try to navigate the new realities presented by COVID-19, where do we go from here? Heart health is a number one priority of the Heart Foundation of Jamaica. With the current onset of the novel coronavirus, our efforts to protect persons with heart complications have increased. You don’t know the health of your heart until you check it out. Hence, adults, especially those over 50 years, those with hypertension, diabetes, or with a family history of these conditions or family history of heart disease should do regular screenings, including screening for heart disease, high blood pressure, cholesterol and body mass index to determine weight status. (Obesity was also found to increase the risk for severe complications of COVID-19).
Health authorities such as the WHO, PAHO, the American Heart Association and others have recommend that persons with compromised heart health take extra precautions to protect themselves through proper and frequent handwashing, keeping surfaces clean, avoiding public gatherings, practising social distancing, wearing masks, following medical advice and the advice of public health authorities.
Seek out healthcare if you have any serious or concerning symptoms such as a sore throat, cough or fever. They should also maintain all the measures already recommended by their healthcare practitioners before the advent of COVID-19, including taking medications as prescribed, exercising regularly, maintaining a healthy weight and having regular medical checks and monitoring as can be safely arranged.
With the rapidly increasing cases of COVID-19, Jamaicans are urged to practise heart-healthy measures to help safeguard themselves.
Here are some tips:
. Eat a variety of nutritious foods from all the food groups. You may be eating plenty of food, but your body may not be getting the nutrients it needs to be healthy. Nutrient-rich foods have minerals, protein, whole grains and other nutrients but are lower in calories. Foods including fresh fruits, vegetables, low-fat dairy, legumes and nuts, skinless poultry and fish help to create a more healthful dietary pattern.
. Avoid foods containing partially hydrogenated vegetable oils to reduce trans-fat in your diet. Limit saturated fat and trans-fat and replace them with the healthier fats, monounsaturated and polyunsaturated. If you need to lower your blood cholesterol, reduce saturated fat to no more than five to six per cent of total calories. For someone eating 2,000 calories a day, that’s about 13 grammes of saturated fat.
. Cut back on beverages and foods with added sugars.
. Eat less salt by cutting down on table salt, salted meats, sauces. Aim for 1 teaspoon salt per day or ½ teaspoon if you have high blood pressure.
. Consume a diet rich in whole grains, nuts, and healthy fats such as in olive, sesame, peanut or other oils rich in unsaturated fatty acids. Such diets may support your immune system and help to reduce inflammation.
. Limit alcohol intake.
. Stop smoking. Smoking cigarettes leads to diseases of the heart and blood vessels and increases the complications of hypertension.
. Exercise regularly. Be more active aiming for at least 30 minutes of exercise daily.
. Read your food labels so that you can limit the purchase and consumption of food high in fat, salt and sugar.
. Take care of your mental health and reduce stress by doing things that relax you.
Going forward, we will need a comprehensive approach to protecting our vulnerable populations in order to help to reduce the impact of COVID-19. Public policies to prevent and control non-communicable diseases lie at the crux of this approach. This includes, but is not limited to, the promotion of and access to safe and nutritious foods as well as screening and treatment, and the increased knowledge about non-communicable diseases.
Dr Andrene Chung is consultant cardiologist, and chair of The Heart Foundation of Jamaica. Send feedback to firstname.lastname@example.org.