COVID-19: A Coronary Artery Disease Risk Equivalent with Genetic Implications

Key Takeaways

• COVID-19, especially in hospitalized cases, is linked to an increased risk of major cardiovascular events (MACE).
• Hospitalization for COVID-19 presents risks similar to coronary artery disease (CAD), even in individuals with no history of cardiovascular disease.
• A genetic interaction between COVID-19 and non-O ABO blood types elevates the risk of thrombotic events, including heart attacks and strokes.
• These findings highlight the importance of long-term cardiac monitoring and preventive strategies in COVID-19 survivors.

Introduction

COVID-19’s impact extends beyond the respiratory system, as studies reveal long-term cardiovascular risks among survivors. Research published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology identifies COVID-19 as a coronary artery disease (CAD) risk equivalent. In this case, the term Risk Equivalent means that individuals hospitalized for COVID-19 face cardiac risks comparable to those with preexisting cardiovascular conditions, in this case, Coronary Artery Disease which carries a severe risk of future heart attacks and other similar issues.

The study also explores the genetic interaction between COVID-19 and ABO blood types, particularly the increased risk of thrombotic events in individuals with non-O blood types.

Study Overview

The study utilized data from the UK Biobank, analyzing over 10,000 individuals who tested positive for COVID-19 between February and December 2020. Participants were compared to nearly 220,000 controls. Researchers focused on major adverse cardiac events (MACE), which include myocardial infarction, stroke, and all-cause mortality, to assess COVID-19’s long-term cardiovascular impact.

Data analysis revealed a significantly increased risk of MACE among COVID-19 patients, with the highest risks observed in those who required hospitalization. Importantly, individuals without a history of cardiovascular disease but hospitalized for COVID-19 exhibited MACE risks comparable to those with CAD.

COVID-19 as a Coronary Artery Disease Equivalent

Coronary artery disease (CAD) is traditionally used as a benchmark to determine heightened cardiovascular risk and to guide preventive measures, such as cholesterol management and the use of antiplatelet therapies. The study findings suggest that hospitalization for COVID-19 poses similar cardiovascular risks to CAD, warranting enhanced preventive care for survivors.

Among hospitalized COVID-19 patients without preexisting cardiovascular disease, the risk of experiencing a major adverse cardiac event was 7 times higher than that of the control group. Notably, these patients also had a 20% higher MACE risk than individuals with preexisting cardiovascular disease but no COVID-19 history.

Genetic Interaction with ABO Blood Types

The study found that the interaction between COVID-19 and ABO blood types played a critical role in determining cardiovascular outcomes. Individuals with non-O blood types (A, B, or AB) were at a higher risk of thrombotic events, such as heart attacks and strokes, compared to those with blood type O. Specifically, the study revealed a 65% higher risk of thrombotic events among non-O blood type individuals who were hospitalized for COVID-19.

This gene-pathogen interaction is one of the first examples of how genetic factors, like blood type, influence COVID-19’s long-term health outcomes. Given that approximately 60% of the global population has a non-O blood type, these findings have widespread public health implications.

Implications for Public Health and Patient Care

The study’s findings underscore the importance of long-term cardiovascular monitoring for COVID-19 survivors, particularly those who were hospitalized. Healthcare providers should consider COVID-19 hospitalization as a CAD risk equivalent and implement preventive strategies accordingly. This includes regular cardiovascular screening, lifestyle interventions, and, where appropriate, the use of antiplatelet therapies.

With millions of individuals recovering from COVID-19 worldwide, prioritizing at-risk patients based on their infection severity and genetic predisposition could help prevent future cardiovascular events. Public health strategies should also emphasize the need for COVID-19 prevention efforts, including vaccination and early treatment, to mitigate long-term cardiovascular risks. It should also be noted that current public health efforts, such as those around Potentially Preventable Hospitalizations, should also consider monitoring COVID hospitalization rates as those may become a major factor in the evaluation of such programs, even with other factors around heart failure and other cardiovascular disease indicators lessening.

Long-Term Risk of Major Adverse Cardiac Events (MACE)

The study revealed that the risk of MACE persisted for up to three years after COVID-19 infection, with no significant attenuation over time. This suggests that COVID-19 survivors may face prolonged cardiovascular risks, making continuous monitoring essential. Patients should be informed about the signs of cardiac issues and encouraged to seek medical advice promptly if symptoms arise.

Additionally, individuals with other cardiovascular risk factors, such as diabetes or obesity, exhibited compounded risks when combined with COVID-19. These findings highlight the importance of managing coexisting conditions in COVID-19 survivors to reduce their overall cardiovascular risk.

Preventive Strategies and Recommendations

Given the study’s findings, healthcare providers might consider implementing preventive measures similar to those used for CAD patients in individuals hospitalized for COVID-19. This could include:

• Regular cardiovascular screening and early detection of cardiac issues.
• Cholesterol management and lifestyle interventions to reduce cardiovascular risks.
• The use of antiplatelet agents, where appropriate, to prevent thrombotic events.
• Patient education on recognizing symptoms of heart attacks and strokes.

Furthermore, healthcare systems should integrate COVID-19-related cardiovascular risks into existing public health guidelines. This includes adapting preventive care protocols to account for the increased risks in COVID-19 survivors and providing targeted interventions based on individual risk profiles. Likewise, encouragement of mask wearing, at the very least during peak COVID seasons, should be considered.

Conclusion

This study offers crucial insights into the long-term cardiovascular risks associated with COVID-19. By identifying COVID-19 hospitalization as a CAD risk equivalent and highlighting the role of genetic interactions with ABO blood types, the research emphasizes the need for proactive cardiovascular care in COVID-19 survivors.

For healthcare providers and policymakers, these findings serve as a reminder that the pandemic’s impact extends beyond acute respiratory symptoms. Long-term monitoring, preventive strategies, and public health interventions will be essential in mitigating the cardiovascular burden of COVID-19 in the years to come.

The image for this article was gathered from Creazilla.