• A new three-part journal series published Monday explores the significant impact COVID-19 can have on the heart.
• Nearly a quarter of hospitalized coronavirus patients experience myocardial injury and many develop arrhythmias or thromboembolic disease.
• Those with preexisting cardiac conditions, like hypertension, diabetes, obesity, or high cholesterol, have a greater risk of worse outcomes with COVID-19.

A three-part journal series, published in the Journal of the American College of Cardiology Monday, takes a deeper dive into the impact COVID-19 has on the heart.

Though COVID-19 was originally thought to be a respiratory infection, it’s since become clear the infection threatens the heart, too.

Nearly a quarter of people hospitalized with COVID-19 develop myocardial injury or injury to the heart tissue.

A significant number of COVID-19 patients have also developed thromboembolic disease or blood clots and arrhythmias.

Those with preexisting cardiac issues — like hypertension, obesity, high cholesterol, and high blood sugar levels — have a greater risk of experiencing worse outcomes with COVID-19.

“As the COVID-19 pandemic has evolved, research has progressively demonstrated this virus’s impact on multiple organs of the body including the heart,” says Dr. Aeshita Dwivedi, a cardiologist at Lenox Hill Hospital in New York City.

Given the significant damage COVID-19 can inflict on the heart, the authors recommend people who have a preexisting heart condition make heart-healthy lifestyle changes now to offset their risk of complications if they were to contract COVID-19.

How COVID impacts the cardiovascular system

COVID-19 is thought to damage the heart in two ways.

First, the infection can lead to widespread inflammation throughout the body, which can hurt the functioning of the heart.

“COVID-19 infection triggers inflammation in the body that may lead to weakening the heart muscle, abnormalities of the heart rhythm, and even cause clot formation in blood vessels,” says Dwivedi.

Second, the virus may directly invade receptor cells, known as ACE2 receptors, within the myocardial tissue and cause direct viral harm.

“It also can affect the heart muscle itself through inflammation or direct invasion of the heart muscle cells and lead to significant heart failure,” says Dr. Benjamin J. Hirsh, the director of preventive cardiology at Northwell Health’s Sandra Atlas Bass Heart Hospital in Manhasset, New York.

According to the researchers, the amount of damage inflicted on the heart depends on the amount of viral inoculum, or infecting dose of virus, a person’s immune response, and the presence of comorbidities.

Though the risk is higher in people with underlying heart conditions, even healthy people have reported heart damage after beating COVID-19.

Those with preexisting heart issues have a greater risk

The main risk factors, according to the research papers, are hypertension (high blood pressure), dysglycemia (high blood glucose levels), dyslipidemia (high cholesterol), and abnormal adiposity (obesity).

Hypertension is thought to be the greatest risk factor. According to one of the studies, hypertension was linked to a 2.5-fold greater risk of COVID-19 severity and mortality, particularly in people over 60.

“One of the most crucial lessons we have learned is that people whose cardiovascular health is compromised are very susceptible to worse outcomes with COVID-19,” says Hirsh.

Dr. Hyung Chun, a Yale Medicine cardiologist and director of translational research of the Yale Pulmonary Vascular Disease Program, says one emerging belief is that the endothelial cells, which line the blood vessels, in people with cardiac issues respond differently to the body’s immune response.

They potentially release inflammatory cytokines that further exasperate the body’s inflammatory response and lead to the formation of blood clots.

“The ‘inflamed’ endothelium likely contributes not only to worsening outcome in COVID-19, but also is considered to be an important factor contributing to risk of heart attacks and strokes,” Chun said.

The damage could be long lasting

Researchers are still uncovering the type of long-term damage COVID-19 can have on the heart, but many health experts suspect people who have recovered could experience complications for months or years.

Though we’ve only known COVID-19 for less than a year, early evidence has found that symptoms linger for months.

One paper looking at patients in a post-COVID-19 clinic found that up to 87 percent of the patients had at least one persistent symptom — like fatigue, chest pain, and joint pain — a couple of months after recovering.

Another paper in JAMA found that 78 percent of recovered patients had abnormalities in the heart and 60 percent had ongoing myocardial inflammation.

“More often than not, these complications have long-term implications, therefore it is important to prevent and recognize them,” says Dwivedi.

Many other illnesses, from the common cold to SARS (the coronavirus that struck in 2002), cause cardiac dysfunction, but COVID-19 appears to have a higher degree of endothelial or vascular injury, according to Chun.

“It is possible that this may lead to worsening long-term sequelae in COVID-19 compared to other illnesses,” Chun said.

Though it’s possible the cardiovascular damage may heal itself, as it often did with SARS, it may also lead to an increase in heart failure in some patients.

Longitudinal follow-up studies will be necessary to determine the full impact COVID-19 can have on the heart, according to the researchers.

“While extensive body of literature has described a close association between COVID-19 and the heart, and it is clear that patients with underlying heart disease have worse outcomes if they become infected with SARS-CoV-2, the long-term impact on the heart of COVID-19 infection remains to be fully understood,” Chun said.

Make changes now to protect yourself later

The researchers involved in the series also emphasized the importance of maintaining a healthy lifestyle.

“Being vigilant of unhealthy behaviors like regularly ordering in unhealthy food and a sedentary lifestyle is essential,” Dwivedi said, recommending people cook healthy meals at home, exercise regularly, and get into a healthy sleep routine.

The researchers also recommend people cut back on alcohol and tobacco.

Those who contract COVID-19 should regularly seek medical care for their conditions and continue to take their medications, such as statins.

Statins are thought to have cholesterol-lowering and anti-inflammatory qualities that can lower a person’s risk of experiencing a cardiac event.

“Improving healthy living must be seen as an important way to combat this and many other diseases in the short and long term,” Hirsh said.

The bottom line

A new three-part journal series published Monday explores the significant impact COVID-19 can have on the heart. Nearly a quarter of hospitalized coronavirus patients experience injury to the heart tissue and many develop arrhythmias or thromboembolic disease.

Those with preexisting cardiac conditions, like hypertension, diabetes, obesity, or high cholesterol, have a greater risk of worse outcomes with COVID-19. To offset their risk, health experts recommend making healthy lifestyle changes.

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