Quality of evidence: B+
Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease
Authors: Clerkin et al.
Journal: Circulation preprint
Objectives: Review the occurence and risk of cavascular diseases in covid-19
Strength of evidence: B+ (narrative, exhaustive)
Methods/publication type: Narrative review
Highlights :
Higher prevalence of cardiovascular disease
7% of patients suffer myocardial injury from the infection (22% of the critically ill)
ACE2 is highly expressed in the heart
ACE inhibitors or angiotensin receptor blockers require further investigation
CFR was 49% among critical patients
CFR 10.5% for cardiovascular disease (CVD)
CFR 7.3% for diabetes mellitus (DM)
CFR 6.3% for Chronic obstructive pulmonary disease
CFR 6% for Hypertension
CFR 5.6% for cancer
Any comorbidity was present in 48% severe disease (67% of non-survivors)
HTN was present in 30% severe disease (48% of non-survivors)
DM in 19% severe disease (31% of non-survivors)
CVD in 8% severe disease (13% of non-survivors)
Potential explanations include CVD being more prevalent in those with advancing age, a functionally impaired immune system, elevated levels of ACE2, or a predisposition to COVID-19 for those with CVD
Elevated high sensitivity Troponin I [hs-cTnI] or new ECG or echocardiographic abnormalities but correlates with other markers of inflammation, possibly just the cytokine storm due to limited T helper activity in the elderly and not specifically heart injury
12% of patients without known CVD had elevated troponin levels or cardiac arrest during the hospitalization
Authors include remark on transplantation and risks
Incidence of fulminant myocarditis and profound cardiogenic shock is low but not impossible because of potential viral infection of the heart
The authors discuss angiotensin convertors inhibitors and the potential of Losartan
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