Strength of evidence: B -
Potential Effects of Coronaviruses on the Cardiovascular. A System Review
Authors: Madjid et al.
Journal: JAMA Cardiology
Objectives: Assess the potential risk of COVID-19 on cardiovascular health through the review of the evidence collected on SARS, MERS and seasonal flu
Strength of evidence: B- (review of other coronaviruses mostly, no information on inclusion/exclusion criteria for review)
Methods/publication type:
a systematic review
53% of cases had missing data on co-morbidities
Highlights :
44,672 cases
80.9% presented a mild form and no mortality, 13.8% a severe form with no mortality, 4.7% a critical form with 49% mortality
4.2% had cardiovascular disease (CVD)and 12.8% had hypertension
Overall Fatality rate in the study = 2.3%
Male sex (nb. more smokers in males in this study), advanced age, and presence of comorbidities including hypertension, diabetes mellitus, cardiovascular diseases, and cerebrovascular diseases are predictors of fatality
CVD in 4.2% of confirmed cases, 22.7% of deceased cases, fatality rate = 10.5%
CFR for hypertension = 6%, diabetes = 7.3%, chronic lung disease = 6.3%
Other risk factors for mortality = elevated troponins (heart damage)/myocarditis and ARDS
Link with Cardiovascular disease :
SARS-CoV-2 can lead to new heart conditions or exacerbate CVD (acute coronary syndrome, arrhythmias, exacerbations of heart failure)
Due to increased inflammatory response and inflammation of blood/atherosclerotic vessels
Recommended treatments for acute cardiovascular complications = antiplatelet, beta-blockers, ACE inhibitors, and statins
Statins might help stabilize plaque and prevent its destabilization by the infection
No study has yet unveiled the effect of ACE inhibitors, ARA2, antagonists of the renin-angiotensin system: keep using them
Immunomodulators could be beneficial in reducing mortality by limiting cytokine storm side-effects
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