When the world first heard about COVID, it was a scary new respiratory disease associated with deaths. But it turned out to be an illness that also affects people’s heart and brain health.
“We have a much better understanding of the nature of COVID today,” says Dr. Peter Liu, Chief Scientific Officer and Vice President of Research at the University of Ottawa Heart Institute, and a Heart & Stroke researcher. “COVID damages preferentially the inner linings of the blood vessels.”
That’s why you might hear COVID called a vascular disease — vascular means anything related to the blood vessels.
Heart & Stroke talked to Dr. Liu about COVID and its impacts, and how to protect yourself against this disease that seems to be here to stay.
What do we know about COVID and the vascular system?
Early on, we saw it could impact the vascular system in cases of serious illness. But now we appreciate the long-term consequences of infection. Large, follow-up studies are showing that people who have been exposed to COVID have increased risk of developing cardiovascular complications — so, increased risk of heart attacks, strokes and heart rhythm disturbances. It can also lead to blood clots, especially to organs that receive a lot of blood such as the brain, heart and kidney.
Who’s at higher risk of these cardiovascular complications?
You’d think this would only happen in people who got really sick with COVID, but the severity of the infection doesn’t seem to make a difference. These complications can occur even in people who have very mild symptoms. The big surprise is how much this can affect younger people. Studies are showing that even young, active people can experience heightened risk of these complications.
What if you already have cardiovascular disease?
People with pre-existing cardiovascular disease are at higher risk of experiencing a more severe COVID infection, and also of having a cardiovascular event after getting infected with COVID. But if you’re able to control your risk factors, such as high blood pressure, diabetes or obesity, your risk goes down.
Does the COVID vaccine reduce the risk of cardiovascular complications?
Yes. The benefits of the vaccine are twofold. It’s going to reduce your chance of getting severe illness if you do get sick. And it reduces your chance of some long-term vascular damage. Vaccination against COVID is associated with a 40-50% reduction in risk of heart attack and stroke post infection. So it’s important to get vaccinated.
Do the vaccines themselves pose any risks to the heart or brain?
Vaccine-induced myocarditis, an inflammation of the heart muscle, happens very rarely, and it’s more common in young men. The long-term complications appear to be mild, and most people recover within weeks. There is much more risk associated with getting COVID; your chances of ending up with heart complications from a COVID infection are about five times higher.
Likewise, the risk of developing a blood clot following a COVID infection is many times greater than after receiving a COVID vaccine. So the benefit of vaccines far outweighs the risk when it comes to COVID, especially now we realize how COVID can be so insidious and harmful for our cardiovascular system.
What do we know about long COVID and your heart risk?
Between 15 and 45% of people who contract the virus will develop some kind of long COVID syndrome, which means having persistent symptoms three months after the initial exposure. With long COVID, everyone experiences a different package of symptoms; some have more brain fog while others have more fatigue or chest pain. It appears that most people get better. Long COVID is not correlated with more cardiovascular risk than acute or mild short-term illness
Now that there are anti-viral medications to treat COVID, who should take them?
If you already have cardiovascular risks such as high blood pressure, or existing cardiovascular disease, you may be eligible to get anti-viral medication (such as Paxlovid) from your doctor or from your pharmacist in some provinces. It’s effective at shortening the duration and severity of symptoms. It’s important to take the medication within the first five days of having symptoms. We don’t have any data on how taking COVID medication impacts your cardiovascular risk.
- Get the latest information from Health Canada about medications to treat COVID infections.
If you get COVID, should you keep taking your heart medications?
Yes. There’s good data to show that taking your medication, such as ACE inhibitors, is protective. Your risk factors for heart disease can aggravate the complications of COVID, so the better you control these risk factors, the better your short- and long-term outcomes will be.
After you’ve had COVID, what should you tell your doctor?
Physicians and patients should be talking about recent infections. Since cardiovascular disease can be silent, it’s important to get your blood pressure checked and do further screening for cardiovascular disease if there are concerns.
What can you do to protect yourself as COVID continues to circulate?
Get vaccinated. Avoid as many risky situations as you can and wear a mask in crowded situations. Address some of the lifestyle factors of cardiovascular disease — so make an effort to get regular physical activity and eat a healthy diet. All of this can help you ward off or minimize some of the complications of COVID. I don’t think we’re going to get rid of COVID, so we need to build our resilience against it.