Now that so much time has passed since those first days of the pandemic, there is enough information to understand its effect on the heart. Of course, there is also a mountain of misinformation on vaccines and the heart which, for the sake of brevity, will follow in the next post.
It was clear as soon as the pandemic arrived this was no ordinary virus. Locking onto ACE (Angiotensin converting enzyme) receptors to gain entry to cells was a particular worry as
ACE is fundamental in controlling the tone of our arteries and thus blood pressure with consequent risk of increasing the main killers in western society: coronary heart disease and strokes in addition to the direct effect of infection.
Society
Those with risk factors of diabetes, obesity and hypertension suffered by far the most. These are far mor prevalent in the poor who live stressed lives, eat affordable health destroying diets, smoke and drink more and live in noisy polluted environments. This social inequality played a huge and damaging role with those in the poorest parts of the UK four times more likely to die than those in the wealthiest, five times more likely in the USA, the world leading nations in inequality.
COVIDs short term impact
The impact early in the pandemic was tragically clear. The risk of having a heart attack or stroke after COVID19 infection was increased sixfold in the two weeks following infection when compared to those not infected during the pandemics first year according to this study of 87,000 Swedish people.
This study of 7,500 people from the UK Biobank infected also before vaccination was available revealed a 4-fold increase in heart problems and an 80-fold increase in mortality up to 21 days after infection. So COVID’s short term impact became clear very quickly.
COVIDs longer term impact
How about the longer term? The Biobank study above followed up patients for 18 months after infection and found a persistent increased risk death from cardiovascular disease of 40% over that period of time.
A review in 2022 found that in between 30 days and a year “Those who had had covid-19 had a 72% increased risk of heart failure, 63% increased risk of heart attack, and 52% increased risk of stroke compared with controls.”
They concluded: “Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial.”
This table describes these risks:
Risks and 12-month burdens of incident post-acute COVID-19 cardiovascular outcomes compared with the contemporary control cohort.
The risk was graded according to health setting but increased still present evident in those not hospitalised.
A follow up of US veterans brings us more up to date. It looked at the three years after COVID19. This risk of death in the first year following infection was three times that of the non-hospitalised, falling to a 44% increase in the second year and 29% in the third. Much of this mortality comes from damage to the heart and lungs. There was also a substantial though thankfully declining incidence of long COVID.
So, early in the pandemic, it became tragically clear that COVID infection was a significant risk to the heart, a risk declining though still evident into the third year.
Vaccination and your heart
One of the major scare stories manipulated by anti-vaxxers was the effect of vaccination on the heart. There were dire warnings that vaccination side effects would translate into long term cardiac damage. Three years later, how has it all played out?
This study in August 2021 examined the records of 800,000 vaccinated people in Israel, and compared cardiac outcomes to those who had, at that time been infected. The incidence of cardiac problems was far less for vaccinated compared to unvaccinated infected people. The graphic below describes the effect. I should also point out that ‘lymphadenopathy’, swelling of the glands, is not necessarily a problem – it reflects activation of the immune systems machinery to identify and remember what is foreign.
This huge study looked at the health records of 46,000,000 English people after vaccination and infection and, even with the clotting problems of ChAdOx1 vaccine and myocarditis from the mRNA vaccines are hugely reassuring. They conclude:
“This England-wide study offers reassurance regarding the cardiovascular safety of COVID-19 vaccines, with lower incidence of common cardiovascular events outweighing the higher incidence of their known rare cardiovascular complications.
We found no novel cardiovascular complications or new associations with subsequent doses. Our findings support the wide uptake of future COVID-19 vaccination programs. We hope this evidence addresses public concerns, supporting continued trust and participation in vaccination programs and adherence to public health guidelines”
Given many vaccinated people will go on to have infections, albeit milder, what happens to your heart then? The effect vaccination on subsequent infection is beneficial, reducing the risk by a half if fully vaccinated.
Vaccination and Myocarditis.
Myocarditis, inflammation of the heart muscle, and pericarditis, inflammation of its capsule, became the whipping boy of the anti-vaccine movement after its early identification as a side effect of the mRNA vaccines mainly affecting young men after the second vaccine.
In the Israeli study above, myocarditis affected 11 people per 100,000 after infection and 2.7 per 100,000 after vaccination.
Evidence showed that when caused by vaccination it was mild, transient and had a good outcome when compared to the myocarditis following COVID infection which had a mortality of 30% in hospitalised patients.
This of course, is the nub of vaccination – the side effects are experienced by real people, while the benefits are only show up in the data.
Vaccination and sudden death
The best evidence I can find suggests there has been no increase in sudden cardiac deaths in college youngsters in the USA. A study of out of hospital cardiac deaths and vaccination in Australia showed no increase in sudden death and specifically, no increase in the 30 days following vaccination.
So, sudden death in younger people is an incredibly sad phenomenon that has been around for some time. There is no increase in deaths of young people due to vaccination, the small number of deaths due to myocarditis after vaccination is dwarfed by the deaths of young people following COVID19.
What now for our hearts?
Much of this is slowly fading into history. Patients experiencing heart problems will, as time goes by, have a mixed and complex history of vaccinations and infections meaning that further research is going to be difficult. The clear increased risk to those infected before vaccination or those unvaccinated will diminish as time goes by as immunity has become almost universal and deaths from that initial pre-vaccine cohort decline, and many will already have died.
Amateur and professional antivaxxers will however, continue to blame just about anything on the vaccines, and will probably go on doing so for ever. It is just too lucrative to drop. This has ongoing consequences with falling rates of vaccination leading to unnecessary suffering and deaths from other infections diseases.
Further, the pandemic has emboldened anti-science, just at the time when humanity needs it most. More on the insanity of that in the next post.
Looking after your heart.
Beyond all this, most heart disease continues to be preventable. Avoiding unhealthy food, not smoking, being physically active and doing our best to avoid anxiety and depression in difficult times add years to life and life to years.
Yet, the telling contribution of poverty, inequality, food policy, the cost-of-living crisis and some of the most awful diets ever consumed by humankind will continue to damage the bodies and minds of too many people. So vote for political parties which at least try to do something about it.
Work with your doctor to get the right medical advice when you run into problems and, as this article suggests, avoid the huge amount of misinformation and disinformation which create avoidable harm to mind, body…and heart.