Effects of Long COVID on Heart Health Remain Unknown
Pharmacists can help manage complications from long COVID-19, as no medications can treat it.
In the 5 years since the COVID-19 pandemic began, the landscape of health care and public health has changed exponentially. Treatment, prevention, and vaccination efforts have thrust the pharmacy industry into a new era, but many unknown effects of the disease remain.
For individuals who recover from infection, the effects of long COVID, also known as postacute sequelae of COVID-19, are still unknown. | Image Credit: Siarhei - stock.adobe.com
Findings from a population-based study published in Frontiers in Cardiovascular Medicine showed modest declines in mean glucose, cholesterol, high-density lipoprotein, and low-density lipoprotein levels after the pandemic in 4558 patients. Further, the data indicated that the prevalence and treatment rates of cardiovascular-related diseases, such as diabetes, hypertension, and dyslipidemia, remained consistent, suggesting that lifestyle improvements and health awareness could offset the adverse pandemic effects.1
However, for individuals who recover from infection, the effects of long COVID, also known as postacute sequelae of COVID-19, are still unknown. Long COVID can include persistent cardiopulmonary symptoms such as breathlessness, chest pain, fatigue, headaches, brain fog, and palpitations. Other symptoms may include cognitive and mental impairments, myalgia, smell and taste dysfunctions, and gastrointestinal issues.1,2
“Patients with preexisting cardiovascular conditions are at an increased risk of developing long COVID. Additionally, new-onset cardiovascular disease has been observed in patients suffering from long COVID syndrome,” Cassandra Richardson, PharmD, BCACP, TTS, senior manager of clinical initiatives at VillageMD, said. “Research is ongoing to determine the prevalence in patients with long COVID, but estimates suggest that 7% to 40% of individuals with COVID may experience myocardial injury, as noted by the Cleveland Clinic.”
Long COVID is thought to be driven by tissue damage and pathological inflammation and has risk factors associated with being female; having more than 5 early symptoms, early dyspnea, or prior psychiatric disorders; and other biomarkers, though more research is needed in this area. Preliminary evidence shows that personalized rehabilitation and repurposed therapeutics from similar conditions could help with long COVID.2
In European Heart Journal, investigators reviewed long COVID, the epidemiology of cardiopulmonary manifestations, mechanisms for acute and chronic cardiac injury due to COVID-19, and management of the effects. Investigators reported on possible mechanisms for postacute illness, such as chronic inflammation responses of COVID-19 affecting heart health. Another potential mechanism could be an autoimmune response to cardiac antigens, resulting in a damage delay.3
The review investigators noted that understanding the cardiac involvement could help identify the mechanisms of action for ongoing injuries. In one study, investigators examined MRI abnormalities with organ health, exercise, cognition, quality of life, and mental health changes.4 They reported that 64% of patients experienced breathlessness, and 55% experienced fatigue at 2 to 3 months from COVID-19 onset. Abnormalities were seen in the lungs (60%), heart (26%), liver (10%), and kidneys (29%). Persistent lung and extrapulmonary organ findings were common and heavily linked to inflammation and severity of acute illness. In another study, failure to recover from multiorgan symptoms following COVID-19 was associated with inflammatory markers, further identifying a link.5
Another contributor to multiorgan dysfunction could be persistent endothelial dysfunction, microvascular dysfunction, and prothrombotic tendencies. In data from multiple studies, investigators have found perfusion deficits in the heart and lungs of those previously affected by COVID-19 from approximately 40 to 60 days post infection. According to findings from one study, multiorgan MRIs showed evidence of small vessel disease (9.3%) and ischemic changes (3.7%) in the brain (9.3%), and 1.9% of patients had myocardial infarctions approximately 2 to 3 months postinfection.4
Though COVID-19 also had many effects on those with comorbid conditions, data from a study of 689,395 patients with asthma showed that those who had a COVID-19 infection did not show a higher risk of ischemic heart disease in a median follow-up of 95 days.6 However, when investigators stratified for severity, patients who had severe COVID-19 demonstrated higher risks of ischemic heart disease than match controls, but those with nonsevere COVID-19 showed no significant increase.
Addressing patient concerns requiresactive and compassionate listening, as many individuals may feelanxious about the unknowns surrounding long COVID —Cassandra Richardson, PharmD, BCACP, TTS
As for managing COVID-19–related cardiovascular symptoms, investigators suggest treating patients according to guidelines from the European Society of Cardiology and the American Heart Association. Investigators suggest the same for heart failure management. After excluding cardiovascular and other organ pathology, the management of long COVID and obesity is linked, so reducing weight via calorie restriction, diet, tailored graded exercise, and stress reduction would be favorable for systemic inflammation, vascular dysfunction, and metabolic syndrome.4
“When counseling patients with long COVID symptoms, it is essential to first listen with compassion and validate their concerns. Many patients may feel frustrated or scared, especially when dealing with an evolving condition,” Richardson said. “Teaching patients how to advocate for their health and seek answers from their health care providers is crucial, as navigating care can be challenging for complex and emerging conditions. Encouraging patients to follow up regularly with their primary care physician and specialists for both new and ongoing symptoms ensures continuity of care and better management of their condition.”
Pharmacists can help manage complications that arise from long COVID because no medications can currently treat the condition. For cardiac symptoms, pharmacists can ensure that patients adhere to their cardiac medications, including β-blockers, antiplatelet therapy, and statins. Richardson added that pharmacists can work closely with other health care providers to identify any medication-related concerns before they evolve into significant issues for patients.
“Open and accessible communication is crucial in this collaboration. For example, having backline phone number access and utilizing electronic medical record messaging can significantly enhance coordination between pharmacists and other health care providers, ultimately improving patient care,” Richardson said. “Addressing patient concerns requires active and compassionate listening, as many individuals may feel anxious about the unknowns surrounding long COVID. It is important not to dismiss their fears but…to educate and reassure them about the importance of routine follow-ups with their primary care providers.”
