Cardiovascular Disease in COVID-19 Patients by Geographic Location

Angiotensin-converting enzyme 2 (ACE2)is a membrane bound protein that functions as a receptor for SARS-CoV-2. Since ACE2 is found in the lungs and heart, systemic inflammatory response triggered by the virus will target those tissues, leading to damage in myocardial cells. This will lead to an increase in cardiovascular symptoms in COVID-19 patients. 

- RAAS and COVID-19 
- ACE Inhibitors and Angiotensin Receptor Blockers 
- Troponin 

Molecular Underpinnings of COVID-19 and the Cardiovascular System

- Myocardial injury (injury to the muscular tissue of the heart)
- Myocarditis (inflamed heart muscle tissue)
- Myocardial infarction (heart attack)
- Heart failure
- Dysrhythmias (Irregular heart rhythm)
- Venous thrombosis (blood clotting)
- Aortic thrombosis
- Heart palpitations 
- Chest tightening 
- Endothelial dysfunction
- Systemic inflammation 

Cardiovascular Complications & Symptoms Associated with COVID-19

- This paper provides a rough summary of the possible induced injuries caused by the comorbidity of cardiovascular disease and COVID-19
- The paper also details some cardiovascular manifestations of COVID-19 by providing some examples of lasting various cardiovascular conditions that can be brought on by the virus itself
- Some direct injuries caused by the comorbidity include direct myocardial injury, systemic inflammation, altered myocardial demand-supply ratio, plaque rupture and coronary thrombosis, adverse effects to various therapies, and electrolyte imbalances
- The paper also describes that patients with preexisting cardiovascular disease have increased risk of for COVID-19 infection as well as worse overall outcomes compared to non-impaired patients
- The paper also describes how the heightened poorer outcomes may also be due to the fact that many cardiovascular disease comorbid patients are also likely to be comorbid with other illnesses such as diabetes or hypertension which also lead to poorer COVID-19 outcomes
- The cardiovascular manifestations described by the paper include acute myocardial injury, arrhythmias,  as well as a short discussion on long term abnormal lipid metabolisms


Cardiovascular Disease and COVID-19 - General Summary

Cardiovascular disease is a risk factor for severe COVID-19, and COVID-19 causes cardiovascular complications. 

University of Michigan - Ann Arbor

Smith College

Michigan State University

Patients with COVID-19 are likely to experience symptoms that can be attributed to  the virus affecting the cardiovascular system. Common complications to the system include arrhythmia, cardiac injury, fulminant myocarditis, heart failure, pulmonary embolism, and disseminated intravascular coagulation. Severe cases of COVID-19 may lead to lasting cardiac damage and those with pre-existing cardiac issues are likely to have worse prognoses. 

Effects of COVID-19 on the Cardiovascular System 

COVID-19 comorbidities are high risk conditions that put patients at greater risk for infection and negative outcomes. Some COVID-19 comorbidities have been found to be: 
- Cancer 
- Cardiovascular Disease
- Diabetes
- Digestive Diseases
- HIV
- Hypertension
- Immunological Disease
- Liver Injury
- Obesity
- Renal disease
- Respiratory System Disease

COVID-19 Patient Comorbidities

- According to the WHO, "Cardiovascular disease is the name for the group of disorders of heart and blood vessels."  
- As per WHO, cardiovascular disease includes hypertension, coronary heart disease, cerebrovascular disease,  peripheral vascular disease, heart failure, rheumatic heart disease, congenital heart disease, and cardiomyopathies. 
- Cardiovascular disease is a risk factor for severe COVID-19, and COVID-19 causes cardiovascular complications. 

Cardiovascular disease 

Wikipedia

Cardiovascular Disease and COVID-19

- AIDS and Behavior
- American Journal of Cancer Research
- American Journal of Hypertension
- American Society of Clinical Oncology Journals
- Annals of Allergy, Asthma & Immunology
- Annals of Internal Medicine
- Annals of Oncology
- Blood Advances
- BMC
- Brain, Behavior, and Immunity
- Cancer Discovery
- Cell Metabolism
- Clinical Immunology
- Clinical Infectious Diseases
- Clinical Reviews in Allergy & Immunology
- Clinical Transplantation
- Cureus
- Diabetes Care
- Diabetes & Endocrinology
- Diabetes & Metabolic Syndrome: Clinical Research & Reviews
- Diabetes, Obesity, and Metabolism
- Diabetes Research and Clinical Practice
- EClinicalMedicine
- European Journal of Cardio-Thoracic Surgery
- European Journal of Clinical Nutrition
- European Respiratory Journal
- Frontiers in Medicine 
- Frontiers in Public Health
- Gut
- Haematologica
- International Journal of Infectious Diseases
- International Journal of Obesity
- Journal of Alzheimer’s Disease
- Journal of American Nephrology
- Journal of Clinical Medicine
- Journal of Endocrinological Investigation
- Journal of Infection
- Journal of Infectious Diseases
- Journal of Intensive Care Medicine
- Mayo Clinic Proceedings
- Medicine
- Nature
- Nutrition, Metabolism & Cardiovascular Diseases
- Obesity
- Obesity Research & Clinical Practice
- Oxford Academic Journals
- Paediatric Respiratory Reviews
- Polish Archives of Internal Medicine
- Practical Diabetes
- PRiMER (Peer-Reviewed Reports in Medical Education Research) 
- Proceedings of the National Academy of Sciences 
- Public Library of Science
- The Brazilian Journal of Infectious Diseases
- The Journal of the American Medicine Association Cardiology
- The Journal of Allergy and Clinical Immunology
- The Lancet
- The National Center for Biotechnology Information
- The New England Journal
- Thrombosis Research
- Translational Stroke Research 

COVID-19 Comorbidities References by Journal

COVID-19 may be worse in patients with comorbidities, and this can cause damage to the heart, liver, kidneys, and blood and immune systems. Many patients have had multiple organ failure that started with pneumonia, and became worse when therapeutic effects were unsatisfactory. Comorbidities can cause a patient's deterioration, leading to multiple organ failure. Organ function should be closely monitored and protective measures such as mechanical ventilation, glucocorticoids, antivirals, symptomatic treatments, and anti-shock therapy should be administered if necessary. 

Multiple Organ Injuries in COVID- 19 Patients with Comorbidities

- Implication of Obesity In Patients with COVID-19 
- Obesity in COVID-19 Patients by Geographic Location 
- Risk of Cytokine Storm in Obese COVID-19 Patients
- Higher Concentrations of IL-17 and TNF-α Lead to Greater Respiratory Damage
- Association of Obesity and Age with severe cases of COVID-19
- Association of Obesity and Hospital Stay Length

Obesity as a Comorbidity of COVID-19 

- Hypertension and COVID-19 by Geographic Location
- Hypertension and COVID-19 by Topic

Hypertension as a Comorbidity of COVID-19

- Respiratory System Disease in COVID-19 Patients by Geographic Location 
- Asthma as a Comorbidity of COVID-19

Respiratory System Disease as a Comorbidity of COVID-19

- Clinical Features and Outcomes of Patients With Human Immunodeficiency Virus With COVID-19
- The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective (General Summary of HIV and COVID-19 Interaction)
- Maintaining HIV care during the COVID-19 pandemic
- HIV in COVID-19 Patients by Geographic Location
- COVID-19 and HIV Coinfection

HIV as a Comorbidity of COVID-19

- By country
- Liver Transplantation
- Chronic Liver Disease

Liver Injuries as a Comorbidity of COVID-19 

- This node acts as a general summary of the comorbidity of cancer and COVID-19 from a paper that analyzed many other papers detailing the same thing at its time of release.
- Via a pooled meta-analysis of studies from around the globe analyzing the prevalence of cancer in COVID-19 patients, it was found that the prevalence of cancer in COVID-19 patients is about 2%, which is higher than the overall prevalence of cancer in the population (I think).
- This leads to a hypothesized conclusion that while there is not a lot of data for COVID-19 infection and cancer patients, there is an elevated risk for these patients. However, due to inconclusive and generally lacking data on this topic, this conclusion is not concrete.
- Many major cancer centers worldwide have taken extra precaution when it comes to the treatment of these patients as many cancer treatments (e.g., chemotherapy) weaken the immune system as a side effect.
- There has currently been no order to withhold chemotherapy, radiotherapy, immunotherapy, or delaying adjuvant therapy to treat cancer patients, however extra care must be taken by patients and physicians alike to not allow these high-risk patients to become infected.

Cancer as a Comorbidity of COVID-19 

Patients with digestive diseases like inflammatory bowel disease (IBD) or gastrointestinal cancer are at a higher risk to experience more severe symptoms of COVID-19. Autopsy studies are important in understanding how COVID-19 affects the digestive system. More data needs to be collected to determine the exact relationship between digestive diseases and COVID-19. 

Digestive Diseases as a Comorbidity of COVID-19

- Cytokine Storm Syndrome
    -  Secondary Haemophagocytic Lymphohistiocytosis
- Common Variable Immunodeficiency 
- Figure illustrating how pathogenic T cells and inflammatory monocytes enter pulmonary circulation and incite an inflammatory storm and immune disorder 
- Severe Combined Immunodeficiency

Immunological Diseases as a Comorbidity of COVID-19

- Prevalence of pathophysiology, prognosis, and practical considerations
- Knowledge in progress
- The link between diabetes and ACE2
- Diabetes in COVID-19 patients by geographic location 
- Degree of Hyperglycemia on COVID-19 mortality
- Diabetes Medication on COVID-19 mortality
- COVID-19 and endocrine diseases. A statement from the European Society of Endocrinology

Diabetes as a Comorbidity of COVID-19

During the COVID-19 era the regular treatment and communication between physicians and patients regarding preexisting comorbidities has been disrupted. New guidelines and safety precautions must be put in place in order for physicians to still treat their patients and treat them through the use of telehealth or other means. While there are a lot of similarities between new communication policies being implemented across different areas of medicine, there are also many differences due to comorbidity specific criteria which facilitates different levels of involvement and communication between physicians and patients.


The comorbidities addressed under this node include:
- Cancer
- Cardiovascular Diseases
- Digestive Diseases
- Elective Surgeries
- Liver Diseases
- Psychological Disorders
- Renal Diseases

Changes to COVID-19 Patient Comorbidity Treatment and Communication

- A retrospective multi-center experience of renal transplants from India during COVID-19 pandemic

Renal Diseases as a Comorbidity of COVID-19

- Summary: This systematic review and meta-analysis is aimed at defining the clinical, electrocardiographic, and pathologic spectrum of cardiovascular disease (CVD), frequency of elevated cardiac and inflammatory biomarkers, and their frequency and relationship with severity of the disease and mortality in COVID-19 patients and to develop a triage risk stratification tool (TRST) that can serve as a guide for the timely recognition of the high-risk patients and mechanism-targeted therapy. Triage Risk Stratification Tool can serve as a guide for the timely recognition of the high-risk patients and mechanism-targeted therapy.
- Method
- Result


Cardiovascular disease in COVID-19: a systematic review and meta-analysis of 10,898 patients and proposal of a triage risk stratification tool

- The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices.
- The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. 
- Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020.  Location in a low-income and lower-middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth.
- COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged.


International Impact of COVID-19 on the Diagnosis of Heart Disease

- Hospitalizations for acute cardiovascular conditions have declined, raising concern that patients may be avoiding hospitals because of fear of contracting severe acute respiratory syndrome- coronavirus-2 (SARS-CoV-2).
- This investigation aimed to evaluate whether population-level deaths due to cardiovascular causes increased during the COVID-19 pandemic.
- The authors conducted an observational cohort study using data from the National Center for Health Statistics to evaluate the rate of deaths due to cardiovascular causes after the onset of the pandemic in the United States, from March 18, 2020, to June 2, 2020, relative to the period immediately preceding the pandemic (January 1, 2020 to March 17, 2020). Changes in deaths were compared with the same periods in the previous year.
- New York City experienced a large relative increase in deaths caused by ischemic heart disease (2.39, 95% confidence interval: 1.39 to 4.09) and hypertensive diseases (2.64, 95% confidence interval: 1.52 to 4.56) during the pandemic. 
- There was an increase in deaths caused by ischemic heart disease and hypertensive diseases in some regions of the United States during the initial phase of the COVID-19 pandemic. 

Cardiovascular Deaths During the COVID-19 Pandemic in the United States

Coronary Artery Disease (CAD) is the second most common form of cardiovascular disease in the United States, according to the American Heart Association. Apart from COVID-19, cardiovascular disease is the leading cause of death in the US, according to the Peterson-KFF Health System Tracker.

Coronary Artery Disease

Hypertension, commonly known as high blood pressure, is a significant cardiovascular disorder and a major risk factor for heart disease. This condition increases the physical strain on the heart by forcing it to pump blood more forcefully. A dangerous aspect of hypertension is that it often presents with no symptoms, leading to its description as the 'silent killer,' as individuals may be unaware they have the condition.

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