Cardiovascular deaths rose in first years of COVID, study says. Experts have ideas why

Deaths from cardiovascular diseases rose during the first two years of the pandemic and peaked when COVID-19 deaths did in the U.S., a new study found.

These deaths occurred across five waves of COVID-19 deaths from March 2020 to March 2022, according to the peer-reviewed research published in the journal Nature Cardiovascular Research on Feb. 27.

Researchers from Shanghai and Hong Kong offer possible reasons for why the rise in cardiovascular deaths was seen in data from the Centers for Disease Control and Prevention’s National Center for Health Statistics.

The U.S. saw 90,160 more cardiovascular deaths than expected during the first two years of COVID-19, according to the study. There were nearly 5% more “excess deaths” due to cardiovascular diseases, with the most prevalent ones identified as ischemic heart disease, hypertensive disease, cerebrovascular disease and other circulatory system diseases, the researchers wrote.

In total, over 1.9 million cardiovascular disease deaths were documented by the NCHS during the study period, the work noted.

Potential explanations for the rise in these deaths, according to the researchers, include the strain COVID-19 placed on the healthcare system, which indirectly disrupted emergency cardiovascular care. Additionally, people experiencing cardiovascular issues may have been hesitant in seeking treatment, or avoided it, over concerns about catching COVID-19 in a medical setting.

In April 2021, the Department of Health and Human Services reported how the pandemic affected access to healthcare, including the postponement of in-person office visits and procedures for patients across the U.S. Additionally, it noted that at the time, emergency department visits were substantially lower.

“A nationwide or regional lockdown may lead to increased physical inactivity, poor dietary intake, interruption of long-term disease management, income loss and so on,” the authors wrote in providing more context on the excess cardiovascular deaths.

Heart issues experienced after contracting COVID-19 may also have a “profound impact,” the researchers said, based on emerging evidence.

COVID-19 infection is linked to lingering health issues, including heart problems, which are among the most common long COVID symptoms, according to the CDC.

The study noted prior research that found a COVID-19 infection creates a greater risk of subsequently developing cardiovascular diseases, citing two studies published by Dr. Ziyad Al-Aly, a clinical epidemiologist studying long COVID and the director of the Clinical Epidemiology Center at Washington University in St. Louis, and others.

“I think we need to start conceptualizing and thinking of COVID as a risk factor for heart disease,” Al-Aly said in a Feb. 10 interview with U.S. News & World Report.

Experts weigh in

Dr. Eric Topol, a cardiologist and the founder and director of the Scripps Research Translational Institute, shared the new study on Twitter on Feb. 27, prompting other health experts to weigh in on the findings.

Stefano Fedele, a professor of oral medicine at the University College London’s UCL Eastman Dental Institute, said he was “perplexed” the authors didn’t attribute the risks of cardiovascular diseases after a COVID-19 infection as one of the main, potential reasons for the excess deaths in reply to Topol, who wrote that he agreed.

The study authors wrote “further evaluation” is needed on the matter to “disentangle the excess (cardiovascular disease) deaths attributed to interrupted healthcare systems” and heart issues arising after a COVID-19 infection.

The study comes after the American Heart Association reported the largest jump in deaths due cardiovascular-related causes in 2020, the first year of the pandemic in the U.S., since 2003 on Jan. 25.

Data from the CDC showed a major rise “in the loss of lives from all causes since the start of the pandemic,” Dr. Michelle Albert, the American Heart Association’s volunteer president, said in a statement. “That this likely translated to an increase in overall cardiovascular deaths, while disheartening, is not surprising.”

“COVID-19 has both direct and indirect impacts on cardiovascular health.”

Dr. Paul Whelton, a professor of epidemiology at Tulane University, told McClatchy News over email that major life-altering events such as Hurricane Katrina or the tsunami that devastated Japan in 2011 have disrupted healthcare, resulting in adverse health outcomes.

In New Orleans, following Katrina, “this has included worsening of many (factors) associated with (cardiovascular disease) and long-term worsening of (cardiovascular disease) outcomes,” Whelton said.

More on the study

The researchers identified the five waves of COVID-19 deaths during the first two years of pandemic using the CDC’s weekly surveillance data.

They found the two major peaks of cardiovascular deaths during the early pandemic occurred from March 2020 through June 2020 and June 2021 through November 2021. This coincided with two peaks of COVID-19 deaths.

There was a higher percentage of excess cardiovascular deaths among males than among females, authors noted.

Additionally, the highest excess death rates were seen among individuals who were Black, followed by Hispanic, Asian and white people, according to the study.

Prior to the work, research examining the differences in the cardiovascular deaths across different COVID-19 waves was lacking, according to authors, who wrote they now “fill the gap” with the study.

The trends in cardiovascular deaths during the waves studied “can be partly explained by the combined effects of transmission dynamics of different variants, politics for disease control, population immunity and reallocation of cardiovascular services,” authors wrote. “First, the five COVID-19 waves had their specific dominant SARS-CoV-2 variants with different virulence and transmissibility, which may partly contribute to different magnitudes of pandemic severity.”

For example, while weekly COVID-19 incidences were lower during the first wave of March 2020 through June 2020, cardiovascular deaths were particularly high, according to the study. This was possibly due to how “the healthcare systems were underprepared” with the onset of the pandemic.

Overall, study authors wrote that their work emphasizes the urgent need to expand healthcare resources for treating cardiovascular issues and chronic diseases.

Some study limitations included how the data only included deaths with cardiovascular disease as the documented cause. Authors noted it’s likely the deaths of people experiencing both COVID-19 and cardiovascular problems before they died were only documented as COVID-19 deaths.

The virus can also trigger heart issues “such as myocarditis, sudden cardiac death, heart failure and so on, resulting in additional deaths associated with (cardiovascular disease),” the authors said.

“Our data was limited to differentiate the two situations.”

Cardiovascular diseases are the leading cause of death across the globe, and most cardiovascular disease deaths are from heart attacks and strokes, according to the World Health Organization.

The research received funding from the Shanghai Science and Technology Development Foundation and the Health and Medical Research Fund in Hong Kong.

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