'A sicker nation': COVID causing increases in heart disease in U.S., studies show

Death rates from heart disease, the number one killer in the U.S. and the world since 1950, were finally starting to drop. They hit record lows in 2019, an 11.65% decrease since 2009, according to the federal Centers for Disease Control (CDC).

Then the COVID-19 pandemic hit and erased 10 years of progress, Dr. Susan Cheng, a cardiologist at Cedars-Sinai Medical Center in Los Angeles, told the Associated Press. Studies are only now starting to get a real sense of how the wildly infectious virus has affected the nation's heart health.

“We are seeing effects on the heart and the vascular system that really outnumber, unfortunately, effects on other organ systems,” Cheng said.

Heart attack-caused deaths rose during every COVID surge, and Cheng's research found a nearly 30% increase in heart attack deaths among 25- to 44-year-olds in the first two years of the pandemic.

“We’re about to exit this pandemic as even a sicker nation” because of virus-related heart trouble, said Washington University’s Dr. Ziyad Al-Aly. The consequences, he added, “will likely reverberate for generations.”

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What is heart disease?

Heart disease, or cardiovascular disease, is the common name for several types of heart conditions. The most common is coronary artery disease, according to the CDC, which affects blood flow to the heart and can lead to heart attacks.

What is the rate of heart disease in Florida?

According to the Florida Department of Health, heart disease accounts for about two out of every 10 deaths in the state.

"In 2020, 5.2% of Florida adults had a heart attack, corresponding approximately to 902,642 individuals," the site says.

How does COVID affect the heart?

COVID-19 is a viral infection that primarily attacks the respiratory system, but it can also affect other areas of the body and cause temporary or lasting damage. For up to a year after contracting even a mild case of COVID-19, a person may be at increased risk for heart-related problems such as blood clots, irregular heartbeats and even heart attacks, the AP reported.

According to Wendy Susan Post, M.D., M.S. and Nisha Aggarwal Gilotra, M.D. at Johns Hopkins Medicine, COVID can cause heart damage in several ways:

Lack of oxygen: The virus causes inflammation and fluid in the air sacs in the lungs and this can block oxygen from reaching the bloodstream. That forces the heart to work harder, which can be dangerous for people with preexisting heart problems.

Myocarditis: The coronavirus may infect and damage the heart muscle directly and cause inflammation. The virus may also cause blood vessel inflammation which can restrict blood flow to the heart and elsewhere,

Stress cardiomyopathy: Viral infections can stress the body and cause it to release a surge of chemicals called catecholamines, which can stun the heart. That affects the heart’s ability to pump blood effectively.

Cytokine storm: The human body released proteins called cytokines to fight invading viruses. For some people, so many cytokines are released that they overwhelm the body, causing inflammation, destroying healthy tissue and damaging organs such as the kidneys, liver and heart.

A type 1 heart attack is rare during or after COVID infection, Post said, but type 2 attacks are more common.

“This heart attack can be caused by increased stress on the heart such as a fast heartbeat, low blood oxygen levels or anemia," she said, "because the heart muscle isn’t getting enough oxygen delivered in the blood in order to do this extra work. We have seen this in people with acute coronavirus disease, but it is less common in those who have survived the illness.”

Has COVID increased the rate of heart disease?

Al-Aly analyzed medical records from a massive Veterans Administration database, AP reported.

"People who'd survived COVID-19 early in the pandemic were more likely to experience abnormal heartbeats, blood clots, chest pain and palpitations, even heart attacks and strokes up to a year later compared to the uninfected," AP's Lauren Neergaard said. "That includes even middle-aged people without prior signs of heart disease.

"Based on those findings, Al-Aly estimated 4 of every 100 people need care for some kind of heart-related symptom in the year after recovering from COVID-19," Neergaard said.

Are people with pre-existing heart conditions more susceptible to COVID?

"Stroke survivors and those with heart disease, including high blood pressure and congenital heart defects, may face an increased risk for complications if they become infected with the COVID-19 virus," according to the American Heart Association.

While anyone can be at risk for contracting COVID-19, people with some pre-existing medical conditions are at a greater risk of serious complications or death from the virus. For heart conditions, that can include heart failure, coronary artery disease, cardiomyopathies, and possibly high blood pressure (hypertension). Anyone with these conditions such take special care.

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Do COVID vaccines affect the heart or cause heart attacks?

A common claim from COVID skeptics and anti-vax commenters is that there is a link between COVID-19 vaccines and cardiac issues. There are claims that the FAA changed guidelines to account for the possibility of sudden incapacitation of vaccinated pilots, that COVID-19 vaccines caused five more times myocarditis than the virus itself and that the FDA acknowledged a link between vaccines and heart attacks and sudden deaths. All of these have been debunked.

There was a kernel of truth, however. In 2022, the CDC said that a small number of cases of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the outer lining of the heart) had been reported in adolescents and young adult males within several days of getting an mRNA (Pfizer-BioNTech or Moderna) COVID-19 vaccination. Usually after the second dose, the agency said, usually within a week, and most patients who received care felt better quickly.

In October 2022, Florida Surgeon General Joseph A. Ladapo generated controversy when he issued new guidance recommending that males ages 18 to 39 avoid the vaccine because of a study on the heart disease dangers. A task force of his own colleagues at the University of Florida reported that his Ladapo's research was flawed and that he committed “reporting bias by cherry picking results; focusing only on evidence that supports his stance, ignoring contradicting evidence and failing to appropriately acknowledge the limitations of his own data set.”

Instead, studies have shown that COVID-19 leads to a much higher risk of myocardial infarction and ischemic stroke, and the percentage of vaccination-related heart issues is extremely small in comparison.

In December, researchers in the Smidt Heart Institute at Cedars-Sinai verified that a small percentage of patients vaccinated developed postural orthostatic tachycardia syndrome, or POTS. They also found that people diagnosed with COVID were five times as likely to develop the same cardiac condition.

What are the symptoms of heart disease after COVID?

Shortness of breath, chest pains or palpitations after COVID infection could be reason for concern, Johns Hopkins' Dr. Post said, but they also can be due to other factors. COVID symptoms also can mimic the symptoms of a heart attack.

If you have shortness of breath that's worse when you're lying down or exerting yourself, accompanied by fatigue or ankle swelling, you may want to call your doctor. If you experience a sudden shortness of breath, bluish lips or face and an oxygen saturation level under 92%, call 911.

Chest pain that is persistent but not severe, that increases in frequency and resolves in under 15 minutes, or that happens when you exert yourself but goes away when you rest should be reported to your doctor. Call 911 for severe chest pain, chest pain accompanied by nausea, shortness of breath or sweating, or sudden chest pain with shortness of breath lasting more than five minutes.

This article originally appeared on The Daytona Beach News-Journal: COVID-19 stopped decrease in U.S. heart disease cases, study shows