Coronavirus pandemic: People with heart disease, diabetes have worst outcomes, should remain alert
Heart disease, diabetes, and high blood pressure are so common that most people likely know someone who has at least one of these conditions. And scientists have now crunched the numbers to show which of these underlying health conditions could be most fatal for people infected with the new coronavirus (COVID-19).
The virus tears apart lungs, but experts say people with heart disease and diabetes have more reasons to be alert. The reason: according to a study, the death rate -- known as the case fatality rate -- was highest among people who had cardiovascular disease (CVD) as a preexisting medical condition at 10.5%. This is followed by those with diabetes 7.3%, 6.3% for chronic respiratory disease, 6.0% for hypertension, and 5.6% for cancer, say researchers in their findings published in JAMA.
Why these numbers are particularly worrisome for the US is because 6 in 10 Americans adults have a chronic disease, while 4 IN 10 adults in the US have two or more.
As of March 16, over 1,770 cases have been reported in the US, and 69 have died. Globally, over 6,500 have died, and 169,385 have fallen sick.
Previous studies have shown that the elderly, especially those with underlying medical conditions, are at the highest risk if they get infected with COVID-19.
According to a study published by the Chinese Center for Disease Control and Prevention -- which analyzed 72,314 cases till February 11 -- those who are 80 and above had the highest case fatality rate of all age groups at 14.8%. The next age group impacted are patients 70-79 years, for whom the case-fatality rate was 8.
“The overall case-fatality rate (CFR) was 2.3% (1,023 deaths among 44,672 confirmed cases). No deaths occurred in the group aged 9 years and younger, but cases
in those aged 70 to 79 years had an 8.0% CFR and cases in those aged 80 years and older had a 14.8% CFR,” says the study.
This seems to be a disease that affects adults, and most seriously older adults, says the US CDC. “Starting at age 60, there is an increasing risk of disease and the risk increases with age. The highest risk of serious illness and death is in people older than 80 years. People with serious underlying health conditions also are more likely to develop serious outcomes including death. The people who are at greatest risk are those older and who also have serious long-term health conditions like diabetes, heart disease, or lung disease,” says the US CDC.
The agency has also issued guidelines for people who are at higher risk for serious illness. It asks people who are and/or have underlying illnesses, to avoid large crowds, mass gathering because those are places where, in general, there is “lots of transmission of respiratory diseases.”
(AP Photo/John Antczak)
According to the American Heart Association, based on early reports, 40% of hospitalized COVID-19 patients had cardiovascular disease or cerebrovascular disease (which refers to blood flow in the brain, such as stroke).
Orly Vardeny, associate professor of medicine at the Minneapolis VA Health Care System and the University of Minnesota explains that the numbers do not mean people with heart disease are more likely to contract the coronavirus. "It just means that those folks are more likely to have complications once they do get it," she says.
In another study, researchers studied adult patients, who were hospitalized in Jinyintan Hospital and Wuhan Pulmonary Hospital with COVID-19 before January 31. The study, published in The Lancet, included 191 inpatients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) in the final analysis. The study shows that 54 patients died during hospitalization and 137 were discharged.
The experts found that comorbidities were present in nearly half of patients, with hypertension being the most common comorbidity, followed by diabetes and coronary heart disease.
“91 (48%) patients had a comorbidity, with hypertension being the most common (58 patients), followed by diabetes (36 patients) and coronary heart disease (15 patients),” says the study.
The analysis shows that among patients who had coronary heart disease (15 or 8%), 13 (24%) died and 2 (1%) survived. Similarly, among diabetic people (36 or 19%), 17 (31%) people died and 19 (14%) survived. Among those who had hypertension as a preexisting condition (58 or 30%, 26 (48%) passed away and 32 (23%) survived.
How does the virus attack people with underlying illnesses?
Patients with underlying medical conditions are more likely to suffer severe illness and even die because their immune systems are weaker. And people with compromised immune systems are especially vulnerable to respiratory infections, say experts. A 2018 study published in the New England Journal of Medicine found that within seven days of a flu diagnosis, people were six times more likely to have a heart attack.
“Patients with cardiovascular disease are especially vulnerable to respiratory infections, although uncertainty remains on just what damage COVID-19, caused by the coronavirus, can do in these patients. The American College of Cardiology (ACC) is steadfast in its reminder that viral respiratory infections can have a greater effect on patients with cardiac issues, especially in light of the flu and coronavirus spreads,” say experts from the American Journal of Managed Care.
Vardeny explains that the virus could affect heart disease patients in several ways. In many patients with COVID-19, the lungs are unable to receive enough oxygen, which could impact other organs.
“The virus's main target is the lungs. But that could affect the heart, especially a diseased heart, which has to work harder to get oxygenated blood throughout the body. In general, you can think of it as something that is taxing the system as a whole," she says. This could exacerbate problems for someone with heart failure, where the heart is already having problems pumping efficiently.
Someone with an underlying heart issue might also have a less robust immune system. “People's immune systems weaken as they age. And in those with chronic medical conditions, the body's immune response is not as strong a response when exposed to viruses,” says Vardeny.
For people with underlying heart issues, the concerns are so serious that the American College of Cardiology (ACC) issued a bulletin in February to warn patients about the potential increased risk and to encourage additional, reasonable precautions. It recommends people with CVD to remain current with vaccinations, and says such patients should be vaccinated against influenza.
According to experts from the International Diabetes Federation, when people with diabetes develop a viral infection, it can be harder to treat due to fluctuations in blood glucose levels and, possibly, the presence of diabetes complications.
“There appear to be two reasons for this. Firstly, the immune system is compromised, making it harder to fight the virus and likely leading to a longer recovery period. Secondly, the virus may thrive in an environment of elevated blood glucose,” says the Federation.
The American Diabetes Association explains that in general, people with diabetes are more likely to experience severe symptoms and complications when infected with a virus. The experts say there is currently no reason to believe that COVID-19 will pose a difference in risk between type 1 and type 2 diabetes. “The problem people with diabetes face is primarily a problem of worse outcomes, not greater chance of contracting the virus. In China, where most cases have occurred so far, people with diabetes had much higher rates of serious complications and death than people without diabetes,” it says.
The ACC recommends that it is reasonable to triage COVID-19 patients according to underlying cardiovascular, diabetic, respiratory, renal, oncological, or other comorbid conditions for prioritized treatment.