Why A COVID-19 Infection Is Risky for Heart Health
PGN talked with a cardiologist in Dallas, Texas, about vaccine safety and considerations for those with heart disease.
Getting vaccinated is a safe and effective way to protect your heart.
Still, across the country, community health workers often face questions and concerns about vaccine safety and myocarditis, or heart inflammation. Ample research shows that myocarditis after vaccination is extremely rare and people are much more likely to have heart problems after a COVID-19 infection than after vaccination.
Public Good News recently spoke to Dr. James A. de Lemos, executive editor of the American Heart Association Journals and chief of the Division of Cardiology at UT Southwestern Medical Center, to gain insights about clinical research and how it can be leveraged for community messaging.
Here’s what he said.
PGN: What have you gleaned about heart health among people who have had COVID-19?
Dr. James A. de Lemos: The risk of heart complications with a COVID-19 infection is substantial.
I started and led the AHA’s COVID-19 Cardiovascular Disease Registry very early in the pandemic. We collected tens of thousands of patients who had COVID-19 and then cataloged the development of their heart problems during the different phases of the pandemic.
In the earlier phases of the pandemic, when people were getting really sick and hospitalized, we were seeing congestive heart failure, electrical abnormalities, arrhythmias, and a lot of blood-clotting disorders related to COVID-19.
We learned that the body’s immune response to COVID-19 led to blood clots in the small blood vessels—called the microcirculation, that you can't really see often—that led to damage of the heart muscle, which is common in very sick COVID-19 patients whose heart muscles are damaged, potentially permanently.
As vaccination took hold and the virus changed and the severity reduced, then, fortunately, the severity of some of these heart complications reduced.
But beyond what we’ve seen in the hospital, it was also clear that people who were infected with the COVID-19 virus—even if not hospitalized, some were moderate and mild COVID-19 infections—had higher rates of heart complications over the next year. Risks of heart attacks and strokes were higher in people who had been infected with the COVID-19 virus, even up to a year later.
PGN: How can community health workers help deliver accurate information about myocarditis and vaccinations to the people they serve?
J.L.: I think the best way is by coming back to the evidence and being honest and transparent about the fact that yes, it is true that with all types of vaccinations, myocarditis—while quite rare, does occur. It’s more common in young men and in adolescents—it’s rare, it’s usually mild, and self-limited—but it may happen.
People only talk about myocarditis related to the vaccine, but it’s actually 11 times more common with a COVID-19 infection itself than it is with a vaccination.
Basically, vaccination is like buying insurance, right? You’re investing in the future, and if you do the math, the numbers add up to it being tremendously favorable for vaccination.
People forget that COVID-19 contributes to increased heart attack risk. And by preventing a COVID infection, you prevent heart attacks, you prevent myocarditis, you prevent heart failure, as well as all the morbidity from the infection itself.
It feeds into human nature that we’re skeptical of authorities and now skeptical of medical advice and medical authorities. That’s the challenge when you’re working with communities: How do you get past that? I think some of it is having to figure out who community members trust, because it might not be me. Even though I’ve done research in this space, and I can stand up and give the numbers.
It has to be figuring out who people in the community would look to as a source of trusted information, rather than trying to convince them to trust us.
PGN: How does preventing heart disease overall factor in? What can community health workers consider?
J.L.: Many people in our communities don’t like to exercise. If they did, they would have been doing it already. So, if you’re working in communities you could simplify the message about exercise and activity to remind people that they don’t have to huff and puff and sweat, they just have to get moving.
I think the biggest thing is just trying to motivate people and remind them that it doesn’t have to be unpleasant or a major initiative to get started.
In many ways, it’s easier to talk about exercise, but I think it’s important to highlight better food choices and remind people that now, for the first time, there’s real evidence; and it's very clear that obesity is a modifiable and reversible risk factor for heart disease complications.
So, obviously, there are dietary nutritional approaches and exercise, but there are also medications.
Other messages really revolve around knowing your numbers. It’s essential for community workers to make sure people know what their blood pressure is. Do they know what their cholesterol is? If they’re abnormal, are those being addressed?
Because even as we near 2024, awareness, treatment and control of these classic cardiovascular risk factors is not where it needs to be.
And, candidly, those interventions will have greater effects than vaccination on cardiovascular disease, for sure.
In fact, many of those interventions lower risks if you get COVID-19. Because people do worse when they get sick with COVID-19 and other viral infections if they have these risk factors, obesity, hypertension, and such.
It’s hard for people who have stressful lives and have a lot immediately in front of them to invest in things when they feel ok, because prevention is inherently difficult. It’s like, ‘I’ve got bills, kids, work, and all these other life stressors, you know, the last thing on my list is preventing a heart attack in 15 or 20 years.’
But when you tie in the fact that many of these things that you’re going to do—like stopping smoking, losing weight, and exercising—are not only going to help you live longer without heart disease, but you’re going to feel better in the short term and feel better about yourself, trying to sort of tie all that together in a holistic wellness approach that has long term benefits may be a way to go.