This is the second part of a IH Blog series on Cardiovascular Disease.
By Brianna Koenick MPH (c) MMS (c) and Dr. Heather F. McClintock PhD MSPH MSW
More than 670 million people have been infected with COVID-19 worldwide. The pandemic exacerbated health disparities between high-income countries (HICs) and low-income and middle-income countries (LMICs), and the global community is continuing to grapple with the immediate and long-term implications of COVID-19. Long COVID is loosely defined as having symptoms at least two months after the initial infection and lasting for at least four weeks. A longitudinal cohort study conducted in South Africa found 39% of participants showed significant symptoms 6 months after a COVID-19 infection. In the United States, approximately 1 in 7 people have suffered from long COVID according to survey data. Cardiovascular disease (CVD) is a leading cause of death in the U.S. and globally, and substantial evidence suggests that the COVID-19 increases risk for poor cardiovascular outcomes. Researchers suggest that biological, social/psychological, and systemic factors underlie the complex relationship between CVD and COVID-19. Biologically, chronic inflammation and other physiological changes may contribute to increased CVD risk. Impaired social, behavioral and psychological well-being related to contextual influences related to the pandemic exacerbate CVD risk. Further, systemic breakdowns and infrastructure challenges lead to poor access to high quality care and services.
Several systematic literature reviews and meta-analyses have documented a relationship between long COVID-19 and CVD. One of these investigations reviewed 150 studies focused on 57 cardiac complications published between January 2020 to July 2023 that persisted for at least 1 month after a COVID-19 infection. Their meta-analysis included 137 studies that identified 17 complications. They found a high prevalence of many complications, particularly chest pain and abnormal heart rhythms (arrhythmias). The authors noted that there were many CVD complications identified that lasted for years post COVID-19. The World Heart Federation has conducted “the largest global effort to reflect geographic spread” of COVID-19 and CVD aiming to determine the short-and long-term clinical sequelae among COVID-19 hospitalized patients across 16 low-middle-,upper-middle and high-income countries. Findings were presented at the 2023 European Society of Cardiology Conference indicating high post-discharge mortality for persons with COVID-19 in LMICs. Future predictions for CVD in the U.S. from 2025 to 2060 indicate that stroke will increase 33.8%, heart failure will increase 33.4%, ischemic heart disease will increase 30.7%, and heart attack will increase 16.9%. These CVD rate increases are expected to have the biggest impact on Black and Hispanic communities in the U.S. Globally, predictions indicate there will be a 50.2% increase in cardiovascular mortality rates between 2025 and 2050 with an increased burden on LMICs.
Many initiatives and interventions have been implemented to try to reduce the CVD burden in the context of COVID-19. For instance, the U.S. Centers for Disease Control and Prevention developed the Community Health Workers for COVID Response and Resilient Communities initiative (CCR) to “strengthen the public health workforce, slow the spread of COVID-19, and move toward health equity.” Regarding long COVID, the NIH RECOVER Initiative was launched in 2021 and included the largest, most diverse study group to learn more about long COVID in hopes to treat and prevent it moving forward. The World Heart Federation has information and resources related to COVID-19 and CVD including those with practical applications for practicing professionals. While many effective and impactful projects have been implemented, further research and initiatives are needed to understand and address the complex relationship between CVD and COVID-19.
Brianna Koenick MPH (c) MMS (c)
Brianna Koenick is a current student in Arcadia University’s Dual Master of Public Health/Master of Medical Science in Physician Assistant Program. As an MPH student, her capstone research explored the relationship between lifestyle factors and cognitive health outcomes related to dementia. She completed an internship at the Jewish Relief Agency, a hunger-relief organization working to inspire volunteerism across the greater Philadelphia region, where she assisted the client services team with community outreach and developed communication materials for both clients and volunteers. Her public health interests include preventative health, environmental health, and health equity. After graduating, she plans to continue practicing evidence-based public health and advocating for the communities she will serve as a Physician Assistant.
Dr. Heather F. McClintock PhD MSPH MSW
Dr. McClintock is an IH Section Member and Associate Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life Study and Integrating Management for Depression and Type 2 Diabetes Mellitus Study.
IH CONNECT 