Breaking! Swedish Study Shows That COVID-19 Is Now A Key Driver For Heart Attacks and Strokes!
Despite many warnings by Thailand Medical New since the mid of last year that the COVID-19 disease was being a high risk factor for getting a stroke or a heart attack for not only for those that were affected but also those who were deemed recovered, many researchers and even doctors simply ignored us. Worse, certain American researchers even went to the extent of saying that this was not true and downplayed the risk that SARS-CoV-2 had on heart issues or strokes.
Thailand Medical New had also asked for many health authorities from various countries to review excess deaths during this pandemic especially those relating to strokes and heart failures, but again this was turned down.
In the last 3 months however more evidence is coming to light that there has been so many deaths from heart failures and strokes in normally healthy young adults and more published research is showing that anyone who contracted the SARS-CoV-2 coronavirus, whether they were asymptomatic or had mild or even moderate conditions should continue to go for continuous health check- ups to make sure that they do not suffer a heart attack or stroke.
Interestingly a new study by researchers from the Umeå University in Sweden provides the strongest evidence to date that COVID-19 is an independent risk factor for acute myocardial infarction (MI) and ischemic stroke.
According to the research team led by Dr Ioannis Katsoularis from the department of Public Health and Clinical Medicine, Umeå University, the risk for acute MI and ischemic stroke increased by roughly eightfold and sixfold, respectively, in the first week following onset of COVID-19 when day 0 (exposure day) was included in the analysis. Even when day 0 was excluded (reducing the risk for bias), the risk for acute MI and stroke was increased by roughly threefold.
Senior author Dr Anne-Marie Fors Connolly, MD, PhD, also from Umeå University, told Thailand Medical News, "The fact that the risk is still increased even when day 0 is excluded indicates that COVID-19 is indeed an independent risk factor for acute myocardial infarction
and ischemic stroke. Our study findings indicate that acute cardiovascular complications might represent an essential clinical manifestation of COVID-19 and the long-term effects might be a challenge for the future."
The study findings were published in the peer reviewed journal: The Lancet https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00896-5/fulltext
Numerous past studies that have suggested that COVID-19 is a "probable" risk factor for acute cardiovascular complications involved relatively few hospitalized patients.
However this study can be considered to be the largest study to date to investigate this association.
The study team linked data from national registers for outpatient and inpatient clinics and the cause of death register for all 86,742 patients (median age, 48 years; 43% male) with COVID-19 between February 1 and September 14, 2020, and 348,481 matched control patients.
The team then used two methods to assess the association of COVID-19 with risk for acute MI and stroke.
The first involved a self-controlled case series (SCCS) method, which was used to compare incidence rate ratios (IRRs) for first acute MI and stroke before and after patients were determined to have COVID-19.
The second approach was a matched cohort study, which determined the odds of acute MI or stroke in the 14 days after COVID-19 onset in comparison with control individuals who had not been diagnosed with COVID-19.
As the date of infection was unknown, the researchers identified the closest date possible and denoted it as day 0 (exposure date).
The study tea reported that there was a large peak in cases of both acute MI and ischemic stroke recorded on day 0.
In the self-controlled case series (SCCS), when day 0 was included in the risk period, the IRR for acute MI was 8.44 (95% CI, 5.45 – 13.08) in the first week, 2.56 (95% CI, 1.31 – 5.01) in the second week, and 1.62 (95% CI, 0.85 – 3.09) in weeks 3 and 4 following COVID-19.
However when day 0 was excluded from the risk period, the IRR for acute MI remained significantly elevated in the first week (IRR 2.89; 95% CI, 1.51 – 5.55) and second week (2.53; 95% CI, 1.29 – 4.94) following COVID-19. The IRR was 1.60 (95% CI, 0.84 – 3.04) in weeks 3 and 4 following COVID-19.
Interestingly the corresponding IRRs for ischemic stroke when day 0 was included in the risk period were 6.18 (95% CI, 4.06 – 9.42) in the first week, 2.85 (95% CI, 1.64 – 4.97) in the second week, and 2.14 (95% CI, 1.36 – 3.38) in weeks 3 and 4 following COVID-19.
Again when day 0 was excluded from the risk period, the corresponding IRRs for stroke were 2.97 (95% CI, 1.71 – 5.15) in the first week, 2.80 (95% CI, 1.60 – 4.88) in the second week, and 2.10 (95% CI, 1.33 – 3.32) in weeks 3 and 4 following COVID-19.
Importantly the matched cohort analysis provided similar results; this time expressed as odds ratios (ORs).
The study findings showed that including day 0, the odds ratio (OR) was 6.61 (95% CI, 3.56 – 12.20) for acute MI and 6.74 (95% CI, 3.71 – 12·20) for ischemic stroke in the 2 weeks following COVID-19.
However excluding day 0, the ORs were 3.41 (95% CI, 1.58 – 7.36) and 3.63 (95% CI, 1.69 – 7.80) for acute MI and stroke, respectively, in the 2 weeks following COVID-19.
Dr Connolly further commented, and explained "The day 0 has been a cause of discussion between clinicians and statisticians during this study. The study team argued that all events should be included, since we believe it is part of the clinical disease presentation.”
However Professor Emeritus Paddy Farrington, PhD, a statistician of the Open University Milton Keynes-United Kingdom, and a key collaboration partner in the study team "argued that day 0 should be excluded because it represents a bias ie seeking healthcare likely precipitates testing for SARS-CoV-2 infection and therefore introduces a test bias that potentially inflates the observed risk.”
Dr Connolly however emphasizes that the observation that the risk for acute MI and stroke remains elevated when day 0 is excluded shows that COVID-19 is an independent risk factor for acute MI and ischemic stroke.
Importantly in the matched cohort study, for each weighted Charlson comorbidity index point, the odds of acute MI and ischemic stroke increased approximately 40%.
The study team warned that the findings reinforce the importance of getting vaccinated against COVID-19, particularly for elderly people with comorbid conditions, to avoid potential acute cardiovascular events.
Dr Connolly added, “Acute myocardial infarction and stroke could be an extrapulmonary manifestation of COVID-19; therefore, this is good to keep in mind for clinicians who see these types of patients."
Medical and research professionals of an accompanying comment note that the transient increase in the risk for myocardial infarction and stroke in association with influenza, pneumonia, acute bronchitis, and other chest infections has been known for decades.
Dr Marion Mafham, MD, and Colin Baigent, FMedSci, of the University of Oxford, Oxford, United Kingdom commented, "It seems reasonable to infer that the persistence of risk for several weeks after SARS-CoV-2 infection is consistent with COVID-19 causing an increased risk of thrombo-occlusive disease, as has been reported for other respiratory infections."
They also write that further studies are needed to evaluate the time course of increased cardiovascular risk for patients with COVID-19 and to investigate possible mechanisms.
They added, "However, it is important to keep in mind that the excess risks of myocardial infarction and stroke in a person with COVID-19 are substantially smaller than those resulting from respiratory failure.”
Thailand Medical News strongly recommends that all that have been diagnosed with a SARS-CoV-2 infection, should constantly go for frequent health checkups irrespective if they were asymptomatic or had mild or moderate conditions only or have been deemed as ‘recovered’ as the risk form strokes and heart attacks are extremely high.
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