10 Oct COVID: Long Term Increased Risk of Heart Disease Associated with ABO Blood Type
MedicalResearch.com Interview with:
Dr. Hazen
Stanley Hazen, MD, PhD
Chair, Cardiovascular & Metabolic Sciences
Lerner Research Institute
CoSection head, Preventive Cardiology & Cardiovascular Rehabilitation
Heart, Vascular and Thoracic Institute
Cleveland Clinic
MedicalResearch.com: What is the background for this study?
Response: One of the unique features of COVID is that in some subjects, there unfortunately appear to be long term adverse effects that can occur following resolution of the acute infection. These studies add to the growing body of data showing that COVID-19 infection can enhance risk for experiencing adverse cardiac events (heart attack, stroke, and death) over time.
MedicalResearch.com: What are the main findings?
Response: These studies show that for as long as follow up data was available (out to 3 yrs following acute infection in 2020), there is heightened risk for heart attack, stroke and death. A surprising finding was that the increased risk showed no sign of attenuation. That is – the 2-fold increased risk observed in year 1 following infection, was also seen in year 2, and even year 3 (i.e. between years 2-3 post COVID-19 infection, there was no sign of dissipation in the heightened (2-fold) increased risk for experiencing MI, stroke or death.
This was seen in all subjects independent of age, sex, risk factors for cardiac disease.
Moreover, the more severe the COVID-19 infection, the higher the risk for post COVID-19 heightened cardiac risks. Specifically, subjects who had severe COVID-19 infection (required hospitalization) – were at even higher risk of experiencing a major adverse cardiac event (MACE=MI, stroke or death) over the ensuing 3 yr of follow-up.
We don’t know why COVID-19 leads to increased MACE risk in subjects.
To explore this we looked for genetic causes of the heightened cardiovascular risks (MACE risk) post COVID-19.
We were surprised to observe that known genetic risk factors for heightened coronary artery disease are not involved.
And similarly, the more common genetic factors known to enhance susceptibility to COVID infection were not involved.
We instead found that ABO blood type – a genotype that some early studies indicated could be linked to COVID risk, were involved in the post-COVID-19 heightened MACE risk.
While we observe post-COVID higher incident MACE risk in all subjects, it is especially higher in those with non-O blood types (i.e. higher risk A, B and AB).
This was especially true in the Severe COVID subjects.
In addition- the type of cardiac risk observed was thrombotic events (MI and stroke).
And in sub analyses, we looked at the impact of reported use of low dose aspirin daily among subjects. Notably – those who reported taking aspirin at time of study enrollment were less likely to experience post-COVID-19 thrombotic events and MACE risks.
MedicalResearch.com: What should readers take away from your report?
Response: There are several things one can and should do.
First and foremost – we should look at COVID-19 (especially severe COVID) as a risk factor for heart disease.
Heart disease is the number one killer world-wide. And COVID-19 appears to be impacting the rate of heart disease. With over a billion individuals world-wide having experienced COVID-19 thus far, these studies argue that this is not a small problem- and I hope this serves as a reminder to address global preventive cardiovascular risk reducing efforts.
Our studies focused on those 50 and older. I hope this data stimulates people to ask their physician if there is something more they can be doing to reduce their cardiac risks.
- To check their cholesterol levels.
- To check their blood pressure.
- To be more mindful of what they eat and adopt an exercise program.
Second – For those with established heart disease – the risks associated with COVID-19 and incident MI, stroke and death risk was even greater.
- SO – even more of the above.
- More aggressive lipid lowering (LDLc goals) are recommended.
- Are you on low dose aspirin (as long as there is no clear contra-indication).
- If you have diabetes, are you on one of the newer drugs that helps lower cardiac risks?
- Is your blood pressure well controlled ?
- What about exercise and diet efforts- these are a critical part of reducing one’s risk for adverse cardiovascular events.
Third – And this is speculative – I think it reasonable to consider low dose enteric coated aspirin in subjects who experienced severe COVID infection who are primary prevention – as long as there is no clear contraindication (history of GI bleeding, ulcers, GI reflux disease).
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: This really needs to be evaluated with new prospective randomized clinical trials.
No disclosures.
Citation:
COVID-19 Is a Coronary Artery Disease Risk Equivalent and Exhibits a Genetic Interaction With ABO Blood Type
James R. Hilser, Neal J. Spencer, Kimia Afshari, Frank D. Gilliland, et al.
ATVB. Wolters Kluwer Health, Inc.
Oct 9, 2024
https://www.ahajournals.org/doi/10.1161/ATVBAHA.124.321001
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Last Updated on October 10, 2024 by Marie Benz MD FAAD