COVID-19 patients may be at an increased risk of cardiovascular impairment, and should be given proven protective anti-inflammatory therapies to aid survival and recovery, according to a study. Researchers from Peking Union Medical College Hospital in China also highlighted the potential problems with drugs currently being administered to fight the novel coronavirus.
The study, published in the journal Frontiers in Cardiovascular Medicine, describes the different ways COVID-19 can trigger serious inflammatory-related cardiovascular problems and provide clinicians with guidance for treating these issues.
"We are the first to comprehensively discuss the application of cardiovascular anti-inflammatory treatments for patients severely affected by COVID-19," said Professor Shuyang Zhang, lead author of the research, based at Peking Union Medical College Hospital Beijing, China. "Our study sets out guidance for the selection of specific cardiovascular anti-inflammatory therapies for COVID-19 patients, depending on the severity of disease and a patient's response to therapy," Zhang said.
The researchers highlight the known risks to the cardiovascular system of treatments currently being tested on patients with COVID-19. The risk of pneumonia and respiratory distress in COVID-19 patients is well known, but there is increasing evidence of severe cardiovascular problems associated with the disease, they said.
"Inflammation plays an important role in the development and complications of cardiovascular diseases and we have seen that COVID-19 patients with greater signs of an inflammatory response are more likely to suffer serious cardiovascular events and are at greater risk of dying," explained Zhang. "We have identified a number of ways that COVID-19 can trigger cardiovascular issues," she said.
Zhang noted that the virus could directly infect and cause inflammation of the heart's tissues, aggravate existing cardiovascular problems, or trigger an over-excessive immune response in the body, often referred to as a 'cytokine storm', which leads to the body attacking itself. By examining current promising COVID-19 treatments as well as cardiovascular anti-inflammatory therapies that have been verified in clinical trials with positive results, Zhang and her colleagues highlight potentially effective treatments and suggest ongoing anti-inflammatory treatment to aid recovery.
"Many clinical trials have been conducted over the past decade to directly test the feasibility of using different anti-inflammatory agents for cardiovascular protection under various conditions, Accumulating evidence supports their ability to improve cardiovascular outcomes," explained Zhang. "Using current knowledge of cardiovascular anti-inflammatory therapies might be of great value in the management of COVID-19 and we recommend referring to this knowledge and experience in clinical practice and conduct related COVID-19 clinical trials," she said.
The researchers warn against using new, pre-clinical drugs for treating COVID-19 because of their unknown efficacy and safety risks. The use of certain anti-viral drugs, some currently under clinical assessment for treating COVID-19, should be used with caution, they said.
"Some drugs currently in use for COVID-19 patients such as lopinavir/ritonavir, interferon-alpha, ribavirin, azithromycin, and hydroxychloroquine may actually increase the risk of cardiovascular impairment," Zhang said.
"Considering that these drugs may be essential in the clinical management of COVID-19 patients, especially the anti-viral agents, cardiovascular protective strategies are urgently needed to improve the overall prognosis," she added.