4 | CARDIOVASCULAR PROTECTION IN THE COVID-19 PANDEMIC
During the Covid-19 pandemic and post-Covid-19 era (39), it is very
important to do better cardiovascular protection and prevention for not
only confirmed, suspected and recovered cases with CVD but also healthy
individuals. The latter should pay attention to unexpected events. Since
there is a high prevalence of established CVD among hospitalized cases,
and it may easily lead to complications in preexisting cases and an
increased risk of adverse outcomes, and/or myocardial injury due to
pulmonary infection and injury as well as other cardiovascular hazards
(Table 2) (40), and increases the uncertainty of medical workers due to
changes in the work mode during the Covid-19 pandemic (41). For example,
patients hospitalized for Covid-19 with history of heart failure have
higher risk of complications and mortality (42, 43).
On angiotensin converting enzyme inhibitors or angiotensin receptor
blockers (ACEI/ARB) in Covid-19 infections, American College of
Cardiology (ACC), Heart Failure Society of American (HFSA), American
Heart Association (AHA), and European Society of Cardiology (ESC)
Hypertension Council had rejected several hypotheses. Obviously, their
positive effects are major and beneficial. RAAS inhibitors do not
increase the risk of Covid-19 (44). But myocardial injury in COVID-19
cases is prevalent and is associated with an adverse prognosis and
increased mortality (45). So far, the Covid-19 pandemic has deeply
changed humankind lifestyle, everyone needs to protect cardiovascular
system due to its acute and long-term complications.
Moreover, during the lockdown and restrictions in the Covid-19 pandemic
era, since these pre-existing CVD (hypertension, arrhythmia,
cardiomyopathy and coronary heart disease) and SARS-CoV-2
infection-related cardiovascular complications or events (myocardial
injury, myocarditis, acute arrhythmia and heart failure) among confirmed
and suspected cases with Covid-19 may together result in myocardial
injury, which is one of the important pathogenic features of Covid-19
(46), herein, it’s very important to cardiovascular protection and
prevention. And there are obvious changes in cardiometabolic medicine in
the Covid-19 era (Table 3) (47-77) due to the isolation policies
(lockdown and restrictions) in different countries.
Since some AMI patients cannot receive timely and effective treatment
with percutaneous coronary intervention (PCI) due to the Covid-19
pandemic, and the more delay, the higher the adverse events and
cardiovascular mortality in Covid-19 cases (78, 79), pre-existing oral
anticoagulants is very helpful to cardiovascular protection in these
patients (80). In addition, Chinese herbal medicine combined with
conventional therapy may be effective and safe among mild to moderate
cases with Covid-19 (81). In fact, Covid-19 cases with acute coronary
syndrome (ACS) or STEMI had increased in-hospital mortality and other
worse outcomes due to cardiogenic shock (82). Primary PCI for these
cases with STEMI is feasible and remains the predominant reperfusion
strategy (83). And antithrombotic strategies are also necessary (27).