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).