What People With Heart Disease and Diabetes Need to Know About Their COVID-19 Risk
What the Studies Say
The three most common underlying health problems associated with more serious complications from COVID-19 were cardiovascular disease, diabetes and chronic lung disease, per a June 2020 report from the Centers for Disease Control and Prevention (CDC). Hospitalizations were six times higher and the risk of death was 12 times higher in people who had these conditions.
Other research has shown a similar relationship. Forty percent of deaths from COVID-19 are related to complications of the cardiovascular system, according to a May 2020 study in Circulation Research. And, diabetes is associated with a two- to threefold increase in adverse outcomes, per a June 2020 study in the Journal of Diabetes Investigation.
The data points to a link between these health conditions and more severe outcomes related to COVID-19.
“A lot of these risk factors and disorders cluster together,” says Duane Pinto, MD, MPH, a cardiologist at Beth Israel Deaconess Medical Center. “We don’t really know if it’s one of those things or all of those things together that’s conspiring and leading to the bad outcomes.”
“Pre-existing conditions don’t raise your chances of catching the virus.”
But researchers are starting to tease apart some of the differences.
Panagis Galiatsatos, MD, an assistant professor at Johns Hopkins School of Medicine, recently completed a meta-analysis of 119 previously published reports to examine the relationships between pre-existing conditions and COVID-19 outcomes. The study hasn’t been published yet, but it found that pre-existing conditions are an independent risk factor for worse outcomes for COVID-19. “It’s not because patients are older. Age is an independent variable and so is having diabetes,” Dr. Galiatsatos tells LIVESTRONG.com.
Why Pre-Existing Conditions Increase Your Risk for Complications From COVID-19
It’s not all that surprising that a healthy person would fare better than someone with heart disease or diabetes. Still, doctors aren’t exactly sure why that appears to be the case — although there seem to be three main factors at play.
1. Pre-Existing Conditions Affect Your Immune System
Underlying health conditions have always been risk factors for infections and worse symptoms. “This isn’t new to COVID-19,” Dr. Galiatsatos says.
For example, diabetes is a condition that affects multiple organs and systems in your body, including your immune system, which may contribute to more severe COVID-19 symptoms. Poor blood sugar control, a common symptom of those diagnosed with diabetes, negatively affects the way your immune system functions, increases inflammation and makes it harder for your body to clear viruses from your system, too, per the June 2020 Journal of Diabetes Investigation study.
2. Your Body Is Fighting on Multiple Fronts
If you have a pre-existing condition, you might have less reserve to deal with what can be quite a severe illness, Dr. Pinto says. With no pre-existing conditions, you would fight COVID-19 on one front. “But if you have heart disease, kidney disease, a pre-existing lung condition, then you’re fighting on three or four fronts at the same time,” Dr. Pinto says.
“Many of the complications associated with COVID-19 are related to the blood vessels,” especially high blood pressure, says Peter Libby, MD, a cardiovascular medicine specialist at Brigham and Women’s Hospital and the Mallinckrodt Professor of Medicine at Harvard Medical School. High blood pressure is associated with a greater likelihood of hardening of the arteries.
If you have normal arteries that supply oxygen and nutrients to the heart, your heart can handle it just fine, Dr. Libby says. But if you have an underlying health condition like high blood pressure, your heart needs to pump harder to increase output and to send blood to the hungry tissues, he says. In other words, your cardiovascular system may not be robust enough to react to the infection.
And damage to the lining of the blood vessels can also lead to an overactive immune system response, known as a cytokine storm, and problems with the body’s clotting mechanism, making you more prone to blood clots.
3. Potential Socioeconomic Factors
Lastly, patients with pre-existing conditions may, generally, be a little sicker overall due to disparate access to health care and other socioeconomic factors. “Not having good access to medical care, socioeconomic status, diabetes and premature heart disease all kind of cluster together,” Dr. Pinto says. “They might not have had the ability to take of themselves. Those are the people who might be overrepresented in the ICU.”
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