An Acute Respiratory Infection Runs Into the Most Common Noncommunicable Epidemic—COVID-19 and Cardiovascular Diseases

Abstract

The outbreak of novel coronavirus disease 2019 , which emerged in Wuhan, China, in December 2019, has rapidly spread to more than 58 countries and areas. 1 As of March 1, 2020, about 79 968 cases in mainland China have been confirmed and 2873 deaths have occurred. 1 The Chinese government is mustering medical personnel around the country to treat patients in Hubei province and preventing further spread of COVID-19 in every region of the country.At the same time, several studies concerning the epidemiological and clinical features of COVID-19 have been published in a timely manner, which has greatly helped health care workers and policy makers to understand COVID-19. Reading these reports, we noticed that many patients with COVID-19 had comorbid chronic cardiovascular diseases (CVDs), which collectively represent the most common noncommunicable epidemic in China currently. Among 44 672 individuals confirmed to have COVID-19 as of February 11, 2020, 2683 patients (12.8%) had hypertension and 873 (4.2%) had CVDs, 2 which were the most common coexisting conditions in patients hospitalized with COVID-19. 3,4 Furthermore, patients with comorbid CVDs were more likely to have severe illness associated with COVID-19 and had a much higher fatality rate: 10.5% for those with CVDs and 6.0% for hypertension, while the fatality rate was 0.9% in patients who reported no comorbid conditions. 2 This information indicated that individuals with underlying chronic CVDs were both more susceptible to COVID-19 and more prone to critical conditions and death. It is well known that acute pulmonary infection can potentially destabilize cardiac diseases, such as heart failure and coronary artery disease. Then deterioration of cardiac diseases would exacerbate COVID-19 management in turn.However, inadequate attention has been paid to comorbid CVDs in patients with COVID-19. Hitherto, to our knowledge, academic reports regarding clinical features of COVID-19 did not classify cardiovascular disorders clearly. For instance, the number of patients with specific cardiovascular diseases, including ischemic heart disease, heart failure, cardiac arrhythmia, and other conditions, were not provided. In addition, hypertension was reported independently of CVDs, even though it is clearly a CVD. It is possible that these CVDs have varying associations with COVID-19 prognosis.Dyspnea and fatigue, 2 cardinal symptoms of heart failure, are very common in patients with COVID-19, particularly in its severe stages. 4,5 Hence, the diagnosis of COVID-19 is made more difficult in patients with chronic heart failure. Also, both COVID-19 and heart failure give rise to hypoxemia, which is the basic pathophysiologi-VIEWPOINT

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