The impact of the COVID-19 pandemic on cardiovascular disease prevention and management

Abstract

How the Coronavirus Disease 2019 (COVID-19) pandemic has affected prevention and management of cardiovascular disease (CVD) is not fully understood. In this study, we used medication data as a proxy for CVD management using routinely collected, de-identified, individual-level data comprising 1.32 billion records of community-dispensed CVD medications from England, Scotland and Wales between April 2018 and July 2021. Here we describe monthly counts of prevalent and incident medications dispensed, as well as percentage changes compared to the previous year, for several CVD-related indications, focusing on hypertension, hypercholesterolemia and diabetes. We observed a decline in the dispensing of antihypertensive medications between March 2020 and July 2021, with 491,306 fewer individuals initiating treatment than expected. This decline was predicted to result in 13,662 additional CVD events, including 2,281 cases of myocardial infarction and 3,474 cases of stroke, should individuals remain untreated over their lifecourse. Incident use of lipid-lowering medications decreased by 16,744 patients per month during the first half of 2021 as compared to 2019. By contrast, incident use of medications to treat type 2 diabetes mellitus, other than insulin, increased by approximately 623 patients per month for the same time period. In light of these results, methods to identify and treat individuals who have missed treatment for CVD risk factors and remain undiagnosed are urgently required to avoid large numbers of excess future CVD events, an indirect impact of the COVID-19 pandemic.Cardiovascular disease (CVD) remains the commonest cause of mortality and morbidity worldwide; it is, therefore, vital to understand the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on CVD and its risk factors. In the UK, strategies for CVD prevention include screening for health conditions and risk factors that can be modified through medication, including type 2 diabetes mellitus (T2DM), hypertension, hypercholesterolemia and atrial fibrillation (AF). When adequately controlled, such measures reduce the level of CVD in the population.The COVID-19 pandemic has disrupted healthcare in multiple ways, putting additional pressure on both primary and secondary care services [1][2][3][4] . How these have impacted on screening and treatment of common risk factors, including CVD risk factors, and the downstream impact of missed detection of risk factors in terms of CVD outcomes, including myocardial infarction (MI) and stroke, remains understudied at a national level 5 .Examining the change in prescribed and dispensed medications used to treat CVD risk factors over the course of the COVID-19 pandemic can be used to assess the impact on future CVD events of not treating these risk factors. This approach is complementary to studying reduction in the level of disease diagnoses and risk factor control. The latter

Pathophysiology, diagnosis, and management of neuroinflammation in covid-19

“…Although incidence of neurological events was not explored in this study, covid-19 severity increases risk of neurological complications. The public health need to catch up on cardiovascular risk modifying treatments missed because of pandemic disruption has also been highlighted, to reduce risk of not just severe covid-19, but also excess cerebrovascular events resulting from missed treatment opportunities 187…”

Ups and downs of conducting a national representative survey on hypertension during pandemic time: main results of SEPHAR IV

“…This is even more relevant because this edition has shown a lower rate of treatment in male individuals (generating an overall trend of less treatment) compared with the previous edition. Real-world data has shown reductions in antihypertensive medication dispensing and patient adherence immediately after the pandemic's beginning [34,35]. Why this has manifested stronger in male individuals is debatable and may be related to sex-specific health-related behavioural patterns [33].…”

Familial hypercholesterolemia: The nexus of endothelial dysfunction and lipoprotein metabolism in COVID-19

“…Such a prolonged post-COVID burden of dyslipidemia brings special challenges to HeFH patients, who have a genetically determined very high serum LDL-C level, and often also a lower serum HDL-C level when compared with the general population [6,13]. Based on the above observations, it is of particular concern that during the COVID-19 pandemic, ASCVD prevention has diminished not only regarding the management of dyslipidemia in the general population but also in patients with HeFH [14,15]. This study shows the high AMI risk of HeFH patients who get infected and particularly of those HeFH patients who have preexisting ASCVD.…”