Rise in COVID-19 linked to rise in heart attacks

A new analysis of data from the Smidt Heart Institute at Cedars-Sinai found that heart attack deaths have increased significantly during pandemics, including waves of COVID-19 Omicron, generally reversing the pre-pandemic trend of healthier hearts.

Before the COVID-19 pandemic, heart attacks were the leading cause of death worldwide, but they have been in steady decline. However, a new study — recently published in Journal of Medical Virology– shows that heart attack death rates turned sharply and rose for all age groups during the pandemic. The spike in heart attack deaths has been accompanied by waves of COVID-19 infection — even during the presumed less severe micron phase of the pandemic. Furthermore, the data showed that the increase was most significant among individuals aged 25 to 44, who are not typically considered to be at high risk of heart attack.

“The dramatic rise in heart attacks during the pandemic reversed what had been a ten-year steady improvement in cardiac death” said Yee Hui Yeo, MD, first author of the study and a Cedars-Sinai physician-scientist. “We are still learning about the many ways that COVID-19 affects the body, regardless of age, gender, ethnicity or race. “

Using data from the Centers for Disease Control and Prevention’s National Vital Statistics System, Cedars-Sinai researchers identified 1,522,699 deaths from heart attacks—medically called acute myocardial infarctions—between April 1, 2012, and March 31, 2022.

The researchers then compared age-related mortality rates between the pre-pandemic and pandemic periods, as well as demographic groups and regions.

Key findings of the study include:

• In the year before the pandemic, there were 143,787 deaths from heart attacks; in the first year of the pandemic, that number increased by 14% to 164,096.
• The elevated mortality associated with acute myocardial infarction has persisted throughout the pandemic, even during the most recent period marked by the rise of the presumed less virulent omicron variant.
• The researchers found that although the number of deaths from acute myocardial infarction during the pandemic increased in all age groups, the relative increase was most significant for the youngest group, aged 25 to 44.
• By the second year of the pandemic, “observed” compared with “predicted” heart attack death rates had risen by 29.9% for adults aged 25 to 44, by 19.6% for adults aged 45 to 64 and by 13.7% for adults age 65 and older.

“There are several possible explanations for the rapid increase in cardiac deaths in patients with COVID-19, but there are still many unanswered questions,” Yeo said. “Importantly, our results highlight disparities in mortality that emerged from the COVID-19 pandemic and persist even through the omicron era.” Possible explanations, Yeo said, include that COVID-19 may trigger or accelerate the onset of pre-existing coronary artery disease, even in younger adults.

Reasons for the increase in heart-related conditions may also be related to the psychological and social challenges associated with pandemicincluding job loss and other financial pressures that can cause acute or chronic stress leads to heart disease.

Members of the research team say they have long known that infections like the flu can increase the risk of heart disease and heart attack, but the sudden increase heart attack death is like nothing seen before.

“There is something very different about how this virus affects cardiac risks,” said Susan Cheng, MD, MPH, director of the Healthy Aging Research Institute in the Department of Cardiology at the Smidt Heart Institute and senior author and co-author of the study. “The difference is likely due to a combination of stress and inflammation, which results from predisposing factors and how this virus biologically interacts with the cardiovascular system.”

Yeo, Cheng and the broader Smidt Heart Institute team hope that greater awareness and more research will expand the medical community’s ability to manage and mitigate these risks.