心脏危险因素, 不是心脏病本身, may increase odds of COVID-19 death

Seeking to clarify connections between pre-existing heart disease and COVID-19, 一项针对危重患者的研究发现，他们死于COVID-19的风险可能并非直接来自心脏病, but from the factors that contribute to it.

患有心脏病的人, 并将继续, at higher risk of developing severe COVID-19, according to the Centers for Disease Control and Prevention. The new study, published Tuesday in the 美国心脏协会 journal Circulation: Cardiovascular Quality and Outcomes, 表明心血管疾病的危险因素——比如年龄和是否吸烟——是导致严重疾病的主要因素, 而不是心脏病本身.

COVID-19 is known to cause organ dam年龄 through uncontrolled inflammation. Inflammation also is common in people with heart disease and stroke, 它还与吸烟和其他心血管疾病风险因素(如高血压和糖尿病)有关.

为了理解其中的联系, 研究人员查看了5人的记录,133名重症COVID-19患者是一项名为STOP-COVID的合作研究的一部分. The patients came from 68 hospitals across the U.S. and were admitted to ICUs between March 1 and July 1, 2020.

这些, 1,174 had pre-existing cardiovascular disease, 在研究中定义为包括冠状动脉疾病(心脏动脉中的斑块), 心力衰竭(心脏不能有效泵血)或心房颤动(一种不规则心跳).

患有先前存在的心血管疾病最初似乎是COVID入院后28天内死亡的危险因素, 资深作者Dr. 萨利姆哈耶克. He's an assistant professor at the University of Michigan in Ann Arbor, where he's director of the Frankel Cardiovascular Center.

但 when researchers separated out things associated with cardiovascular disease, 比如年龄, 高血压和糖尿病, 心血管疾病本身与COVID死亡之间的联系在统计上似乎微不足道.

The researchers found the most important risk factors for death to be, 为了, 年龄, 体重指数(衡量肥胖的指标), 种族和民族, 以及吸烟史.

研究结果表明，在心脏病患者中，死亡风险的增加与动脉斑块的增加无关, and more that they have risk factors contributing to COVID-19's hyperinflammation, 哈耶克说. 他承认, 然而, 这是因为这项研究中很少有接受心脏移植或患有严重心血管疾病的人, 比如晚期心力衰竭, the researchers could not draw 结论 about them.

在他们分析的第二部分, the researchers looked at a biomarker for heart dam年龄 called troponin. Troponin is commonly used as a test for whether someone has had a heart attack. 但, 哈耶克说, 它也可能表明身体在与COVID-19感染作斗争时心血管系统受到压力或心脏损伤.

在这两个人中,741 patients for whom troponin levels were available, "cardiac injury was a strong predictor of bad outcomes," 哈耶克说 – regardless of whether the patient had cardiovascular disease. The higher the troponin level, the more likely a patient would die. “从本质上来说, 我们在这里看到的是，心脏损伤是COVID-19疾病严重程度的替代标志物,他说.

总结, 哈耶克说, 该研究的第一部分“强调了这不是预先存在的心脏病. And the second part highlights that cardiac injury is linked to worse outcomes.”在一起, 这表明心脏损伤可能与急性COVID-19疾病的压力有关，而不是心血管疾病新并发症的迹象.

他说，这项研究强调，严重的COVID-19是一个过度炎症的过程，而与心血管风险相关的炎症过程也使人们面临患严重COVID的风险.

这项研究并不意味着患有心血管疾病的人可以忽视这个问题, 哈耶克说. Instead, people need to think about those shared risk factors.

Dr. 特蕾西Y. 北卡罗莱纳州达勒姆市杜克大学心脏病学医学教授王对此表示赞同.

People with heart disease are still at higher risk of dying from COVID-19, 王说, 谁没有参与这项研究. 但 the study helps clarify what's harming people.

她说:“这与他们之前患有心脏病的事实没有太大关系。. "It's about their overall health status that makes them higher risk. So that distinction I think is really interesting."

她说，心脏损伤和死亡之间的联系“似乎是显而易见的”. Severe COVID-19 causes dam年龄 到处都是, not just the heart. "Patients who die tend to have more organ hits, so to speak," she said. Troponin levels would be just one more marker of the fact that they're sick.

She noted that "a good chunk of these patients never had troponin measured," which makes it harder to draw 结论.

但 she said the findings, overall, offered a bit of a silver lining to patients.

她说:“这表明，即使你之前患有心脏病，也不是所有的希望都失去了。. 这些结果表明，如果研究人员能够学会如何限制心脏损伤的水平, "then we have a much better chance of having patients survive their ICU stay, and hopefully have better quality of life and longevity after this as well."

Regardless of whether they've been diagnosed with heart disease, people could think about the findings as a way of inspiring self-care, 王说. "If you can practice good preventive therapy – see a doctor regularly, 控制你的糖尿病, 保持健康的体重, 以积极的生活方式为目标——所有这些事情的结合不仅应该限制你患心脏病的风险, 这也将有助于降低你的疾病严重程度和不良后果的风险，即使你感染了COVID-19."

哈耶克说，他希望这项研究能让人们更好地了解心脏病之间的根本联系, 炎症和传染病, perhaps to tease out better markers that all the conditions might share.

"Because there is an overlap between inflammation and cardiovascular disease, 从机制上理解这种联系不仅对这次大流行有价值, 但对于心脏病患者暴露的任何严重传染病,他说.

Editor's note: Because of the rapidly evolving events surrounding the coronavirus, the facts and advice presented in this story may have changed since publication. 访问的心.Org获取最新报道, 并向疾病控制和预防中心以及当地卫生官员咨询最新的指导意见.

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