7 replies to this topic

[Hip]

Explanation for the Decrease in Myocardial Infarctions and Strokes During the Coronavirus Pandemic

 

During the coronavirus pandemic, the number of patients presenting with heart attacks or strokes has dropped dramatically across multiple countries. A US study found that interventions for serious heart attacks have fallen 38% since the beginning of March 2020, and there are similarly large reductions in other countries. A Twitter poll of cardiologists finds most report a 40% to 60% drop in hospital admissions for heart attacks.

 

People have tried to explain this by proposing fear of catching coronavirus may have kept heart attack and stroke patients away from seeking medical help. Or alternatively that patients avoid medical help as they do not want to place extra burdens on the hospitals. While those might be possible factors, I would like to propose a completely different explanation: that heart attacks are often caused by acute viral infections, and social distancing and lockdown conditions are reducing transmission of the viral infections which trigger heart attacks.

 

The idea that acute infection may trigger myocardial infarction has long been suspected, and there are a number of studies which support this, particularly in the case of enterovirus infection of the heart (those studies detailed below). And the link between acute infections and stroke is a strong one.

 

If heart attacks are frequently caused by catching an infection, then clearly the social distancing and lockdown measures in place during the pandemic will not only decrease coronavirus transmission, but will also reduce transmission of all other respiratory infections among the general population.

 

So the substantial decrease in heart attack and stroke patients presenting at hospitals could be due to the overall reduction in transmission of the respiratory viruses which may cause heart attack and strokes. 

 

Assuming this is a primary explanation for the reduction in heart attacks, then it shows that lots of heart attacks and strokes may actually due to catching an acute infection.

 

 

 

 

Studies linking infection to myocardial infarction:

 

This 2007 autopsy study found 40% of those who died of sudden heart attack had enterovirus markers in their endomyocardial tissues, compared to 8% in controls.

 

There are about 225,000 fatal heart attacks per year in the US (ref here), and if enterovirus is indeed the cause of 40% of these heart attacks, it means enterovirus may be killing 90,000 people annually in the US. This incidentally suggests that introducing a new vaccine for the enterovirus species involved (such as coxsackievirus B) should be a high priority.

 

This 1977 study found that 10 out of 38 patients admitted to hospital suffering acute heart attack had serological evidence of a very recent coxsackievirus B infection.

 

Other studies which have linked enterovirus to heart attacks include this one, this one and this one. 

 

 

Acute infections with influenzavirus and Streptococcus pneumoniae have also been linked to heart attacks as well as stroke in this 2018 study in Scotland. 

Edited by Hip, 12 May 2020 - 09:44 PM.

[Rosanna]

Not something I would have thought was relevant but actually it's very interesting.  I attributed the apparent reduction in heart attacks and strokes to reduction in stress and inflammation in the body, but yes, reduction of infection would play a part.  

 

Interesting also that women tend to have an easier time with coronavirus and this may be due to oestrogen?  I don't have sources, sorry, just what I've read recently, but oestrogen is reported to protect against heart disease as well.

 

Children get very dirty though while playing and are the least able to socially distance and yet they don't, as a general rule, suffer heart attacks...

Edited by Rosanna, 19 May 2020 - 11:19 PM.

[Rosanna]

I wish there was as much energy going into trying to understand the mechanisms of heart disease as there was ageing, as sudden heart attacks cut short people's lives even if they are well in all other respects.  It is just as much a threat as Covid.

[pamojja]

... sudden heart attacks cut short people's lives even if they are well in all other respects.  It is just as much a threat as Covid.

 

You must be joking. These were the major worldwide killers in 2017:

Cause of Death         Rank      Deaths

Coronary Heart Disease  1	8,727,670
Stroke                  2	6,221,072
Influenza and Pneumonia	3	3,177,204
Lung Disease	        4	3,162,054
Lung Cancers	        5	1,683,893
Diabetes Mellitus	6	1,570,100
Alzheimers/Dementia	7	1,533,855
Diarrhoeal diseases	8	1,388,418
Tuberculosis	        9	1,372,855
Road Traffic Accidents	10	1,339,206
Liver Disease	        11	1,154,240
Kidney Disease	        12	1,121,214
HIV/AIDS	        13	1,059,626
Low Birth Weight	14	1,056,984
Hypertension	        15	938,129
Suicide	                16	783,407
Liver Cancer	        17	777,816
Colon-Rectum Cancers	18	767,280
Stomach Cancer	        19	749,806
Birth Trauma	        20	690,870

Covid-19 now end of May has killed about 330,000. It probably will double till the end of this year. Still 22 times less, or only 4.4%, then how many died in 2017 of CHD and strokes combined.
 

 

[pamojja]

A US study found that interventions for serious heart attacks have fallen 38% since the beginning of March 2020, and there are similarly large reductions in other countries.

 
CDC data shows for the first 4 1/2 month of this year 99% of expected deaths. Just a 1% reduction of overall mortality.
 
https://www.cdc.gov/...s/vsrr/covid19/

Edited by pamojja, 20 May 2020 - 10:22 AM.

[Hip]

I wish there was as much energy going into trying to understand the mechanisms of heart disease as there was ageing, as sudden heart attacks cut short people's lives even if they are well in all other respects.  It is just as much a threat as Covid.

 

Yes, there are 225,000 fatal heart attacks per year in the US alone, and the evidence of enterovirus in the heart tissues in autopsy suggests enterovirus may be causing 40% of these heart attacks, meaning acute enterovirus infection may be killing 90,000 people per year in the US alone.

 

That's comparable to the amount of deaths coronavirus has so far caused in the US.

 

Yet nobody has ever instituted a lockdown to prevent heart attacks. But logically we should.

[Rosanna]

Yes, there are 225,000 fatal heart attacks per year in the US alone, and the evidence of enterovirus in the heart tissues in autopsy suggests enterovirus may be causing 40% of these heart attacks, meaning acute enterovirus infection may be killing 90,000 people per year in the US alone.

 

That's comparable to the amount of deaths coronavirus has so far caused in the US.

 

Yet nobody has ever instituted a lockdown to prevent heart attacks. But logically we should.

 

Yes I agree.  I'd even say if there was enough focus and scrutiny on what is causing heart attacks, we might solve many other illnesses as well.  There are doctors that have noticed decreases in other illnesses, like breast and prostate cancer, and slowed down progressions of these diseases when heart disease was addressed nutritionally.

[Rosanna]

You must be joking. These were the major worldwide killers in 2017:

Cause of Death         Rank      Deaths

Coronary Heart Disease  1	8,727,670
Stroke                  2	6,221,072
Influenza and Pneumonia	3	3,177,204
Lung Disease	        4	3,162,054
Lung Cancers	        5	1,683,893
Diabetes Mellitus	6	1,570,100
Alzheimers/Dementia	7	1,533,855
Diarrhoeal diseases	8	1,388,418
Tuberculosis	        9	1,372,855
Road Traffic Accidents	10	1,339,206
Liver Disease	        11	1,154,240
Kidney Disease	        12	1,121,214
HIV/AIDS	        13	1,059,626
Low Birth Weight	14	1,056,984
Hypertension	        15	938,129
Suicide	                16	783,407
Liver Cancer	        17	777,816
Colon-Rectum Cancers	18	767,280
Stomach Cancer	        19	749,806
Birth Trauma	        20	690,870

Covid-19 now end of May has killed about 330,000. It probably will double till the end of this year. Still 22 times less, or only 4.4%, then how many died in 2017 of CHD and strokes combined.
 

 

I agree with you, I didn't know the exact figures but my main point was that these other illnesses need addressing.  I probably didn't word it very well.