The Role of the American Heart Association in the Global COVID-19 Pandemic

Abstract

s the United States and the world confront the novel coronavirus (COV-ID-19) pandemic, the American Heart Association (AHA) and its thousands of science volunteers have an important role to play to help stop the spread.That may seem counterintuitive to some, considering that COVID-19 is an infectious disease and the AHA has spent the last nearly 100 years focused on noncommunicable diseases such as cardiovascular diseases (CVDs), stroke, and other vascular disorders.However, COVID-19 is very much a concern of the AHA because patients with underlying cardiovascular conditions appear to face a greater risk of complications.In addition, as an organization dedicated to overall health and well-being, we are very concerned about significant domestic and global health problems. CONTAGIOUS INFECTIONS AND CVDEven before the first outbreak of COVID-19, the AHA and its professional members were aware of evidence suggesting that acute coronary events and strokes could be triggered by common infections. 1,2Respiratory and urinary tract infections, among others, have been associated with a short-term increase in the risk of myocardial infarction and ischemic stroke. 3Influenza in particular is associated with increased risk, and some clinical trials provide additional evidence that the influenza vaccination decreases cardiovascular risk. 1 Since 2006, the AHA and the American College of Cardiology have recommended that patients with CVD receive the influenza vaccination to prevent flu-related respiratory disease and other complications, including cardiovascular events. 3This approach represents the first instance of routine use of anti-infective strategies to reduce CVD.Mechanisms for the increase in risk with influenza remain unclear but may reflect greater cardiovascular stress in the setting of infection, reduced oxygenation in the setting of lung disease, or systemic inflammation with consequent thrombosis or intraplaque disruption predisposing to rupture.Although much remains unknown about COVID-19, it is reasonable to assume that increased risk of cardiovascular events after infection is possible.In China, CVD and hypertension were associated with an increased COVID-19 case fatality rate. 4Among patients who died of COVID-19, substantial cardiac damage was observed. 5Furthermore, it appears that elderly people with coronary heart disease or hypertension are more likely to be infected and to develop more severe symptoms.Surveillance for cardiovascular events after COVID-19 seems very warranted, and this could be an area for future investigation. PREPARING TO MITIGATE SPREADIt is important to understand that we are in a mitigation phase for this pandemic.Mitigation strategies are nonpharmaceutical interventions to help slow the

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