Cardiovascular disease (CVD) is the world’s deadliest family of non-communicable diseases. Since the advent of the covid-19 pandemic, it has become clear that CVD and covid-19 multiply each other’s severity and, ultimately, lethality.

A growing body of studies indicates that those who have recovered from covid-19 face higher risks of multiple forms of CVD, as well as of major adverse cardiovascular events (heart failure, myocardial infarction, stroke or arrhythmia). While these studies have their limitations, a focus on the shortcomings of any individual study risks missing the message coming from the research as a whole: covid-19 itself, along with various measures taken to fight that pandemic, are likely to drive an overall increase in the CVD burden in the coming years.

Healthcare officials are now in the position to see the threat materialising on the horizon; it is prudent to prepare for it, even if the exact scale and shape still defy precision. This Economist Impact study, supported by Daiichi Sankyo Europe, describes current research looking at the direct effects of covid-19 on CVD risk, its indirect impact on CVD management during the pandemic, and the interactions between long-covid
and CVD. 

The study focuses on five large Western European countries: France, Italy, Germany, Spain and the UK. It considers basic first steps to prepare for the growing health risk, taking a forward-looking view of how health systems might better integrate communicable disease
and non-communicable disease care.

Key findings include:

• Survivors of covid-19 have an elevated probability of developing various forms of CVD and experiencing related serious health events. For example, a UK study found that 4.8% of people hospitalised because of coronavirus infection experienced a major adverse cardiovascular event during the five months after discharge, three times the rate seen in the general population. A review of medical records of those diagnosed with covid-19 within the US Veterans’ Health Administration estimated an average of 45 more cases of negative cardiovascular outcomes per 1,000 such patients in the year following infection than would normally have occurred.
• The severity of covid-19 infection correlates with greater danger of CVD sequelae, but even mild cases raise risks. Perhaps predictably, those most affected by acute covid-19 more often suffer from further issues later on. The previously noted VHA study reports that, for every 1,000 patients treated in an intensive care unit for covid-19, 314 more suffered a negative cardiovascular event within a year than would normally have done so. That said, cardiac sequelae are not a problem restricted to those with the most severe covid-19. As one expert told our researchers, the heart risks for anyone who experienced the infection “are still raised and non-trivial.”
• Limited capacity of overworked health systems and patient fear both impeded delivery of various forms of CVD-related care, in turn increasing immediate mortality and driving longer-term risk. Nearly a year after the pandemic began, the World Health Organization (WHO) continued to report widespread disruption in blood-pressure management and emergency cardiac treatment. The most common explanations were the need to shift resources to covid-19 care and patients staying away from health facilities for fear of infection. 
• Certain common manifestations of long covid, while not themselves cardiovascular diseases, increase the risk of CVD for those affected. Shortness of breath (dyspnoea) is associated with greater risk of heart failure and myocardial infarction; over half of people with diabetes eventually die from some form of CVD; individuals affected by anxiety and depression have a higher risk of developing CVD. The general health challenges arising from long covid could, in due course, increase the CVD burden.

In response to the threat of CVD associated with covid-19, each health system will need to
make its own specific adjustments. Our report discusses several measures that would be widely beneficial:

• Better strategy. Moving from an unsustainable, emergency-driven, narrow focus to look at the entire health burden and shape provision accordingly. Planning for future pandemics should also go beyond dealing with the pathogen of immediate concern to consideration of how to keep the entire health system functioning.
• Better information. We still know too little about covid-19’s sequelae, including how to prevent and treat them. No substitute exists for the hard work of further research to inform more effective health policy.
• Better tactics. Health systems should consider which of the pandemic-enforced temporary expedients to providing care proved themselves as good as, or better than, business as usual, and implement these on a more permanent basis and wider scale.