Fauci: Underlying CVD drives risk for COVID-19 severity, death
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COVID-19 can cause severe CV complications, manifested by arrythmias, myocardial injury, thromboembolic phenomenon and cardiomyopathies, Anthony S. Fauci, MD, said during a presentation at the American Heart Association Scientific Sessions.
Older adults and adults of any age with certain underlying medical conditions — including type 2 diabetes, chronic kidney disease, obesity and CVD — are at increased risk for severe COVID-19 illness, said Fauci, director of the National Institutes of Allergy and Infectious Disease. Other underlying medical conditions that may confer increased risk for severe COVID-19 illness include cerebrovascular disease, hypertension, type 1 diabetes and overweight, he said.
“Paramount among this is obesity and chronic obstructive pulmonary disease, as well as other conditions such as chronic heart conditions and hypertension,” Fauci said.
The COVID-19 pandemic — the third coronavirus pandemic since 2002 and by far the largest — presents large public health and scientific challenges that cardiologists and other clinicians are struggling to meet, Fauci said during his presentation.
“Here we are now with a global pandemic of historic proportions, the likes of which we have not seen in the last 102 years since the now-iconic outbreak of the pandemic of 1918,” Fauci said. “Currently, there are close to 50 million cases with 1.2 million deaths worldwide.”
The United States has been hit harder than any other country, with close to 10 million cases and over 230,000 deaths, Fauci said.
COVID-19 and CVD
The presence of underlying CVD in adults with COVID-19 is associated with increased mortality, and studies now show COVID-19 can cause severe CV complications, Fauci said.
He cited a study in Nature Reviews Cardiology, published in September, showing that the interaction between the viral spike (S) protein and angiotensin-converting enzyme 2, which triggers entry of the virus into host cells, is likely involved in CV manifestations of the disease.
“If you look at the severe manifestations of COVID-19, they are plentiful,” Fauci said. “I mention the cardiac manifestations, but there are others, such as acute respiratory distress syndrome, kidney injury, neurologic injury, a hypercoagulable state and acute thrombotic phenomenon, sometimes seen in otherwise well, young individuals.”
New research also suggests many who contract COVID-19 develop a “post-COVID-19 syndrome,” Fauci said — a range of symptoms that do not necessarily require hospitalization, but can still be debilitating, and may also include CV complications.
“When they recover virologically, a certain percentage, sometimes as high as one-third, experience lingering symptoms from weeks to months, including profound fatigue, shortness of breath, muscle aches, occasional fever and what some describe as brain fog,” Fauci said.
Additionally, a study conducted in Germany and published in JAMA Cardiology suggests that a substantial number of patients who recovered from COVID-19 showed, on MRI, indications of myocardial inflammation.
“This needs to be repeated in other labs and followed up,” Fauci said. “But if this is true, then we need long-term follow-up, because this may be clinically inconsequential, or it could lead to chronic effects.”
‘Cautious optimism’ on vaccines
The NIH has developed a strategic approach to vaccines, with harmonized protocols in which the six companies involved in Operation Warp Speed, supported by the federal government, adopted a common data safety monitoring board, common primary and secondary trial endpoints, and common immunological parameters, Fauci said.
“That allows us to bridge one study to another,” he said.
There are now six vaccine trials across three vaccine platforms — nucleic acid, with messenger RNA candidates, viral vector platforms and protein subunits together with an adjuvant. Of those, two have recently shown “exciting” news, Fauci said.
On Nov. 9, Pfizer and BioNTech reported their vaccine candidate was more than 90% effective in preventing COVID-19 and showed no serious safety concerns, according to an interim analysis of phase 3 clinical trial results released by the companies. Fauci called the announcement “a very important advance.”
“Moderna is very close behind and the other companies are also not far behind,” Fauci said.
“We look at this with cautious optimism that by the end of this calendar year and well into 2021, we will be administering doses, first to the highest priority, and then ultimately to virtually everyone in the United States as we get into 2021.”
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Fauci A. Latest insights on COVID-19 and cardiovascular disease. Presented at: American Heart Association Scientific Sessions; Nov. 13-17, 2020 (virtual meeting).
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