After COVID-19, Experts Say Watch for These Potential Heart and Brain Problems

Michael Merschel wrote . . . . . . . . .

COVID-19 was full of surprises early on, causing mild problems in the short term for some people and serious complications for others.

Long term, it may be just as capricious.

Studies are spotting potential heart and brain problems up to a year after infection with SARS-CoV-2, even in people who had mild COVID-19.

The possible long-term effects include “a myriad of symptoms affecting different organs,” said Dr. José Biller, director of the COVID-19 neurology clinic at Loyola Medicine in Maywood, Illinois. “So, it could be the lungs, it could be cardiovascular, it could be the nervous system, it could be mental health or behavioral problems.”

Estimates vary widely on how many people may be affected. Research suggests about 10% to 20% of people experience mid- or long-term issues from COVID-19, according to the World Health Organization.

That may sound small, but COVID has affected hundreds of millions of people, said Dr. Siddharth Singh, director of the post-COVID-19 cardiology clinic at the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles. In the U.S. alone, about 80 million people have been infected with the coronavirus since the pandemic started in early 2020.

There are many more questions than answers, including about who is most at risk for post-COVID problems and how long the effects might last. But experts say people who have had COVID-19 should be aware of these potential risks:

Heart disease and stroke

A study published in Nature Medicine in February concluded the risk of heart problems one year after COVID-19 infection is “substantial.”

Those heart problems include irregular heartbeats, heart failure (the inability of the heart to pump properly), coronary disease (buildup in arteries that limits blood flow), heart attacks and more.

The study included 153,760 U.S. veterans, most of them white and male, who tested positive for COVID-19 between March 1, 2020, and Jan. 15, 2021, and survived at least 30 days. They were compared to a control group of more than 5.6 million veterans without COVID-19.

Researchers adjusted for pre-existing conditions and found that after one year, those who had COVID-19 were 63% more likely to have some kind of cardiovascular issue, resulting in about 45 additional cases per 1,000 people.

Risks were elevated even among people who did not have severe COVID-19. That matches what Singh has seen in his post-COVID clinic, which began treating patients in December 2020. “A lot of patients that we have seen with long-haul symptoms had minor illness and had been treated at home.”

Singh also treats many people with postural orthostatic tachycardia syndrome, or POTS, which can cause dizziness, fainting and heart palpitations. “These palpitations mostly tend to happen when people are standing or sitting upright,” he said.

In rare cases, “smoldering inflammation around the heart or in the heart” can occur, Singh said.

The Nature Medicine study also found a 52% increased risk of stroke at one year among COVID-19 survivors, or about four extra strokes per 1,000 people.

Brain problems

Among the 113 patients in Biller’s long COVID clinic, almost 3 in 4 reported so-called brain fog. “They are unable to multitask, and have difficulties in learning new skills,” said Biller, who also leads the department of neurology at the Loyola University Chicago Stritch School of Medicine.

A recent Nature study of 785 people ages 51 to 81 found those who had COVID-19 lost more grey matter and had more brain shrinkage than those who had not.

Mental health

A study published in February in BMJ used the same pool of U.S. veterans as the Nature Medicine study and found a 35% increased risk of anxiety disorders after COVID-19, or 11 additional cases per 1,000 people after one year compared to those without COVID-19. The risk for depression was slightly higher.

When researchers compared people who’d had COVID-19 versus the flu, the risk of mental health disorders was again significantly higher with COVID-19.

“Mental health is closely tied to cardiovascular health,” Singh said. If somebody is anxious or depressed, “they’re not going to exercise that much. They’re not going to watch their diet, take control of their hypertension and other risk factors, their sleep is affected which can impact cardiovascular health, and so on.”

He said many COVID-19 survivors also have unresolved pain, grief and post-traumatic stress disorder, which can contribute to a decline in mental health.

Fatigue

At Biller’s post-COVID clinic, patients often describe experiencing “crushing” fatigue. Fatigue was the most common post-COVID symptom reported in a review of several studies published in August in Scientific Reports.

What you can do

Even though the long-term risks from having COVID-19 may be real, Singh said, they should not cause most people to be terribly worried. Instead, he said, it’s a good time to be proactive:

  • Take care of yourself. “A lot of my family and friends have gotten COVID earlier this year and last year,” Singh said. “What I’m telling them is just to be a bit more vigilant when it comes to their cardiovascular health and making sure their cardiovascular risk factors are well-controlled. Obviously, if one is having chest pain, shortness of breath or palpitations, that should not be ignored.”
  • Symptoms lingering? See a doctor. “It can take anywhere from two to six weeks to completely bounce back from the infection,” Singh said. But if people have persistent physical and mental symptoms beyond four to six weeks, “it’s wise to get checked out.”
  • Pay attention to sleep. Sleep disorders – which are linked to heart problems – can develop after COVID-19, research shows. “The importance of good sleep cannot be overemphasized,” Singh said. If you’re having trouble, you might need to see a specialist.
  • Stay informed. As research continues to untangle the mysteries of COVID-19, people will need trustworthy information. The Centers for Disease Control and Prevention offers regular updates about the coronavirus, and the National Library of Medicine provides a tutorial for evaluating health information.
  • Get vaccinated. COVID-19 vaccines reduce the risk of infection and severe illness. And while it’s not yet clear whether vaccination influences long-term symptoms in people who get breakthrough infections, Biller said, “prevention is the key.”

Source: American Heart Association

Flavonoids Are a Flavorful Way to Boost Heart and Brain Health

Laura Williamson wrote . . . . . . . . .

What do blueberries, spinach and dark chocolate have in common?

They’re all rich in flavonoids, the chemical compounds found in plants that give them color – and medicinal powers. Research shows flavonoids provide a wide range of health benefits, from fighting cancer and lowering the risk for heart disease to preserving brain function. They’ve even been used to fight wrinkles.

“The key reason flavonoids are good for us is they have anti-inflammatory effects and are antioxidants,” said Kristina Petersen, an assistant professor in the department of nutritional sciences at Texas Tech University in Lubbock.

Antioxidants help fight inflammation and aging. Flavonoids also have properties that could help prevent blood clots. And a study published last year in the American Heart Association journal Hypertension suggests flavonoids in foods such as berries, red wine, apples and pears may influence gut bacteria in a way that lowers blood pressure.

Because of this, flavonoids play a central role in the Mediterranean, DASH and MIND diets, the eating patterns most recommended by heart and brain health experts. While there are some differences, all three place a heavy focus on flavonoid-rich fruits, vegetables, nuts and beans.

But most people in the U.S. aren’t getting enough flavonoids, largely because they don’t eat the recommended daily allowance of fruits and vegetables. Federal dietary guidelines recommend adults eat 1.5-2 cups of fruit each day and 3-4 cups of vegetables. But only 1 in 10 U.S. adults eat that many vegetables and only 1 in 8 eat a sufficient amount of fruit, according to data from the Centers for Disease Control and Prevention.

The good news is, flavonoids are found in such a wide range of fruits, vegetables and other foods that it shouldn’t be hard to fit them into your diet, Petersen said. They’re found in berries of all kinds, cherries, apples, grapes, leeks and leafy green vegetables such as spinach, romaine lettuce and kale. Like garlic and onions? You’ll find them there as well. Soybeans? They’ve got them, too.

Petersen recommends eating a wide range of flavonoid-rich foods for the greatest nutritional value. “The goal is to eat a variety of fruits and vegetables of different colors. Eat a rainbow,” she said.

If you’re not used to eating a lot of produce, you can build it into your diet slowly, she said.

“Eat one more piece of fruit per day,” Petersen said. “Put one more vegetable on your plate at dinner time. Trying to overhaul your entire diet can be difficult, so start by making small changes.”

Eating fresh, whole foods is the best way to get the flavonoids you need, she said. But it’s not the only way.

If fresh fruits aren’t available, frozen berry mixes are a good alternative, Peterson said. Fruits and vegetables that are flash frozen retain high levels of nutrients, store easily and can add variety to the plate even when out of season.

You can also drink flavonoids. Beverages such as red wine and tea, especially black or green tea, are good sources. Fruits and vegetables can be squeezed into juices or smoothies as well, but Petersen said juicing is less than ideal because it removes a lot of beneficial fiber.

However, she said, “if that’s the only way you can get them into your diet, then do it.”

And, of course, dark chocolate is a sweet way to add flavonoids to your day.

There’s no need to force yourself to eat foods you don’t like in order to get your flavonoid fix. “We never have success in telling people to eat things they don’t like,” Petersen said. “There are so many you can choose from,” so eat the ones you like. And don’t be afraid to try new ones.

Anyone already following the Mediterranean, DASH or MIND diets – or any high-quality plant-based diet – shouldn’t have to worry.

“The goal is to consume a healthy dietary pattern,” Petersen said. “And if we’re doing that, we’re going to be consuming enough flavonoids.”

Source: American Hart Association

Regular Use of Acetaminophen Tied to Higher Heart Risks

Amy Norton wrote . . . . . . . . .

Acetaminophen may do wonders for a headache, but using it for long-term pain relief could prove risky for people with high blood pressure, a new clinical trial suggests.

Over two weeks of use, the painkiller caused blood pressure to spike in people who already had elevated numbers, the researchers found. That was true whether they were on blood pressure medication or not.

The findings — published in the journal Circulation — strengthen evidence that acetaminophen (Tylenol) can raise blood pressure when it’s taken regularly.

But the study findings may also leave people with heart disease, or risk factors for it, with more questions about how to deal with long-lasting pain.

That’s because other common painkillers — nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin, Advil) and naproxen (Aleve) — are already known to raise blood pressure. What’s more, they are linked to an increased risk of heart disease and stroke when used long-term.

Experts said it’s not clear whether acetaminophen carries the same heart and stroke risks as NSAIDs. But the blood pressure rise seen in this trial is concerning.

“Especially in people who already have hypertension [high blood pressure], an increase in blood pressure is always bad,” said Dr. Donald Lloyd-Jones, president of the American Heart Association and chairman of preventive medicine at Northwestern University Feinberg School of Medicine, in Chicago.

“This trial certainly gives us important information,” added Lloyd-Jones, who was not involved in the research.

He said doctors should ask patients about use of acetaminophen and other medications whenever their blood pressure is hard to control.

And if patients do need to take acetaminophen for chronic pain, Lloyd-Jones said, their blood pressure should be carefully watched, with the help of home monitoring.

“We want to detect any blood pressure changes early, so we can respond appropriately,” he said.

Acetaminophen is a fever reducer and pain reliever found in many medications, but is probably best known as the active ingredient in Tylenol.

Past studies have found that people who regularly use acetaminophen show a heightened risk of developing high blood pressure. But those types of studies do not prove the medication is to blame, said Dr. David Webb, senior researcher on the new study.

So Webb’s team conducted a clinical trial that directly tested the effects of acetaminophen on people’s blood pressure.

They recruited 110 patients with high blood pressure and randomly assigned them to take acetaminophen or a placebo every day for two weeks, followed by a two-week wash-out period. Then the placebo users were switched to the real medication for two weeks, while acetaminophen users were given the placebo.

That way, each person served as their own “control,” which helped isolate any effect of the drug.

On average, the trial found, participants’ blood pressure rose by 5 points while they were on acetaminophen, compared to the placebo.

It’s still possible acetaminophen is a safer choice than NSAIDs, according to Webb, a professor at the University of Edinburgh in Scotland.

At this point, he said, it is unclear how they stack up in long-term risks of heart trouble or stroke. Plus, he added, NSAIDs are more likely to cause gastrointestinal upset and bleeding.

But in addition to safety, people in pain also want relief. Webb said an NSAID might be preferred when a patient needs an anti-inflammatory, which acetaminophen is not.

With all of that in mind, Lloyd-Jones said, it’s best for people to discuss all their pain treatment options — drug and nondrug — with their doctor.

That point was echoed by Dr. Gregg Fonarow, another cardiologist who reviewed the findings.

If acetaminophen must be used long-term, people should watch their blood pressure numbers — even if they do not currently have high blood pressure, said Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles.

What about quick relief from a fever or headache? Fonarow said that using acetaminophen short-term, intermittently, is unlikely to be a concern.

Webb had another word of advice: If acetaminophen is the choice for longer-term pain relief, start with a low dose, and go no higher than is needed to ease the pain.

Source: HealthDay

Unhealthy Heart May Be Bigger Threat to Women’s Brains Than Men’s

Amy Norton wrote . . . . . . . . .

What’s good for the heart is good for the brain, and a new study suggests that connection might be especially critical for women.

The study, of more than 1,800 adults in their 50s and 60s, found that those with heart disease, or risk factors for it, generally showed a greater decline in their memory and thinking skills over time.

That was not a surprise, since past studies have revealed an association between heart health and mental acuity. But it turned out that the link was especially strong among women, researchers found.

“It’s extremely important for both women and men to have their cardiovascular risk factors treated and well-controlled,” said study author Michelle Mielke, a professor at Mayo Clinic in Rochester, Minn.

But, she added, these findings suggest that could be especially critical for women’s cognitive function.

The study, published Jan. 5 in the journal Neurology, is the latest to highlight the connection between heart and brain health.

Like the heart, the brain relies on healthy blood vessels to supply its cells with oxygen and nutrients. Research over the years has found that many of the risk factors for heart disease and stroke are also tied to a quicker decline in cognitive abilities as people age — and possibly a heightened risk of dementia.

Those risk factors include high blood pressure, high cholesterol, diabetes, smoking and obesity.

On the flip side, research suggests that some heart-healthy practices, such as physical exercise and a diet rich in fish, vegetables and “good” fats, may help shield the aging brain. And a 2019 clinical trial found that aggressively lowering high blood pressure in older adults reduced the risk of mild cognitive impairment.

That refers to subtle but noticeable declines in memory and thinking that in some cases progress to dementia.

According to Mielke, it’s not clear why poorer cardiovascular health might be tougher on women’s cognition.

It’s natural to speculate that menopause and hormonal changes could play a role, she said. But, Mielke added, there are many other possibilities, too.

For one, heart disease in women and men can be different. Women are more likely than men to have dysfunction throughout smaller blood vessels in the body, versus blockages in larger ones feeding the heart. It’s possible that could contribute to cognitive decline.

In addition, Mielke said, there’s the question of whether women’s risk factors were as aggressively managed as men’s.

The findings are based on 1,857 adults ages 50 to 69. Most — 79% — either had heart disease or a history of stroke, or any of several risk factors: obesity, smoking, high blood pressure, diabetes or high cholesterol.

The participants took standard tests of memory and other cognitive abilities at the outset, and then every 15 months.

Mielke’s team found that while cardiovascular risk factors were more common in men, they had a bigger impact on women’s cognitive performance over time. Among people with heart disease, for example, women showed twice the rate of decline that men did on their overall composite score.

It all fits into the body of research on the heart-brain connection, said Claire Sexton, director of scientific programs and outreach for the Alzheimer’s Association.

It’s critical, she said, for everyone to see their doctor, know their numbers and get any cardiovascular risk factors under control. There may be “added benefit for your brain,” Sexton said.

She agreed there could be various reasons for the current findings — including differences in lifestyle factors, like exercise, between women and men.

And those things matter long before old age.

“This study adds to the evidence that even in middle life, what is bad for the heart is bad for the brain,” said Dr. Richard Lipton, a professor of neurology at Albert Einstein College of Medicine in New York City.

And while cardiovascular risk factors are more common in middle-aged men than women, he said, this study suggests they are more detrimental to women’s brain function.

Both Lipton and Sexton, who were not involved with the study, noted that declines in test scores do not mean a person is destined to develop dementia.

Some amount of decline is part of the normal aging process, Lipton said. And in many cases, it may be related to a specific health condition or medication effects.

Sexton also said that cardiovascular health is only one factor in cognitive well-being. Research also suggests that people can support their brain health by staying socially and mentally active, getting adequate sleep and seeking help for depression or other mental health concerns.

Source: HealthDay

Exposure to Toxic Metals May Increase Risk of Clogged Arteries

Environmental exposure to low-levels of the toxic metals arsenic, cadmium and titanium appears to increase the risk of plaque buildup in arteries in the neck, heart and legs, according to new research published today in the American Heart Association’s journal Arteriosclerosis, Thrombosis and Vascular Biology (ATVB).

Traces of metal may enter the body through contaminated soil that infiltrates food, through drinking water, air pollutants or tobacco smoke. There is strong evidence that toxic metals, such as arsenic and cadmium, are cardiovascular risk factors. Arsenic and cadmium are often found in tobacco and food, while arsenic is also found in water. Titanium exposure is mainly derived from dental and orthopedic implants, screws, pacemaker encasings, cosmetic products and some foods.

“Metals are ubiquitous in the environment, and people are chronically exposed to low levels of metal,” said lead investigator of the study Maria Grau-Perez, M.Sc., of the Institute for Biomedical Research Hospital Clinic de Valencia INCLIVA in Valencia, Spain, and a Ph.D. candidate in the department of preventive medicine, public health and microbiology at the Universidad Autonoma de Madrid, in Spain. “According to the World Health Organization, 31% of the cardiovascular disease burden in the world could be avoided if we could eliminate environmental pollutants.”

Atherosclerosis develops when fatty deposits, or plaque, builds up in the arteries causing them to narrow, weaken and stiffen. Depending on the arteries affected, it can lead to a heart attack, stroke, angina, peripheral artery disease or kidney disease.

Prior research on the impact of metal exposure on atherosclerosis has traditionally centered on the carotid arteries, the major arteries in the neck. This study focused on subclinical atherosclerosis – before symptoms are present – and examined the impact of metal exposure on the carotid, femoral and coronary arteries. Previous research suggests that imaging of the femoral artery, which is the main artery supplying blood to the lower body, may lead to earlier detection of atherosclerosis.

Researchers evaluated 1,873 adults (97% men) in the Aragon Workers Health Study. The study participants worked at an auto assembly factory in Spain and ranged in age from 40 to 55. Researchers measured participants’ environmental exposure to nine toxic metals— arsenic, barium, uranium, cadmium, chromium, antimony, titanium, vanadium and tungsten—and the exposure’s association with the presence of subclinical atherosclerosis in the carotid, femoral and coronary artery regions. The study explored the potential role of individual metals and metal mixtures on the development of atherosclerosis.

During the participants’ annual occupational health visits between 2011 and 2014, socioeconomic and health information for each participant were recorded, including education level, smoking status and medication use. Each person in the study had a medical examination to measure body mass index, blood pressure, blood glucose levels, cholesterol levels, triglyceride levels and more. Urine samples were collected to assess metal exposure from air, water and food. Researchers performed carotid and femoral ultrasounds, as well as coronary calcium scoring tests.

The analysis found:

  • Older study participants had higher levels of most of the metals measured in the urine
  • The few female participants in the study had higher metal levels compared to men, when levels were measured in the urine.
  • Adults who had smoked at any time showed higher levels of arsenic, cadmium, chromium and titanium than the people who had never smoked.
  • Higher levels of arsenic, cadmium, titanium, and potentially antimony were associated with a higher probability of having subclinical atherosclerosis.
  • Arsenic and cadmium appear to be most closely associated with increased plaque levels in the carotid arteries; cadmium and titanium are of greater concern for the femoral arteries; and titanium, and possibly cadmium and antimony, are of more concern for the coronary arteries.
  • Arsenic may be more toxic for the arteries when found in combination with cadmium and titanium.

“This study supports that exposure to toxic metals in the environment, even at low-levels of exposure, is toxic for cardiovascular health,” said study co-author Maria Tellez-Plaza, M.D., Ph.D., a senior scientist at the National Center for Epidemiology and the Instituto de Salud Carlos III in Madrid, Spain. “The levels of metals in our study population were generally lower compared to other published studies. Metals, and in particular arsenic, cadmium, and titanium, likely are relevant risk factors for atherosclerosis, even at the lowest exposure levels and among middle-aged working individuals.”

The study included a very specific population of mostly men in one area of Spain, so the results may not be completely extrapolated to women or other populations world-wide. Additional research is needed to understand the mechanisms involved in the development of atherosclerosis based on associations to metals.

“Current global environmental, occupational and food safety standards for cadmium, arsenic and other metals may be insufficient to protect the population from metal-related adverse health effects,” said Tellez-Plaza. “Metal exposure prevention and mitigation has the potential to substantially improve the way we prevent and treat cardiovascular disease.”

Source: American Heart Association