Why People With Heart Disease Are More Vulnerable to COVID-19

Find out how COVID-19 affects the heart and why fewer people are seeking help for heart attack and stroke.

older man taking medication

Updated on April 20, 2020.

Although COVID-19 can affect people of any age, that doesn’t make it an equal-opportunity virus. People with heart problems, particularly high blood pressure or a history of heart attack or stroke, are among those at higher risk for severe infections or complications from the disease.

In fact, COVID-19-related death rates in this high-risk group could be up to three times greater than in the general population.

An April 2020 study of 1,527 patients with COVID-19 published in Circulation showed that 17 percent had high blood pressure and roughly 16 percent had heart disease or disease of the blood vessels in the brain. These patients were also more likely to have severe infections. For example, patients with a history of coronary heart disease accounted for 5.8 percent of severe cases but only 1.8 percent of mild or moderate infections.  

How COVID-19 attacks the heart

Scientists are still working to understand the link between heart problems and COVID-19. Advancing age may play a role. For example, high blood pressure is more common among older people who are already at higher risk of infection and complications since the immune system weakens with age. The connection could also be related to the effects of medications or reduced kidney function.

Many people with high blood pressure also have other chronic health issues, such as high cholesterol and obesity—other factors that increase the risk for COVID-19-related complications.

But ongoing research also suggests that COVID-19 itself could lead to heart-related problems—even among those who don’t already have heart disease. Scientists gathering data from China, Italy, New York and other hot spots around the world suspect that the novel coronavirus may infect the heart muscle.

A virus like SARS-CoV-2, which causes COVID-19, can also lead to inflammation that triggers an overwhelming release of proteins called cytokines. Normally, cytokines help coordinate the body’s response to infection. But in some cases, this response can range out of control, doing more harm than good. This so-called cytokine storm can damage the blood vessels and organs and lead to blood clots.

If you have heart disease, it’s likely more important now than ever to make sure you’re doing all you can to protect your heart health—and avoid exposure to the coronavirus that causes COVID-19.

Keep taking your medications

At the best of times, it can be hard to keep up with medications and lifestyle efforts, including following a healthy diet and getting regular exercise. But if you’ve survived a stroke or heart attack, or if you know you have circulatory issues such as high blood pressure or atherosclerosis (the hardening and narrowing of the arteries), it’s especially important to stay the course and stick to your treatment plan during the pandemic.

“We really encourage patients to do all the things that they normally do,” says Mariell Jessup, MD, FAHA, Chief Science and Medical Officer at the American Heart Association. “Watch their diet. Be careful about salt. Monitor their weight if they’ve been told to monitor their weight.”

Taking your medications as directed by your doctor is also essential, Dr. Jessup cautions. Do not stop taking any of your prescriptions unless your doctor instructs you to do so. This is true even if you’re taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).

Many people with heart disease—including heart failure, high blood pressure or ischemic heart disease—take these drugs, which can increase the abundance of ACE2 receptors on the outer cells in the lungs, arteries, heart, kidney and intestines. When researchers found that SARS-CoV-2 uses these receptors to invade lung and heart cells, it raised some concerns.

But the American College of Cardiology, the American Heart Association, the Heart Failure Society of America and the European Society of Cardiology have all issued guidelines saying patients should not stop taking these drugs, reassuring patients that there is no evidence to suggest they could contribute to more severe cases of COVID-19. The benefits of these drugs in managing heart problems, however, are very clear. There is also some evidence that ACE inhibitors and ARBs could possibly benefit patients with COVID-19 by widening blood vessels and reducing inflammation.  

That said, it’s important to not let your prescriptions run out. Give yourself plenty of time to get refills, advises Jessup. Make sure you have enough prescription medications to last for a prolonged period of time. Ask your doctor about getting early refills or more than usual at one time, such as a 90-day supply.

Make arrangements for a refill and have it mailed to you if possible, to save yourself a trip to the pharmacy.

Other ways to protect your health

Keep taking your medications as directed but talk to your doctor before taking any supplements or over-the-counter remedies. Some of these products, such as decongestants, ibuprofen and other NSAIDs, could raise your blood pressure.

Some other things you can do to maximize your resiliency during the pandemic:

Eat right. This would be a good time to explore heart-healthy recipes in cookbooks or online. There are many options that make use of shelf-stable and frozen foods.

Stay active. Exercise remains as important as ever—even while you’re under stay-at-home orders. If you usually exercise outdoors, be sure you can continue to practice social distancing in your area. If you’re doing cardiac rehab, you should be able to continue doing exercises at home; ask your provider for instructions. And if you’re isolating indoors, one option is to develop your own at-home circuit workout by stringing together short bursts of several types of exercise, such as jumping jacks and lunges, then repeating several times. Talk to your doctor about which exercises would be safe for you to do at home.

Try to keep stress under control. Life is challenging enough without a pandemic. Now the virus is introducing new stress and uncertainty. Take steps to counter the effects of stress, such as meditating, talking with friends and family over the phone and improving your sleep hygiene.

Follow preventive advice to avoid infection. Steps you can take to prevent COVID-19 include washing your hands often with soap and water for at least 20 seconds, covering coughs and sneezes with a tissue that you then throw away, not touching your face with unwashed hands and socially distancing as best you can.

Know when and how to seek help

If you can avoid the hospital, you should. Many hospitals are crowded right now with COVID-19 patients, stretching resources and staff and putting other patients at risk for infection. But if you have heart problems, that doesn’t mean you can’t or shouldn’t seek medical attention when you need it.

Having problems not related to COVID-19 remains a legitimate reason to call your doctor, according to Eduardo Sanchez, MD, MPH, FAAFP, Chief Medical Officer for Prevention at the American Heart Association. Such problems are “going to keep happening, because COVID-19 didn’t result in disease distancing,” Dr. Sanchez says. “We still have our diseases, and we’re still going to live with them.”

“More now than ever, it’s really important that patients with chronic complicated cardiovascular disease, including stroke, keep in touch with their physicians and their nurses,” Jessup adds.

The first step is to be prepared. Know the best way to reach your doctor—before problems arise.

Right now, you should know exactly what number you can text, what number you can call, what address you can send an email to,” advises Sanchez.

If you have an existing heart condition and you develop symptoms that might be COVID-19, such as fever or shortness of breath, don’t hesitate to contact your doctor.

“The threshold for calling your doctor or your nurse should be lower if you have underlying cardiovascular disease. So, fever, cough, extreme fatigue, shortness of breath in particular, those are reasons to call your doctor or your nurse,” Sanchez says. “It’s better to overreach and make that call in advance than to be in a frenzy and unable to reach the people that you need to reach.”

Recognize serious warning signs

Doctors have noticed a drop in the number of heart attack and stroke patients in emergency rooms, suggesting many patients are suffering through at home instead of getting help. Putting off care or ignoring treatable conditions could lead to avoidable bad outcomes for people who don’t even have COVID-19, a prospect that doesn’t sit well with Jessup and other experts.

It’s important to call 911 and seek immediate medical attention if you develop warning signs of a stroke or heart attack, such as:

  • Pain, squeezing, burning or pressure in the center of the chest
  • Pain or numbness in one or both arms, the back, neck, jaw or stomach
  • Sudden nausea or vomiting
  • Shortness of breath
  • Lightheadedness or dizziness
  • Unexplained fatigue
  • Cold sweat
  • Sudden numbness or weakness of the face, arm or leg, particularly on one side of the body
  • Sudden confusion or trouble speaking
  • Vision loss in one or both eyes
  • Loss of balance or coordination
  • Sudden and severe headache

Serious warning signs of COVID-19 also warrant emergency medical attention. These reg flags may include:

  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest
  • Feeling confused
  • Bluish lips or face

If you think you have COVID-19, call 911 and let the operator know. If you have a medical mask, put it on before help arrives.

Article sources open article sources

Kevin J. Clerkin, MD, MSc; Justin A. Fried, MD; Jayant Raikhelkar, MD, et al. “Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease.” Circulation. April 20, 2020.
American College of Cardiology. “Coronavirus Disease 2019 (COVID-19): Epidemiology, Clinical Spectrum and Implications for the Cardiovascular Clinician.”
Ernesto L. Schiffrin, John M. Flack, Sadayoshi Ito, Paul Muntner, R. Clinton Webb. “Hypertension and COVID-19.” American Journal of Hypertension. April 6, 2020.
American Heart Association. “Experts Q and A on COVID-19 part 1.”
American Heart Association. “What people with high blood pressure need to know about COVID-19.”
New England Journal of Medicine: Journal Watch. “ACE Inhibitors and ARBs During the COVID-19 Pandemic.”
American Heart Association. “Patients taking ACE-i and ARBs who contract COVID-19 should continue treatment, unless otherwise advised by their physician.”
Centers for Medicare & Medicaid Services. “FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets.”
American Heart Association. “As COVID-19 cases increase, preventing a second heart attack or stroke is vital.”
American Heart Association. “Resources to maintain healthy lifestyle amidst COVID-19 outbreak.”
Centers for Disease Control and Prevention. “Coronavirus Disease 2019 (COVID-19): How to Protect Yourself & Others.”
American Heart Association. “Heart Attack and Stroke Symptoms.”
Mayo Clinic. “Stroke.”

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