COVID-19 and cardiovascular disease, including stroke

Dear Council on Stroke Member,

The current COVID-19 pandemic is our main medical worry these days. There is increasing awareness of the cardiovascular manifestations of COVID-19 and the adverse impact that cardiovascular involvement has on prognosis. Coronary heart disease (HR 4.3) and cerebrovascular disease (HR 3.1) are independent risk factors associated with fatal outcome.¹ The disease predisposes patients to thrombotic disease, both in the venous and arterial circulations, due to excessive inflammation, platelet activation, endothelial dysfunction, and stasis.² Severely ill patients are at risk of myocardial infarction and stroke. In a observational series of severe COVID-19 cases from France with, 3 out of 13 patients undergoing brain MRI for unexplained encephalopathic features, had cerebral ischemic strokes.³ This pandemic is a challenge in many ways.

The ESC has created a specific homepage dedicated to COVID-19 and cardiovascular disease with a variety of regularly updated resources covering many questions related to the disease. You may find it useful. Stay safe!

Markus Schwerzmann, ESC Council on Stroke Communications & Young Community Officer

1. Chen R, Liang W, Jiang M, Guan W, Zhan C, Wang T, Tang C, Sang L, Liu J, Ni Z, Hu Y, Liu L, Shan H, Lei C, Peng Y, Wei L, Liu Y, Hu Y, Peng P, Wang J, Liu J, Chen Z, Li G, Zheng Z, Qiu S, Luo J, Ye C, Zhu S, Liu X, Cheng L, Ye F, Zheng J, Zhang N, Li Y, He J, Li S, Zhong N, Medical Treatment Expert Group for C. Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China. Chest 2020.
2. Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, Nigoghossian C, Ageno W, Madjid M, Guo Y, Tang LV, Hu Y, Giri J, Cushman M, Quere I, Dimakakos EP, Gibson CM, Lippi G, Favaloro EJ, Fareed J, Caprini JA, Tafur AJ, Burton JR, Francese DP, Wang EY, Falanga A, McLintock C, Hunt BJ, Spyropoulos AC, Barnes GD, Eikelboom JW, Weinberg I, Schulman S, Carrier M, Piazza G, Beckman JA, Steg PG, Stone GW, Rosenkranz S, Goldhaber SZ, Parikh SA, Monreal M, Krumholz HM, Konstantinides SV, Weitz JI, Lip GYH. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up. J Am Coll Cardiol 2020.
3. Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, Collange O, Boulay C, Fafi-Kremer S, Ohana M, Anheim M, Meziani F. Neurologic Features in Severe SARS-CoV-2 Infection. N Engl J Med 2020.