心脏风险因素，而不是心脏病本身，可能会增加COVID-19的死亡几率

试图澄清先前存在的心脏病与COVID-19之间的联系, a study of critically ill patients has found their risk of dying from COVID-19 may stem not directly from heart disease, 而是从促成它的因素.

患有心脏病的人, 并将继续, 患严重COVID-19的风险更高, 根据疾病控制和预防中心. 这项新研究发表在周二的《沙巴体育平台点击进入》上 循环:心血管质量和结果, suggests cardiovascular risk factors – such as being older and whether a person smoked – were the main contributors to serious illness, 而不是心脏病本身.

已知新冠肺炎会通过不受控制的炎症导致器官损伤. 炎症在心脏病和中风患者中也很常见, and it's associated with smoking and other cardiovascular disease risk factors such as 高血压和糖尿病.

为了理解其中的联系, 研究人员查看了5人的记录,133 critically ill COVID-19 patients who were part of a collaborative study called STOP-COVID. 这些患者来自全美68家医院.S. 并在2020年3月1日至7月1日期间入住icu.

这些, 1,174人先前患有心血管疾病, defined in the study as including coronary artery disease (plaque in the heart's arteries), heart failure (where the heart fails to pump effectively) or atrial fibrillation (a type of irregular heartbeat).

Having pre-existing cardiovascular disease initially appeared to be a risk factor for dying within 28 days of hospital admission for COVID, 资深作者Dr. 萨利姆哈耶克. 他是密歇根大学安娜堡分校的助理教授, 他是弗兰克尔心血管中心的主任.

但当研究人员将与心血管疾病相关的因素分离出来时, 比如年龄, 高血压和糖尿病, the link between cardiovascular disease itself and death from COVID appeared to be statistically insignificant.

研究人员发现，最重要的死亡风险因素是, 为了, 年龄, 体重指数(衡量肥胖的指标), 种族和民族, 以及吸烟史.

The results suggest the increased risk of death among heart disease patients studied is less that they have plaque-lined arteries, 更重要的是，他们有导致COVID-19过度炎症的风险因素, 哈耶克说. 他承认, 然而, that because the study had few people with heart transplants or severe cardiovascular disease, 比如晚期心力衰竭, 研究人员无法得出关于它们的结论.

在他们分析的第二部分, 研究人员观察了一种称为肌钙蛋白的心脏损伤生物标志物. 肌钙蛋白通常被用来检测某人是否有心脏病发作. 但, 哈耶克说, it also can indicate stress on the cardiovascular system or cardiac injury as the body struggles with a COVID-19 infection.

在这两个人中,741例可获得肌钙蛋白水平的患者, “心脏损伤是不良结果的一个强有力的预测因素,哈耶克说——不管病人是否患有心血管疾病. 肌钙蛋白水平越高，患者死亡的可能性就越大. “从本质上来说, what we're seeing here is that cardiac injury is a surrogate marker for the severity of the COVID-19 illness,他说.

总结, 哈耶克说, the first part of the study "highlights that it's not the pre-existing cardiac disease. 第二部分强调心脏损伤与更糟糕的结果有关.”在一起, that suggests the cardiac injury is probably related to the stress of the acute COVID-19 illness rather than a sign of new complications of cardiovascular disease.

He said the study emphasizes that severe COVID-19 is a hyperinflammatory process – and that the inflammatory processes linked to cardiovascular risk also put people at risk of having severe COVID.

The study does not mean that someone with existing cardiovascular disease can ignore the problem, 哈耶克说. 相反，人们需要考虑那些共同的风险因素.

Dr. 特蕾西Y. Wang, a professor of medicine in cardiology at Duke University in Durham, North Carolina, agreed.

心脏病患者死于COVID-19的风险仍然较高, 王说, 谁没有参与这项研究. 但这项研究有助于弄清是什么在伤害人们.

"It's not so much about the fact that they previously had heart disease," she said. “他们的整体健康状况使他们的风险更高. 我认为这种区别很有趣."

The association between cardiac injury and death "seems like a bit of a no-brainer," she said. 严重的COVID-19会导致全身损伤，而不仅仅是心脏. 她说:“可以说，死亡的病人往往有更多的器官受损。. 肌钙蛋白水平只是他们生病的另一个标志.

她指出，“这些患者中有很大一部分从未检测过肌钙蛋白,这使得得出结论变得更加困难.

但她说，总的来说，这些发现给病人带来了一线希望.

"It's saying not all hope is lost even if you've had prior heart disease," she said. These results suggest that if researchers can learn how to limit levels of heart dam年龄, “那么我们就有更大的机会让病人在重症监护病房存活下来, 希望在这之后能有更好的生活质量和寿命."

不管他们是否被诊断出患有心脏病, 人们可以把这些发现看作是一种激励自我照顾的方式, 王说. “如果你能进行良好的预防治疗，定期去看医生, 控制你的糖尿病, 保持健康的体重, aim for an active lifestyle – the combination of all of those things should not only limit your risk of developing heart disease, that also would help keep your disease severity lower and your risk of adverse outcomes lower even if you were to contract COVID-19."

哈耶克说 he hoped the research would lead to a better understanding of the root links between heart disease, 炎症和传染病, 也许是为了找出所有条件可能共有的更好的标志.

“因为炎症和心血管疾病之间存在重叠, understanding the link mechanistically will be of value not just for this pandemic, but for any severe infectious illnesses to which patients with heart disease are exposed,他说.

编者注:由于围绕冠状病毒的沙巴体育平台点击进入迅速演变, 本文中提供的事实和建议自出版以来可能已经发生了变化. 访问的心.Org获取最新报道, and check with the Centers for Disease Control and Prevention and local health officials for the most recent guidance.

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