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Our Take: COVID-19 appears to be an independent risk factor for heart attack, stroke, large study shows

Aug 09, 2021

In the weeks following infection with SARS-CoV-2, the risk for acute myocardial infarction (MI) and ischemic stroke is substantially increased, results from analyses conducted in Sweden suggest.

The overall study population included more than 85,000 people with lab-confirmed COVID-19 between February and mid-September of last year, whether they required hospitalization or not, and nearly 350,000 people who had not received a COVID-19 diagnosis.

Researchers analyzed the data using two methods. First, they evaluated the increased rate ratio (IRR) for acute MI and stroke for the people with COVID-19 (i.e., the difference in the rate of incidence of each health condition before and after infection).

Since specific dates of infection were not known, the researchers determined the closest date possible for each person and identified that as day 0, or the exposure date.

In the results, the IRR was greater when day 0 was included in the analysis than when it was excluded — but even when day 0 was excluded, the IRR for both health conditions was still nearly three times higher in the first week after infection.

Although the IRR decreased in the second week, it still was about 2.5 times higher for acute MI and 2.8 times higher for stroke (as compared with before infection). For weeks three and four, the IRR was approximately 1.6 times higher for acute MI and slightly more than double for stroke (again, as compared with before infection).

In the other method of analysis, the COVID-19 cases were matched by age (70 and younger vs. older than 70), sex, and county of residence with people who had not received a COVID-19 diagnosis.

In that analysis, the people with COVID-19 were 3.4 to 6.6 times more likely than the controls to have an acute heart attack in the two weeks following exposure, depending on whether day 0 was included or excluded from the analysis. They were also 3.6 to 6.7 times more likely than the controls to have an ischemic stroke during the same time period.

The researchers found an increased number of acute MIs and strokes during the month before day 0, which they attributed to nosocomial COVID-19, or cases that originated in the hospital.

The study was published online July 29 in The Lancet.

Our Take: As much as we would all like to wave a magic wand and have this virus disappear, it’s looking more and more like we’re going to have to adapt. Researchers are learning about the various effects it can have.

For instance, we just read about a study that seems to have shed more light on the association between COVID-19 and dementia. For six months, the researchers followed two groups of patients hospitalized with COVID-19 — a group that had neurologic complications and one that didn’t. The patients in the group with neurologic complications had worse scores on the Modified Rankin Scale, which is used to measure disability in people who’ve had a stroke, and they scored worse on activities of daily living.

When the researchers compared plasma biomarkers associated with Alzheimer’s disease between the two groups, they found elevations of markers of neuronal injury and neuroinflammation in the group with neurologic symptoms.

One of the investigators noted that patients with Alzheimer’s disease have a threefold risk of SARS-CoV-2 infection and twice the risk of dying as a result of the infection.

The question is does the correlation go both ways? He said his team’s findings may suggest that people with COVID-19 who have neurological sequelae might experience an acceleration of Alzheimer’s disease symptoms and pathology, although additional follow-up is needed.

In the months ahead, scientists will learn more about the delta variant that is ravaging so many communities here in the U.S. and throughout the world. When we last checked, the variant accounted for 93% of all COVID-19 cases. The percentage could be even higher by now.

In both India, where it was first identified, and the U.K., the delta variant quickly became the dominant strain. Cases in both places surged for several weeks but then the number dropped off almost as quickly as they had risen. If and when that will happen here is anybody’s guess.

Eventually, one can hope, enough people will either have natural immunity from having had COVID-19 or immunity from the vaccines so that we can reach the herd immunity threshold — though that target seems to keep moving. Previously, experts believed that somewhere between 70% and 80% of the population would need to be immune to the original virus in order for herd immunity to kick in, but the delta variant may be pushing the number toward 90%.

Meanwhile, two of delta’s successors, lambda and delta-plus, have already been identified, along with several mutations in lambda’s spike protein. Either of those, or a variant that has yet to hit the radar screen, could prove to be more dangerous even than delta, to the point where existing vaccines confer little protection. Scientists are exploring the possibility of using broadly neutralizing antibodies to develop a vaccine that could protect against entire families of viruses.

We’re happy to say that there is some good news to report:

The nation finally achieved the goal that President Biden set in early May — albeit a month later than he had hoped. As of Aug. 2, 70% of the U.S. population had received at least one dose of the currently available vaccines.

Vaccination rates are increasing once again all across the country, driven by mandates and fear of the delta variant.

And Regeneron’s injectable cocktail known as REGEN-COV, a combination of casirivimab and imdevimab, is showing promise as a preventive treatment for COVID-19.

In a clinical trial, REGEN-COV reduced the relative risk of infection by 72% within the first week, when compared with placebo in a group of people at high risk of infection. After that, the reduction in relative risk increased to 93%. It also reduced the duration of symptoms by two weeks. The results were published online Aug. 4 in The New England Journal of Medicine.

What else you need to know
A federal judge granted the Federal Trade Commission’s request for a preliminary injunction to halt the merger between Hackensack Meridian Health and Englewood Health. The two New Jersey-based health systems agreed to merge back in 2019, but the FTC filed an administrative complaint in December stating that the merger would adversely affect competition in Bergen County, the state’s most populous county. A trial is scheduled to start in mid-October.

Separately, the FTC recently stated in a blog post that it has been inundated with merger filings — more than 2,000 so far this year — and advised that it cannot review them all before the designated deadlines. The agency cautioned that if companies proceed with a proposed merger before the FTC has fully investigated it, they do so “at their own risk.”

Avera Health sold its telemedicine services to private equity firm Aquiline Capital Partners for an undisclosed amount. The Sioux Falls, S.D.-based business, previously known as Avera eCare, has more than 600 sites spanning 32 states. Avera noted in a press release that Aquiline Capital will execute the carve-out and rename the business Avel eCare. Some services, such as virtual specialty consults, will remain with Avera Health. The acquisition is expected to close in the fourth quarter.

The Department of Justice intervened in lawsuits against several Kaiser Permanente affiliates, including Kaiser Foundation Health Plan, that allege the affiliates submitted falsified claims for Medicare Advantage members to increase reimbursement. The six lawsuits, filed by private parties under whistleblower provisions in the False Claims Act, contend that the affiliates pressured physicians to “create addenda to medical records” subsequent to patient visits; specifically, physicians allegedly were encouraged to add risk-adjusting diagnoses that the patients did not have and/or were not addressed during the office visit. “Today’s action sends a clear message that we will hold health care providers and plans accountable if they seek to game the system by submitting false information,” the DOJ said in a statement. Kaiser disputed the allegations.

A private equity firm has launched Valtruis, a value-based care portfolio company that will invest in and partner with “disruptive” health care companies seeking to “realign and transform U.S. health care along the principles of value-based care.” The firm, Welsh, Carson, Anderson & Stowe, said in a press release that it is committing an initial $300 million to the new company.

The U.S. ranked last in a comparison of health care systems in 11 high-income countries. The Commonwealth Fund conducted an analysis of 71 performance measures in five domains using data from its own surveys and international health organizations. Even though the U.S. spends much more of its gross domestic product on health care, the country ranked last overall, and last on access to care, administrative efficiency, equity, and health care outcomes. The U.S. ranked second on measures of care process. Norway, the Netherlands, and Australia were the top-performing countries overall.

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