Patients with coronary heart disease (CHD) who are also affected by coronavirus disease 2019 (COVID-19) face an elevated risk of experiencing coronary events. Numerous studies have established an association between cardiovascular disease and COVID-19.
Furthermore, patients with pre-existing cardiovascular disease have demonstrated worse outcomes and a higher mortality risk when afflicted with COVID-19. According to the World Health Organization, the mortality rate due to COVID-19 is estimated to be 3.4% overall. However, in individuals with cardiovascular disease, this figure rises to 10.5%, surpassing the death rate among those with underlying diabetes or chronic respiratory diseases.
Exploring the Link between COVID-19 and Stable Angina Pectoris: Several blood components, including platelets and neutrophils, play crucial roles in ischemic heart disease, particularly acute myocardial infarction. White blood cells and their subtypes have been investigated as inflammatory biomarkers for adverse cardiovascular outcomes. COVID-19 infection significantly impacts blood constituents.
In this retrospective observational study, we aimed to better understand the relationship between stable angina pectoris (AP) and COVID-19 in order to provide clinical guidance.
Methodology: The study was approved by the Research Ethics Committee of the Fourth Affiliated Hospital of China Medical University. Data were collected from 83 patients with stable AP and COVID-19 who received treatment between February and April 2020 at Wuhan Thunder God Mountain Hospital, as well as 49 patients with stable AP treated at Shenyang Fourth People’s Hospital during March and April 2020.
Various parameters were assessed, including age, sex, clinical symptoms, complications, electrocardiographic findings, blood biochemistry, neutrophil count, lymphocyte count, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), mean platelet volume-to-lymphocyte ratio (MPVLR), myocardial enzymes, and muscle calcium.
Results and Discussion: Patients with COVID-19 and stable AP exhibited a significantly higher neutrophil count, MPV, lymphocyte count, and PLR compared to the control group. Among the COVID-19 + stable AP group, the COVID-AP event group (angina attacks) had significantly elevated platelet count, neutrophil count, MPV, NLR, PLR, and MPVLR compared to the COVID-no AP event group. Univariable logistic regression analysis identified several risk factors for angina attacks in patients with COVID-19 and stable AP. However, multivariable logistic regression analysis revealed that only neutrophil count and MPV remained significant predictors of angina attacks after adjusting for confounding factors.
The findings suggest that an increased neutrophil count and elevated PLR may serve as potential biomarkers for identifying COVID-19 patients with stable AP who are at a higher risk of experiencing angina attacks. Neutrophils are involved in the inflammatory response and have been associated with the pathogenesis of atherosclerosis and coronary artery disease. PLR, as a marker of systemic inflammation and cardiovascular risk, may also be relevant in this context.
Moreover, the study investigated the association between myocardial enzymes, muscle calcium levels, and angina attacks in COVID-19 patients with stable AP. Elevated levels of myocardial enzymes (CK-MB, MYO, and TnI) were significantly associated with angina attacks. Additionally, higher levels of muscle calcium were observed in the COVID-AP event group compared to the COVID-no AP event group.
These findings highlight the potential implications of COVID-19 on patients with coronary heart disease (CHD) and emphasize the importance of monitoring blood components as potential risk factors for acute ischemia. The relationship between COVID-19 and CHD appears to involve hematological abnormalities, and understanding these connections can provide valuable insights for clinical practice and patient management.
The COVID-19 pandemic has presented numerous challenges to healthcare systems worldwide. One of the concerning aspects is the increased risk of adverse outcomes in patients with pre-existing cardiovascular conditions, including CHD. Studies have consistently shown that patients with cardiovascular disease, including CHD, who contract COVID-19 are more likely to experience worse outcomes and higher mortality rates compared to those without underlying cardiovascular conditions .
The mortality rate in COVID-19 patients with cardiovascular disease has been reported to be as high as 10.5%, surpassing the rates observed in individuals with other comorbidities such as diabetes or chronic respiratory diseases .
To investigate the relationship between COVID-19 and stable angina pectoris (AP), a retrospective observational study was conducted. The study reviewed data from patients with stable AP and COVID-19 who were treated at Wuhan Thunder God Mountain Hospital and Shenyang Fourth People’s Hospital in China between February and April 2020. Various clinical parameters and blood components were analyzed to gain insights into the interplay between these two conditions and identify potential risk factors for angina attacks.
The study revealed several significant findings. First, there were no significant differences in patient characteristics, such as sex, age, smoking status, hypertension, diabetes, or ischemic stroke, between the control group (patients with stable AP alone) and the COVID-19 + stable AP group. This suggests that the two groups were well-matched and that any observed differences could be attributed to the presence of COVID-19.
Comparison of blood components between the control group and the COVID-19 + stable AP group demonstrated significant differences in neutrophil count, mean platelet volume (MPV), lymphocyte count, and platelet-to-lymphocyte ratio (PLR). Specifically, the COVID-19 + stable AP group exhibited higher neutrophil count, MPV, lymphocyte count, and PLR compared to the control group. These findings indicate altered inflammatory and hematological profiles in patients with COVID-19 and stable AP, suggesting a potential pathogenic relationship between these conditions.
Further analysis within the COVID-19 + stable AP group revealed that patients who experienced angina attacks (COVID-AP event group) had higher platelet count, neutrophil count, MPV, PLR, neutrophil-to-lymphocyte ratio (NLR), and MPV-to-lymphocyte ratio (MPVLR) compared to those who did not experience angina attacks (COVID-no AP event group).
However, there was no significant difference in lymphocyte count between these two subgroups. These results highlight the potential association between increased blood component levels and the occurrence of angina attacks in COVID-19 patients with stable AP.
Univariable logistic regression analysis identified several blood components as risk factors for angina attacks in patients with COVID-19 and stable AP, including neutrophil count, lymphocyte count, platelet count, PLR, MPVLR, NLR, and MPV. Multivariable logistic regression analysis further confirmed neutrophil count and MPV as independent risk factors for angina attacks in this patient population. These findings suggest that elevated neutrophil count and MPV may contribute to acute ischemia in patients with COVID-19 and stable AP.
Previous research has already linked neutrophil count and MPV to CHD. Neutrophil elastase, increased platelet adhesion, and vascular endothelial injury caused by neutrophil extracellular traps have all been implicated in the pathogenesis of atherosclerosis and coronary artery disease . MPV, on the other hand, is associated with platelet activation and reactivity, which play crucial roles in thrombus formation and acute ischemic events . The findings of this study further support the relevance of these blood components in the context of COVID-19 and stable AP.
Additionally, the study examined the association between myocardial enzymes (creatine kinase-MB, myoglobin, and troponin I) and angina attacks in COVID-19 patients with stable AP. The results showed significantly higher levels of these enzymes in the COVID-AP event group compared to the COVID-no AP event group. Elevated myocardial enzyme levels suggest myocardial injury, which may be a contributing factor to the occurrence of angina attacks in these patients.
Furthermore, the study explored the relationship between muscle calcium levels and angina attacks in the same patient population. The COVID-AP event group had significantly higher muscle calcium levels compared to the COVID-no AP event group. Abnormal calcium metabolism has been associated with increased myocardial contractility and enhanced vascular reactivity, both of which can contribute to angina attacks .
In conclusion, the retrospective observational study provides valuable insights into the relationship between COVID-19 and stable angina pectoris. Elevated neutrophil count, MPV, and PLR were identified as potential risk factors for angina attacks in COVID-19 patients with stable AP. These findings highlight the importance of monitoring blood components and considering inflammatory and hematological profiles when managing patients with CHD affected by COVID-19. Further research is needed to elucidate the underlying mechanisms and develop appropriate strategies for risk assessment and targeted interventions in this vulnerable patient population.
reference link : https://journals.lww.com/cmj/Fulltext/9900/Risk_factors_in_blood_for_attacks_of_angina_in.598.aspx