The diabetes-heart connection and the potential threat of COVID-19

Every year, around 1,71,00,000 people die of cardiovascular disease worldwide. To raise awareness regarding cardiovascular health, every year, the World Heart Federation celebrates World Heart Day.

The theme of World Heart Day this year is "Use heart to beat cardiovascular disease (CVD)" and in celebration of this occasion, Beacon Pharmaceuticals Limited and The Daily Star jointly organised a webinar titled "The diabetes-heart connection and the potential threat of COVID-19" on September 25, 2020.

The webinar focused on significant issues concerning the correlation and causation between COVID-19 and other underlying cardiovascular conditions. It also discussed the risk factors presented by COVID-19 for patients with diabetes and hypertension and ways to minimise them. At the beginning of the pandemic, it was suspected that the SARS-CoV-2 infects the lung cells and affects the respiratory system. However, new data has now revealed its impact on the cardiovascular system and other major organs of the body.

Professor Dr S M Ashrafuzzaman, Head of the Endocrinologist Department of Endocrinology & Diabetes at BIRDEM shared, "People with diseases such as hypertension, diabetes, cardiovascular disease (CVD), asthma etc., are at a higher risk of contracting COVID-19." Furthermore, he discussed that elderly people with such underlying conditions have a much more difficult recovery path ahead of them besides the risk of having higher mortality rates.

He elaborated on what really ties these underlying conditions together, saying, "Currently, 425 million people are living with diabetes and, around 50 to 60 percent people with diabetes develop CVD. Also, since a person with diabetes is immunocompromised, they are much more likely to develop CVD."

Professor Mir Jamal Uddin, Director of NICVD, added, "The mortality rate for diabetes patients with COVID-19 is four to eight times higher than that of a healthy individual."

According to Dr AKM Monwarul Islam, Associate Professor of Cardiology at NICVD, "Hypertension is also just as common as heart disease and diabetes, if not more. 30 percent of adults in Bangladesh and 113 crore people worldwide have hypertension and since this condition causes internal damage within patients without showing any significant outwardly symptoms, by the time people realise they have hypertension, it is already too late." Therefore, he went on to refer to hypertension as a silent killer.

Professor Jamal shared a more in-depth view on how COVID-19 affects the heart. His observations show that COVID-19 can cause myocarditis which is an inflammation of the heart muscle. Myocarditis also leads to irregular heartbeats, which is a medical condition known as arrhythmia. All these conditions can eventually culminate into a heart attack in the absence of proper treatment.

He added, "We carried out a joint study with icddr,b which revealed that ten percent of the patients being admitted for heart attacks were found to be COVID-19 positive upon testing."

Professor Jamal agreed on how this can be concerning for the doctors as they generally treat these patients without prior knowledge. But, at NICVD, the risk is minimised by sending any suspected patients to their isolation ward which currently has 48 beds. After proper treatment of the underlying condition, these COVID-19 positive patients are sent to hospitals dedicated to their treatment.

Minimisation of the risk factors was a key point discussed by all the speakers who reiterated the importance of prevention. "Prevention of CVD depends on the management of the associated risk factors. The risk factors include hypertension, diabetes, obesity, high cholesterol level, etc," said Professor Dr AKM Fazlur Rahman of the Department of Cardiology at BSMMU.

He advised that people living sedentary lives should be more active and should exercise daily as well as maintain a healthy diet consisting of heart-healthy foods. He further related the devastating effect of smoking on heart health. "A person who quits smoking will have a lower risk of heart disease within a year. In 15 years, the risk will lower to that of a non-smoker."

Dr Ashrafuzzaman suggested keeping factors such as Body Mass Index (BMI) and cholesterol levels in check and reiterated the importance of early detection since it makes prevention easier.

For patients with special conditions, such as heart valve patients, Dr Monwarul emphasised on the importance of regular check-ups. "Due to COVID-19, many people are now scared to visit hospitals. However, these patients still need to keep the dosage of their medications in check."

The discussion came to an end with insights into the current state of the pharmaceutical industry in our country.

"Our country has many pharmaceutical companies of international standards," acknowledged professor Fazlur Rahman.