Interplay of COVID-19 and cardiovascular diseases in Africa: an observational snapshot

Abstract

The COVID-19 pandemic, which started around December 2019 has, at present, resulted in over 450,000 deaths globally, and approximately 1% of these deaths have been reported in Africa. Despite the high prevalence of COVID-19 risk factors, namely: hypertension, diabetes, chronic pulmonary disease, cardiovascular diseases (CVDs) such as rheumatic heart disease, compromised immunity and obesity, low case fatality rates have been recorded in many parts of Africa so far. COVID-19 severity has previously been shown to be worse in patients with CVD and hypertension. We observed the severity of COVID-19 and mortality rates in Africa, and compared outcomes with prevalence of established risk factors (hypertension and CVD). We stratified data as per the United Nations’ 5 African subregions. North African countries show a positive association between the risk factors and the mortality rates from COVID-19. However, we observed discordant patterns in the relationship between COVID-19, and either CVD or hypertension, in sub-Saharan African countries. In this paper, we also review the pathogenesis of SARS-CoV-2 infection and how it worsens CVD and postulate that the differences in modulation of the renin–angiotensin–aldosterone system (RAAS) axis which controls angiotensin-converting enzyme (ACE)/ACE2 balance may be an important determinant of COVID-19 outcomes in Africa. Electronic supplementary material The online version of this article (10.1007/s00392-020-01720-y) contains supplementary material, which is available to authorized users.

Evolving concepts of myocardial phenotypes, myocardial injury, cardiovascular consequences and management in patients with SARS-CoV-2 infection

“…There is evidence that drivers of oxygen supply/demand mismatch -hypotension, increased metabolic demands, arrhythmia, hypoxia and new-onset hypertension -play a central role in ischaemic myocardial injury. (1,2,14) Direct viral cardiomyocyte toxicity is supported by autopsy studies. (2,15) The cytokine storm, microangiopathy, hypercoagulability, vascular dysfunction and the complex interaction of dysregulated host immune response with pre-existing CVD, epicardial coronary plaque rupture and Takotsubo are important mechanisms of myocardial injury and are reported in the literature.…”

“…(1,2,14) Direct viral cardiomyocyte toxicity is supported by autopsy studies. (2,15) The cytokine storm, microangiopathy, hypercoagulability, vascular dysfunction and the complex interaction of dysregulated host immune response with pre-existing CVD, epicardial coronary plaque rupture and Takotsubo are important mechanisms of myocardial injury and are reported in the literature. (16)(17)(18)(19)(20) There remain many knowledge gaps in our understanding of the relationship between COVID-19 and CVD -Table 1.…”

“…Of interest, African countries seem to have much lower mortality rates compared to their American and European counterparts. (2) While the pneumocyte is the primary site of infection for SARS-CoV-2, where it causes characteristic pneumonia, ARDS and diffuse alveolar damage, there are multiple extra-pulmonary…”

WHF Position Statement on COVID Vaccination

“…It is thought that SARS-CoV-2 can directly replicate inside the myocardium resulting in primary myocardial injury which may further aggravate pre-existing myocardial injury [ 33 34 ]. It is unknown if the effects of direct viral replication in the heart may be amplified in patients with chronic CVD, especially in those with coronary artery disease.…”

Response to COVID-19 in a large academic Centre in South Africa

“…2 It is curious that the case load and case fatality rates are far less in African countries compared to their North American and European counterparts. 3 …”