Former CDC Chief Dr. Tom Frieden: Coronavirus and cardiovascular disease – stopping a deadly duo

As the COVID-19 pandemic continues to spread, one thing we have learned is that people with pre-existing chronic diseases are at substantially higher risk of severe complications and death. As we race to respond to this pandemic, we need to protect and provide care for the most vulnerable among us, including people living with cardiovascular disease and other chronic diseases.

People with coronavirus infection and cardiovascular disease, hypertension and diabetes are at least twice as likely to die. Smoking is especially deadly – one study found that smokers have 14 times greater odds of developing COVID-associated pneumonia than non-smokers.

Even before the pandemic, cardiovascular disease has been the leading cause of death in the United States. Now, high levels of cardiovascular disease and its risk factors are amplifying the lethality of the COVID-19 pandemic.

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Cardiovascular health is important, both during the pandemic and in times of relative calm. During flu season, people with heart disease or who have had a stroke are at higher risk for developing severe complications. Heart attacks are six times more likely within the first week of getting a flu infection, with the risk increasing with age.

In addition to fighting COVID-19, we need to increase our resilience as individuals and as a society. Not only will this reduce the need for scarce intensive care beds and save lives during this pandemic, but it will also prevent heart attacks and strokes even after the pandemic has gone.

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Although cardiovascular disease is often referred to as a chronic disease, improving our heart health can start quickly. Within days of stopping smoking, the risk of having a heart attack falls dramatically.

Governments can protect heart health by raising taxes on tobacco (we’re going to need the revenue, and tobacco taxes are the single most effective way to encourage smokers to quit) and making all public places smoke-free (so we can go out and breathe air that is free of both coronavirus and cancer-causing smoke!). Currently, 4 out of 10 people in the U.S. aren’t fully protected by smoke-free indoor air policies in all bars, restaurants and worksites.

By getting business to steadily reduce sodium in our food, we can prevent hypertension and reduce heart attacks and strokes. Structuring our communities so people can walk and bicycle safely and easily will help us stay fit.

We also need a much better primary health care system. In the U.S., despite spending more than $3.5 trillion on health care each year, we don’t get the basics right. Controlling blood pressure would save more lives than anything else doctors can do – but the U.S. does this only half the time. Expanding team-based care, in which every person on the health care team provides care to the fullest of their abilities and training, will allow more people to get the care they need. We also need to reduce barriers to patient care.

Some may think that the COVID-19 pandemic means that “chronic” health problems should go onto the back burner – but the opposite is true. Building healthy populations through proven policies and strong primary health care systems will increase community resilience now and in the future. 

Medicine for high blood pressure – the best drugs are generic and low cost – should be free to patients, and health care systems should be held accountable for the proportion of patients whose blood pressure is controlled.

Especially when infectious disease epidemics strike, community-based care and a dramatic expansion of telemedicine will help keep our most vulnerable people, and their health care providers, out of harm’s way. The possibility that our health care system could become overwhelmed by people needing intensive care for COVID-19 if we don’t “flatten the curve” is our biggest fear right now. Not only will telemedicine help keep our health system from becoming overwhelmed, it can also greatly increase access to care because people don’t have to travel to get it.

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Some may think that the COVID-19 pandemic means that “chronic” health problems should go onto the back burner – but the opposite is true. Building healthy populations through proven policies and strong primary health care systems will increase community resilience now and in the future.

Because people with chronic disease are the most likely to require scarce intensive care beds, and the most likely to die, it’s more urgent than ever that we act, now, to help people quit smoking, be physically active, and get their blood pressure and diabetes under control. And it’s not just for their own sake – all of us will be safer when each of us is healthier.

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