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The Novel Coronavirus Disease (COVID-19) Threat for Patients With Cardiovascular Disease and Cancer

2020; Elsevier BV; Volume: 2; Issue: 2 Linguagem: Inglês

10.1016/j.jaccao.2020.03.001

2666-0873

Sarju Ganatra, Sarah P. Hammond, Anju Nohria,

Long-Term Effects of COVID-19

A s the novel coronavirus severe acute respira- tory syndrome coronavirus-2 (SARS-CoV-2) continues to spread across the globe, millions of people may be affected (1,2).Although knowledge regarding the complications and fatality rate associated with SARS-CoV-2 (COVID-19) infection is evolving, preliminary data from China suggests that patients with pre-existing comorbidities, particularly cardiovascular disease (CVD) and cancer, may be among those at highest risk of not just acquiring the infection but also having worse outcomes (1-3).The risk of adverse outcomes may be even higher for those afflicted with a dual diagnosis, particularly the elderly.This is extremely concerning from a public health perspective since cancer and CVD are amongst the most prevalent diseases worldwide (4), and the impact of the current pandemic of coronavirus disease 2019 (COVID-19) could be devastating for these patients.The World Health Organization (WHO) has recently declared COVID-19 a public health emergency of international concern (2).COVID-19 caused by SARS-CoV-2 originated in Wuhan, in the Hubei province of China, but it is spreading rapidly and efficiently (2).SARS-CoV-2 is a novel enveloped RNA betacoronavirus, similar to severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), pathogens responsible for the severe acute respiratory syndrome (SARS) outbreaks in 2002 to 2003 in Guangdong Province, China, and severe respiratory disease outbreaks in 2012 in the Middle East, respectively (5).Although there are phylogenetic similarities between the coronaviruses responsible for SARS and COVID-19, the transmission is exponential with COVID-19, and it can be transmitted by people who are just mildly ill or even asymptomatic, leading to 10 times as many cases as SARS in one-quarter of the time (2,5,6).Although our understanding about the risk of infection with SARS-CoV-2 and its impact is limited, we examine its interaction with the 2 most common disease entities: cancer and CVD. PRE-EXISTING CANCER AND CARDIOVASCULAR DISEASEPatients with cancer are typically at higher risk of infection due to compromised host defenses and the sequelae of antineoplastic treatment, namely, leukopenia, disruption in barriers to infection, and shifts in microbial flora.The current COVID-19 pandemic is particularly concerning, given the potential of spread from asymptomatic carriers (1-3).A report from China suggests that among those confirmed infected with SARS-CoV-2, approximately 1% of patients had cancer (3): 5-fold higher than the general incidence of cancer in China (201.7 per 100,000 persons) (7).A retrospective analysis of MERS-CoV infection has demonstrated that it was more likely to occur in