How a Pandemic Worsens Overall Cardiovascular Health in the U.S.
The novel coronavirus pandemic, currently holding the global population hostage in their homes, has killed over 150,000 people and infected over 2 million. The US leads all nations in both categories. One only needs to look out the window, or visit the local grocery store, to understand the overwhelming sentiment amongst the people.
In a pre-COVID blog post, I reviewed a paper by Brewer et al. that investigates the deleterious affects of chronic stress, minor stresses and major life events on one´s overall cardiovascular health, as determined by the AHA´s Life´s Simple 7 initiative.1 In summary, the authors found that the study participants performed worst in diet, BMI, physical activity and smoking metrics. They reference research studies of depression, CVH and smoking when proposing a theory as to why this profound correlation exists. The studies identify binge eating and smoking to be adverse behavioral responses to psychosocial stress, as well as decrease in physical activity.
The current pandemic is an acute stressor, and major life event, for us all. Unemployment claims in the U.S. have topped 20 million, stock prices are 40% lower than their 2019 highs, one third of the world´s school-aged children are home, local and international businesses are closed, flights are grounded and this graduation/wedding season will be like none we´ve ever witnessed. Psychiatric telehealth consultations are at an all-time high because this is not our steady state; we are social by nature. The current pandemic´s acute stress on our society will inevitably affect its overall cardiovascular health.
I like this illustration of the effects of psychosocial stress on the hypothalamic-pituitary-adrenal axis, and how that translates to increased cortisol level and the subsequent worsening of many cardiovascular risk factors.2
When juxtaposed with the graphic below, illustrating AHA´s Life´s Simple 7, it is quite clear that our current state of stress is antithetic to our goals of reducing cardiovascular death and improving cardiovascular health by 20% by the end of 2020.
With no clear end in sight, but promising figures showing flattening of the disease curve, we must begin tackle the deleterious effects of this acute but soon to be chronic stress on our patient population. Otherwise, we will awake from this pandemic with clinics full of less healthy patients at higher risk of succumbing to an already deadly disease.
At home strategies for exercising, healthy eating, meditation etc will be discussed in my next blog post. For now, be safe, stay home and keep hope alive!
1) Brewer LC, Redmond N, Slusser JP, Scott CG, Chamberlain AM, Djousse L, Patten CA, Roger VL, Sims M. Stress and Achievement of Cardiovascular Health Metrics: The American Heart Association Lifes Simple 7 in Blacks of the Jackson Heart Study. Journal of the American Heart Association, 7(11). doi:10.1161/jaha.118.008855
2) Iob, Eleonora & Steptoe, Andrew. (2019). Cardiovascular Disease and Hair Cortisol: a Novel Biomarker of Chronic Stress. Current Cardiology Reports. 21. 10.1007/s11886-019-1208-7.
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