By Hafeza Shaikh, DO, FACC, RPVI, FACOI, Cardiologist—Virtua Cardiology

Cases of the coronavirus, COVID-19, are increasing and people with heart disease seem to be especially vulnerable. If you have a heart disease diagnosis, you should be extra vigilant in following Centers for Disease Control and Prevention guidelines.

Based on the information we’re receiving, many of the patients who become severely ill from the virus have underlying conditions such as hypertension, coronary artery disease or heart failure.

Here are four reasons why:

First and foremost, people who are older or have a heart condition may have a weakened immune system, so the body’s response to the virus may not be as strong. People who have cancer, lung disease, or diabetes, take medication that suppresses the immune system, or had an organ transplant also are at additional risk.

Second, COVID-19, like the flu, is a respiratory illness targeting the lungs. Respiratory illnesses also affect the heart, which has to work harder to deliver oxygen-rich blood throughout the body. For someone with congestive heart failure, whose heart is already having problems pumping efficiently, this can significantly worsen symptoms and lead to complications.

Third, COVID-19 may pose a particular danger to the heart because of how the virus attacks the body’s cells. The virus latches onto a protein called angiotensin-converting enzyme 2, or ACE2. ACE2 is found on cells in the lungs, heart and inner lining of the blood vessels. Doctors in China found some people with COVID-19 suffered myocardial injury, the death of heart cells for reasons other than a heart attack. If your heart is already damaged from a heart attack or other condition, you could develop heart failure.

ACE2 also is part of a system of hormones that regulate blood pressure and cardiovascular and kidney function. One-third of Americans have high blood pressure, with millions taking medicines to control it. The virus may interfere with how well those medicines work.

Finally, COVID-19 poses a risk for people with atherosclerosis, the build-up of fats, cholesterol, and other substances (known as plaque) inside the arteries. Inflammation, the body’s normal response to infection, can destabilize the plaque, potentially resulting in the blockage of an artery and a heart attack.

To help reduce your risk:

• Follow social distancing guidelines. That means:

• Obey state stay-at-home orders.
• When in the community, stay at least 6 feet away from others.
• Use Skype, FaceTime or other video apps to stay in touch with family and friends. 

• Avoid close contact with people who are sick.
• Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
• If soap and water are not available, use a hand sanitizer with at least 60 percent alcohol. Always use soap and water if your hands are visibly dirty.
• Avoid touching your eyes, nose, and mouth.
• Cover your cough or sneeze with a tissue, then throw it in the trash.
• Clean and disinfect frequently touched objects and surfaces with a household disinfectant.
• Maintain healthy habits, like eating well, getting enough sleep, and managing your stress levels.
• Do not stop any medication unless directed by your doctor.