What to Know About Coronary Artery Disease and COVID-19

Older adults, especially those with coronary artery disease (CAD) or high blood pressure, are among those most at risk for developing severe symptoms from COVID-19.

Like influenza and other viruses, the novel coronavirus (SARS-CoV-2) that causes COVID-19 can damage the respiratory system and force the heart to work faster and harder to supply oxygen-rich blood to major organs.

If you have CAD (the narrowing or blockage of the major blood vessels supplying the heart), your heart muscle may be at higher risk of becoming inflamed and weakened, decreasing its ability to meet increased energy demands. Even worse, COVID-19 has been shown to cause blood clots in your heart’s arteries, increasing the risk of heart attack and stroke.

A viral infection of the heart muscle, myocarditis, also can exacerbate coronary artery disease.

Coronary Artery Disease and COVID-19 Risk

Research has shown that some people with heart conditions may be at higher risk of severe illness from COVID-19. These heart conditions include:

• Heart failure
• Coronary artery disease (CAD)
• Cardiomyopathies
• Hypertension (high blood pressure)

In addition, COVID-19 can cause heart muscle or vessel damage, resulting in severe problems.

CAD is not only a serious risk factor for COVID-19, it’s also one of the leading causes of death and the most common type of heart disease worldwide. In fact, between 2.5% and 10.5% of all COVID-19 patients have some level of coronary artery disease.

The true magnitude of COVID-19 risk and CAD is still unknown due to:

• Research limitations such as the lack of a standardized definition of CAD
• Incomplete accounting for other coexisting conditions frequently intertwined with CAD
• Short-term follow-up

Research is ongoing. 

Complications of Coronary Artery Disease and COVID-19

COVID-19 impacts many organ systems including the:

• Lungs
• Brain
• Liver
• Kidneys

The cardiovascular system, which has many ACE2 receptors (angiotensin converting enzyme-2 receptors that allow the novel coronavirus to enter and infect a cell), is also affected, with complications including:

• Myocardial injury
• Myocarditis
• Acute myocardial infarction
• Heart failure
• Dysrhythmias
• Venous thromboembolic events

Current therapies for COVID-19 may also interact with cardiovascular medications, but research into the magnitude of these interactions is ongoing.

Coronary Artery Disease Treatments and COVID-19

We are still learning about COVID-19, but currently there is no evidence that heart medications make you more likely to get the novel coronavirus leading to COVID-19 or become seriously ill from the disease. In fact, stopping your medications might cause more harm by worsening your heart disease symptoms, especially if you come down with COVID-19.

Remember that your medications—like statins, beta-blockers, ARBs (angiotensin receptor blockers), and ACE inhibitors (angiotensin converting enzyme ibhibitors)—help prevent:

• Heart attacks
• Dangerous heart rhythms
• Strokes
• Other complications

Drugs that affect the electrical impulses of the heart, specifically the interval in the electrical rhythm called the QT interval, are called QT-prolonging drugs.

These drugs include:

• Some antidepressants
• Antimalarial drugs such as hydroxychloroquine and chloroquine
• Opioid medications (painkillers)
• Muscle relaxers

Because QT-prolonging drugs are commonly used, healthcare providers prescribing azithromycin often discontinue the use of QT-prolonging drugs if the antibiotic is needed. 

Chloroquine and hydroxychloroquine, which also have been used experimentally in the treatment of COVID-19, have both anti-arrhythmic and proarrhythmic properties. These drugs can have negative impacts on cardiac function and conduction that are broad and fatal if not used properly.

These drugs should not be used off-label to treat COVID-19. If they are to be prescribed, they should be used under the direct supervision of a healthcare professional.

Frequently Asked Questions

Does taking my heart medications increase my risk of catching the novel coronavirus?

No. Early in the pandemic, some media outlets reported that there were concerns about taking certain blood pressure drugs—like ACE inhibitors and ARBs—because it was thought that these drugs could alter the receptors in lung cells, making it easier for people who take these drugs to catch the novel coronavirus. This has since been proven to be untrue.

If you are taking an ACE inhibitor or another blood pressure medication, such as an ARB or beta-blocker, you should continue to do so unless advised not to by your healthcare provider.

Do people with CAD have a higher chance of serious complications from COVID-19?

Yes. People with preexisting heart disease who become ill with COVID-19 may experience rapid worsening of their cardiovascular health due to a combination of severe illness from the disease and their heart working too hard to meet the increased demands of the body.

COVID-19 infection has also been shown to increase one’s propensity to form blood clots which can result in a heart attack, peripheral artery disease, or the development of congestive heart failure. In addition to the increase in these heart problems, a more unusual condition called myocarditis has been observed in COVID-19 patients.

I have CAD. Is it safe for me to get the COVID-19 vaccine?

Yes. People with heart disease or risk factors for heart disease and stroke are at much greater risk from the virus than they are from the vaccine. While the vaccine has a risk of anaphylaxis, the event is exceedingly rare. There have been very few reported side effects of the COVID-19 vaccine in people with CAD, and research shows that taking the COVID-19 vaccine decreases the risk of:

• Hospitalizations
• Severe disease
• Death

The vaccines also can be safely administered while you remain on your heart medications. To lower your risk of severe disease, the Centers for Disease Control and Prevention (CDC) strongly urges those with cardiovascular disease to get the vaccine as soon as they can. 

If I catch the novel coronavirus, should I continue taking my heart medications?

Yes, you should continue with your medicines, unless told otherwise by a healthcare professional who is overseeing your care. 

How to Stay Safe

Engaging in health-positive behaviors is the key to staying healthy and limiting the risk of complications from COVID-19 infection. This includes:

• Practicing social distancing
• Washing your hands with soap and water for at least 20 seconds
• Wearing a face mask over your nose and mouth

You may also wish to talk to your healthcare provider about whether your vaccinations and other preventive services are up to date to keep you from becoming ill with other diseases. Other tips to stay healthy include:

• Making sure that you receive your recommended vaccinations against influenza and pneumococcal disease. This is especially important in those who are over the age of 65, are overweight, are immunocompromised, or have a preexisting health condition such as diabetes, heart disease, or cancer.
• Talk with your healthcare provider about maintaining preventive services like cancer screenings during the pandemic.
• Stay physically active.
• Limit stress. 
• Ask your healthcare provider about telemedicine or remote healthcare visits, and know when to, instead, go to the emergency department for treatment.
• Continue to take your prescribed medications and have a 30-day supply on hand. Stopping your medication puts you at higher risk of developing serious complications if you contract the novel coronavirus infection. Only stop your medications if directed by your healthcare provider. 

A Word From Verywell

Preventive health measures like properly wearing a mask, handwashing, limiting social contact and distancing yourself at least six feet from others are the best ways to limit transmission of the virus causing COVID-19. You should also remain on your regular medication regimen unless advised otherwise by a healthcare professional.

If you have CAD, it is strongly recommended that you get the vaccine. The vaccine has been shown to decrease the severity of the disease, which means your heart will not have to work as hard to meet the body’s energy demands if you contract the virus. Monitor your symptoms and if you begin to feel dizzy, experience chest pain, shortness of breath, or feel as if you are going to faint, seek immediate medical attention. 

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.