Vascular Events, Vascular Disease and Vascular Risk Factors-Strongly Intertwined with COVID-19

Abstract

Purpose of review: To elucidate the intertwining of vascular events, vascular disease and vascular risk factors and COVID-19.

Recent findings: Strokes are a leading cause of disability and death worldwide. Vascular risk factors are important drivers of strokes. There are unmodifiable vascular risk factors such as age and ethnicity and modifiable vascular risk factors. According to the INTERSTROKE study, the 10 most frequent modifiable vascular risk factors are arterial hypertension, physical inactivity, overweight, dyslipidaemia, smoking, unhealthy diet, cardiac pathologies, diabetes mellitus, stress/depression and overconsumption of alcohol. Also, infection and inflammation have been shown to increase the risk of stroke. There is high-quality evidence for the clinical benefits of optimal primary and secondary stroke prevention. The COVID-19 pandemic brought a new perspective to this field. Vascular events, vascular disease and vascular risk factors-and COVID-19-are strongly intertwined. An increased risk of vascular events-by multifactorial mechanisms-has been observed in COVID-19 patients. Also, a higher rate of infection with COVID-19, severe COVID-19 and bad outcome has been demonstrated in patients with pre-existing vascular disease and vascular risk factors.

Summary: At present, we suggest that regular interactions between healthcare professionals and patients should include education on COVID-19 and on primary and secondary vascular prevention in order to reduce the burden of disease in our ageing populations.

Keywords: COVID-19; Ischaemic stroke; Prevention; Vascular events; Vascular risk factors.

Fig. 1

Patient with ischaemic stroke because of large vessel occlusion. An 86-year-old female patient was brought by ambulance to our emergency department because of left-sided hemiparesis, forced eye deviation towards the right and confusion. She had a history of atrial fibrillation, coronary heart disease and diabetes mellitus type 2. The initial evaluation revealed an NIHSS score of 17. Because her levels of anti-Xa were elevated due to recent intake of rivaroxaban, an endovascular therapy with thrombectomy (successful reperfusion: TICI 2b) without intravenous thrombolysis was performed. One day after intervention, the clinical assessment showed a residual NIHSS score of 8 because of moderate left-sided hemiparesis, left-sided facial droop and dysarthria.