Research begins to rapidly understand deadly link between Covid-19 and cardiovascular diseases

People with heart and circulatory diseases are disproportionally affected by COVID-19. Data from the Office of National Statistics (ONS) has consistently shown heart disease to be among the most common pre-existing health conditions in people who have died with the virus in England and Wales.

COVID-19 has also been shown to damage the heart and blood vessels, and increase the risk of blood clotting and inflammation, which can lead to heart attacks and strokes.

The research projects will address urgent questions, such as who is most at risk, how best to manage COVID-19 infection in people with pre-existing cardiovascular illnesses, and how to prevent the longer term effects that the virus might have on people's heart and circulation.

Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation, said: "This virus may be a respiratory infection, but the most common underlying health conditions in those who die are cardiovascular. People with heart disease are at higher risk of dying from the virus and the risk for people with diabetes is two to three times higher than the general population. We are also rapidly learning that the virus can have devastating effects on the heart and circulatory system and increase the risk of heart attacks and strokes.

"By awarding flagship status to these projects, we hope to mobilise resources and research effort behind studies that have the best chance of swiftly improving care and saving lives. The speed at which we've done this is testament to the strength of UK cardiovascular science, and could lead to results within weeks."

In one project, carried out through the new BHF Data Science Centre, multiple datasets from hospitals, GP surgeries and cardiovascular registries will be linked to give a unique insight into people with heart circulatory diseases who have suffered with COVID-19.

Professor Cathie Sudlow, Director of the BHF Data Science Centre, said: "The answers to many questions about COVID-19 will lie in the data we're gathering from patients. By combining datasets and making them safely available to world-leading researchers, we hope to quickly understand who is most at risk and what existing treatments might increase or reduce the damage caused by the disease."

In another project, a team led by researchers from the University of Bristol and University College London (UCL), is linking data from large cohort studies to uncover which cardiovascular diseases, as well as genetic, demographic or lifestyle factors are associated with increased risk of COVID-19 infection and its severity. It will also look at mechanisms linking COVID-19 to adverse cardiovascular health. This could pave the way for improved treatments or better ways of identifying those at risk.

Deborah Lawlor, Professor of Epidemiology at the University of Bristol, said: "Identifying the factors which may explain why some people are at increased risk of COVID-19 infection is critical to our understanding of the disease and reducing mortality.

"While we know that certain underlying health conditions, such as being overweight or obesity, heart disease and diabetes, are associated with a higher risk of people getting COVID-19, or becoming very seriously ill when they get it, and more at risk of dying from it if they get it. We are not yet clear why this is the case and what we can do to protect people from COVID-19. There is also evidence that COVID-19 increases the risk of subsequent heart disease and we need to understand more about these long-term effects.

"Our aim is to link genetic, health and lifestyle data from the UK's biobanks and population cohorts, including Bristol's Children of the 90s study, with primary care and hospital data, including data on who has had COVID-19, and apply a cause-and-effect analytical technique known as Mendelian randomisation.

"Using this technique will allow us to separate and identify the causal role that genetics, lifestyle factors such as alcohol and smoking, a range of cardiovascular conditions, obesity and diabetes has on increased risk of COVID-19, and ultimately, help us determine who is most at risk in terms of disease severity and mortality."

Studies will also look at the damage the virus causes to the heart and circulatory system. Researchers led from UCL will set-up a registry to track the heart health complications caused by COVID-19, while another consortium of universities and hospitals led by investigators from Leeds and Oxford hope to follow people recovering for six months and use MR scans to assess longer-term damage to their heart and vital organs.

Scientists at the University of Oxford will use artificial intelligence techniques to assess CT scans to see if the virus causes long-term vascular inflammation. This could lead to wider use of anti-inflammatory treatments and other medicines to lower people's future risk of heart attacks or strokes.

Finally, researchers will investigate how the pandemic has affected care for people with heart and circulatory diseases. This follows a sharp fall in non-Covid-19 admissions to hospital, including for heart attack and stroke.

The initiative builds on a pre-existing partnership between the BHF and NIHR. The research funders have awarded flagship status to peer-reviewed projects to avoid duplication of effort and maximise opportunities for collaboration and rapid results.

Professor Keith Channon, Chair of the NIHR-BHF Cardiovascular Partnership, said: "Through the NIHR-BHF partnership, we've rapidly mobilised our existing scientific data, infrastructure and research community to answer important questions that could lead to improved ways of treating and caring for people with COVID-19. A positive from this devastating pandemic is that scientists are collaborating at a speed and scale we've never seen before. We're only just starting to understand this disease and need to make rapid progress that will improve care for people in hospital, and in their recovery."

Summary of projects:

Using big data to understand the big picture

The project will link data on COVID-19 testing and cardiovascular health data in hospital and primary care datasets. This will enable researchers to carry out projects to understand why people with heart and circulatory disease are more at risk, how the virus might impact long-term cardiovascular health, and the impact of the pandemic on care for people with heart and circulatory diseases. The findings could therefore lead to improvements in treatment and care.

Led by Professor Cathie Sudlow, Director of the BHF Data Science Centre

What determines our risk of Covid-19?

Researchers will take large cohort studies where participants have already provided information about their general health and wellbeing and information on their genetic make-up. They will link these datasets with COVID-19 diagnosis and, in some cases to the results of swab and antibody testing in order to uncover which genetic, demographic or lifestyle factors that are associated with increased risk of COVID-19 infection and its severity.

Led by Professor Aroon Hingorani, Director of the UCL Institute of Cardiovascular Science and the UCL BHF Research Accelerator, Professor Deborah Lawlor, University of Bristol and Professor Cathie Sudlow

Can Covid-19 cause acute heart problems?

The research team will use hospital data from across the UK on the outcomes of people with COVID-19 to understand how cardiovascular disease and risk factors increase the risk of developing severe complications of COVID-19 and which acute cardiovascular complications are most common in patients who develop COVID-19. This UK project links with the European-wide Capacity-Covid project.

Led by Professor Bryan Williams, Director of the NIHR University College London Hospitals BRC

Using biomarkers to predict who will be most affected

Researchers will use routinely collected clinical data from patients tested for COVID-19 to see whether certain biomarkers (biological molecules found in blood, other body fluids, or tissues that are a sign of a normal or abnormal process, or of a condition or disease) can predict those most likely to suffer severe complications as a result of the disease. This data will allow the researchers to establish whether commonly prescribed medications affect this risk. The team will also review the wider implications of the pandemic through investigating heart and circulatory disease admissions to hospital during the pandemic.

Led by Professor Jamil Mayet, Professor of Cardiology at Imperial College London

How does Covid-19 affect our organs?

Researchers hope to run two related projects that will follow nearly 1,000 patients from over a dozen hospitals across the UK recovering from relatively severe symptoms of COVID-19 infection. Detailed biomarker measurements and cardiac MR imaging will be carried out with follow-up scans at 6 months. In some of the participating centres, additional tests will be performed to image the damaging effects of the virus on the brain, lungs, liver and kidneys, and to assess patients' exercise capacity and overall well-being. If funded, the trial will improve our understanding of the long term impact of COVID-19 on health and well-being, and shed light on which patients are most at risk of lasting complications.

Led by Professor John Greenwood, Cardiovascular Director of the NIHR Leeds CRF, and Professor Stefan Neubauer, Head of the Division of Cardiovascular Medicine and BRC Imaging Theme lead, University of Oxford and Oxford University Hospitals NHS Foundation Trust.

Using AI to see long-term effects on the heart

Many patients with severe COVID-19 infections will have a chest CT scan in hospital. Researchers will use new artificial intelligence techniques applied to these scans to accurately measure the level of inflammation in the vessels and surrounding tissues which might be caused by the virus. Repeat scans after infection has subsided will be compared to get a picture of inflammation during and after the infection. The Researchers are developing an early warning system to identify the patients at risk for adverse in-hospital outcomes, which will allow timely deployment of appropriate treatments and improve resources management within the NHS. They also hope to understand whether infection has lasting effects on vascular health and if extra medication should be given to reduce peoples' risk of heart attacks or strokes in the months or years after the infection.

Led by Professor Charalambos Antoniades, BHF Senior Clinical Research Fellow and Professor of Cardiovascular Medicine at the University of Oxford