the covid-19 outbreak has fundamentally changed the world and, consequently, is changing our day-to-day routines and our behaviour. this pandemic is creating profound changes in governments, healthcare and education systems, the global economy, and diplomatic and interpersonal relationships.the world health organization (who) and other national and international public health authorities recommend implementing social distancing and self isolation to mitigate the impact of this disease. however, and paradoxically, the implementation of these measures could have significant and lasting negative implications on cardiovascular health.social isolation is a common source of chronic stress. prolonged social isolation has been shown to increase the risk of morbidity and mortality similar to known factors, including hypertension, smoking and
obesity. in some studies, social isolation was associated with an increase in the possibility of death by 29% and was correlated with an increased risk of coronary heart disease (29%) and stroke (32%).persistent social stress is associated with the activation of the sympathetic nervous system, the hypothalamic-pituitary adrenal axis, leading to inflammation and oxidative stress. these mechanisms can possibly contribute to the increased risk of cardiovascular diseases.even though the long-term effect of covid-19 on cardiovascular health is as yet unknown, concerns have been raised in the medical community of a possible association of covid-19 with acute coronary events, heart failure exacerbations and cases of myocarditis.elderly patients and patients with pre-existing cardiac conditions are considered at increased risk for covid-19 infection. healthcare authorities recommend these vulnerable populations implement social distancing and self-isolation measures. it is possible, therefore, that these behavioural changes could have long-term implications for the cardiovascular health of the general population.it is crucial that the implementation of mitigation strategies for vulnerable and susceptible individuals take into consideration their safety and their social well being.healthcare authorities should consider deploying financial and human resources to support the elderly and other high-risk groups during this pandemic so that those individuals can remain as connected as possible. in this respect, radio, podcasts streaming services television programs and many other sources of virtual communication can significantly reduce the risk and impact of social isolation.remote medical monitoring via phone or the internet is an available tool that assists healthcare providers in delivering care to patients at home. however, for many older people, these options are not readily accessible, so other interventions aimed at promoting good health and focused on improving health and psychological wellbeing should be considered.promoting social integration in these times of social isolation is undoubtedly challenging but vital for these vulnerable individuals. regular phone calls to discuss health and non-health related issues have shown to increase socialization and satisfaction and reduce loneliness. education related to good eating habits and routine physical exercise at home can be delivered effectively to these populations at risk.the current outbreak provides an opportunity to reset our goals as a society and as individuals. we do not know how long we will be recommending our patients to self isolate, but we need to be prepared to face the psychological and cardiovascular consequences of our recommendations.as healthcare providers we have the obligation to deliver the best possible care to our patients. for the duration of the covid-19 pandemic, we must be prepared to promote health in unconventional forms, beyond socio economic and cultural barriers.
dr. diego delgado is associate professor of medicine, university of toronto, division of cardiology, university health network. want to keep up with covid news and trending health stories? sign up for our newsletter here.
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