Identifying cardiovascular risk

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COVID-19

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Identifying increased cardiovascular risk associated with respiratory viral infections

While most people with a COVID-19 infection—a clinical disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—have only mild symptoms and recover uneventfully, certain groups are at increased risk for serious disease, complications, and death.1-3

The risk of more severe outcomes from respiratory viral infections such as COVID-19 increases with preexisting conditions, including cardiovascular disease (CVD).4,5

1.6% overall mortality rate for patients with no underlying conditions
19.5% mortality rate among patients with underlying conditions such as CVD or diabetes6

Additionally, a recent study in the New England Journal of Medicine (NEJM) showed that patients are far more likely to have a myocardial infarction (MI) within 7 days of a viral infection such as COVID-19 or seasonal flu than prior to the infection.7

Up 2.4x increased risk
in patients 65 years old or younger
Up 7.3x increased risk
in patients over 65 years old

Quest Diagnostics can help you identify patients at increased cardiovascular risk through advanced cardiometabolic testing, allowing for risk mitigation strategies to be deployed to optimize their outcomes from respiratory viral infections.

Patients most at risk for severe outcomes from COVID-19 or seasonal flu infection are those with underlying risk factors and conditions including:

  1. Age 65 or older
  2. History of elevated HbA1c (>6.5%)
  3. Diagnosed cardiovascular disease
  1. Diagnosed hypertension
  2. Obesity (BMI 30)
  3. History of elevated myeloperoxidase (540 pmol/L within past 2 yrs)

 

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Identify increased cardiovascular risk associated with respiratory viral infections:

Cardiometabolic
conditions
 
 
Vascular
inflammation
 
 
Metabolic
conditions

 

The COVID-19 pandemic has highlighted the importance of cardiometabolic testing

Doctor

Patients with preexisting CVD are at increased risk for severe COVID-19 infection and death.4-6 The mortality rate for patients with underlying conditions such as CVD or diabetes is 19.5% compared to a 1.6% mortality rate for patients with no reported underlying conditions.6 The reasons are unclear but may be related to generally poorer health status, changes in ACE2 receptors as a result of medical treatment, or underlying immune dysfunction as a result of the CVD.4,8,9

Patients with preexisting CVD are also at risk for developing a critical illness.4,8,9 Additionally, patients with co-morbidities such as diabetes, chronic kidney disease, and chronic obstructive pulmonary disease (COPD) are at increased risk of cardiac involvement during a COVID-19 infection.4,8,9

 

Identifying patients most at risk for severe outcomes

Heart disease remains the leading cause of death in the US. Also the severity of upper respiratory infections such as COVID-19 or seasonal flu can significantly compound complications to patients most at risk.

The American College of Cardiology notes a COVID-19 case fatality ratio 3 times higher for diabetes and 4 times higher for cardiovascular disease.5

3x higher fatality rate from COVID-19 for patients with diabetes
4x higher fatality rate from COVID-19 for patients with CVD

The CDC agrees that patients who are obese or have heart conditions are at a greater risk for severe diseases such as COVID-19.10

And according to the journal Circulation, among COVID-19 patients with intubation or death, 36% had hypertension, 27% had diabetes, and 9% had coronary heart disease.4

36%

hypertension

27%

diabetes

9%

coronary heart disease

 

The risk for onset of cardiovascular disease increases after COVID-19 infection

According to a recent study in NEJM, complications from COVID-19 can lead to increased risk for myocardial infarction (MI) within 7 days of a viral infection compared to before the infection (65yo: 2.4x increased risk, >65yo: 7.3x increased risk).7 The increase in MI rate is thought to be driven by the increase in vascular inflammation and risk of plaque rupture due to respiratory viral infection.

The increase in MI rate is thought to be driven by the increase in vascular inflammation and risk of plaque rupture due to respiratory viral infection.

According to JAMA Cardiology, COVID-19 may “induce new cardiac pathologies” including vascular inflammation, myocarditis, and arrhythmia, warning doctors and patients to expect “significant cardiovascular complications with COVID-19.”11

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The American College of Cardiology suggests that up to 17% of hospitalized patients could develop arrhythmia and 7% could experience acute cardiac injury.5

 

 

How the laboratory can help

Quest Diagnostics and Cleveland HeartLab® provides tests to assist in the assessment and care of patients who are at increased risk for severe outcomes from COVID-19.

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Biomarker assessment for vascular inflammation

TEST NAME TEST CODE
Cardio IQ®
Myeloperoxidase (MPO)a
92814
ADMA/SDMAa 94153
Cardio IQ® Lp-PLA2 Activitya 94218
Lipid Panel, Cardio IQ®a,b 91716
Cardio IQ® Apolipoprotein Ba 91726
 
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Test to determine risk of diabetes

TEST NAME TEST CODE
Cardio IQ® Insulin Resistance
Panel with Scorea,b
36509
Cardio IQ® Hemoglobin A1ca 91732
Glucose 483
  1. If ordering through Cleveland HeartLab (CHL) use the following test order codes: Myeloperoxidase (MPO) (C133), ADMA/SDMA (C301), Apolipoprotein B (ApoB) (C123), Lipid panel (C906), Insulin Resistance Panel with Score (1388), Hemoglobin A1C (HbA1c) (C145)
  2. Panel components may be ordered separately. For CHL panel components: Cholesterol, Total (C117), HDL Cholesterol (C118), Triglycerides (C119), Insulin (C146), C-Peptide (C136). For Quest panel components: Cardio IQ® Cholesterol, Total (91717), Cardio IQ® HDL Cholesterol (91719), Cardio IQ® Triglycerides (91718), Insulin, Intact, LC/MS/MS (93103), C-Peptide (372)
 
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For more information on cardiovascular testing or a complete list of our tests, visit our test directory

Cardiometabolic testing can help you better identify patients most in need of more aggressive management to optimize outcomes should they become exposed to COVID-19.

Resource center

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Cardiovascular disease, diabetes, and COVID-19

Risk factors of patients with cardiovascular or metabolic diseases

 

Vascular inflammation markers can help you identify patients who have vulnerable plaque

vascular-inflammatio

In a recent study, researchers demonstrated that patients are far more likely to have a myocardial infarction (MI) within 7 days of a viral infection than prior to the infection (65yo: 2.4x increased risk, >65yo: 7.3x increased risk).7

The increase in MI rate is thought to be driven by the increase in vascular inflammation and risk of plaque rupture due to respiratory viral infection.

 
vascular-inflammation-graphic
 

Biomarker testing of vascular inflammation provides critical insight

A biomarker assessment of specific vascular inflammation markers associated with risk can help you identify patients who have vulnerable plaque and who may benefit from preventive care and risk factor mitigation.

Understanding a patient’s prior cardiovascular risk profile will help you identify those patients in need of more aggressive management in order to optimize their outcome should they become exposed to COVID-19 or seasonal flu.

 
vascular-inflammation-graphic

Helping you identify those most at risk

Quest Diagnostics COVID-19 antibody testing and biomarker testing helps provide critical insight into elevated cardiovascular risk.

 

Ordering from Quest Diagnostics

Ordering from Quest Diagnostics SARS-CoV-2 Serology Antibody Immunoassay CardioIQ Myeloperoxidase ADMA/SDMA CardioIQ Lp-PLA2 Activity

 

Ordering from Cleveland HeartLab®

Ordering from Cleveland HeartLab SARS-CoV-2 Serology Antibody Immunoassay Myeloperoxidase ADMA/SDMA Lp-PLA2 Activity
  • CPT codes are based on American Medical Association guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.
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Download our brochure on biomarker testing and COVID-19 risk

Resource center

The following resources provide more information on the risk factors of patients with cardiovascular or metabolic diseases and respiratory viral infections.

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FAQ on Respiratory Viral Infections and Heart Attacks

 

 
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Webinar: Cardiovascular Clinical Conversations

 

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QuestDiagnostics.com/CVD

 
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4myheart® program

References

  1. Centers for Disease Control and Prevention (CDC). Interim clinical guidance for management of patients with confirmed coronavirus disease (COVID-19). Updated June 30, 2020. Accessed June 30, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
  2. American College of Cardiology (ACC). ACC’s COVID-19 Hub. Accessed April 15, 2020. https://www.acc.org/latest-in-cardiology/features/accs-coronavirus-disease-2019-covid-19-hub#sort=%40fcommonsortdate90022%20descending
  3. Singh AK, Gupta R, Ghosh A, Misra A. Diabetes in COVID-19: prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr. 2020;14(4):303-310. doi:10.1016/j.dsx.2020.04.004
  4. Clerkin KJ, Fried JA, Raikhelkar J, et al. COVID-19 and cardiovascular disease. Circulation. 2020;141(20):1648-1655. doi:10.1161/ CIRCULATIONAHA.120.046941
  5. American College of Cardiology (ACC). COVID-19 clinical guidance for the cardiovascular care team. Reviewed March 6, 2020. Accessed April 8, 2020. https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/2020/02/S20028-ACC-Clinical-Bulletin-Coronavirus.pdf
  6. Sun LH. Patients with underlying conditions were 12 times as likely to die of COVID-19 as otherwise healthy people, CDC finds. The Washington Post. June 15, 2020. Accessed July 30, 2020. https://www.washingtonpost.com/health/2020/06/15/patients-with-underlying-conditions-were-12-times-more-likely-die-covid-19-than-otherwise-healthy-people-cdc-finds/
  7. Kwong JC, Schwartz KL, Campitelli MA, et al. Acute myocardial infarction after laboratory-confirmed influenza infection. N Engl J Med. 2018;378:345-353. doi:10.1056/NEJMoa1702090
  8. Guo T, Fan Y, Chen M, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):1-8. doi:10.1001/jamacardio.2020.1017
  9. Bansal M. Cardiovascular disease and COVID-19. Diabetes Metab Syndr. 2020;14(3):247-250. doi:10.1016/j.dsx.2020.03.013
  10. Centers for Disease Control and Prevention (CDC). People who are at increased risk for severe illness. Updated June 25, 2020. Accessed July 15, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-increased-risk.html?CDC_AA_ refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fpeople-at-higher-risk.html
  11. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system. JAMA Cardiol. 2020;5(7)831-840. doi:10.1001/jamacardio.2020.1286