How Cortisol Might Be Affecting Heart Attack Rates

A recent article in the NYT titled, “Where Have All the Heart Attacks Gone?” is an interesting piece that fits nicely in the cortisol puzzle. Most hospitals are busy treating Covid-19 patients and less with heart attacks and strokes. The key word is less, there are still heart attacks and strokes. There are at least 3 to 4 stroke alerts per day in my hospital alone. But the fact remains, strokes and heart attacks are less frequent nowadays. Logic would dictate that we should see more heart attacks because respiratory infections typically increase the risk of heart attacks and the coronavirus affects the heart directly as well. Soon after a respiratory infection develops, COVID-19 or severe Influenza, the heart becomes stressed and a heart attack can ensue. Stressful times in general increase the risk of heart attacks and strokes. Depression, anxiety and frustration, feelings that the pandemic will never end, are all associated with a doubling or more of heart attack risks. Work and life stress can markedly increase the risk of a heart attack. Remember the 9-11 terrorist attacks caused an increase in heart related deaths. COVID-19 can affect the heart, which should be increasing the number of patients with heart problems

The doc who wrote the NYT article described how the hospital is usually so full that patients wait in gurneys along the walls of the emergency department for a bed to become available on the general wards or even in the intensive care unit … the pandemic has caused a previously unimaginable shift in the demand for hospital services. A Twitter poll by @angioplastyorg (an online community of cardiologists), almost half of the respondents reported observing large reduction in admissions for heart attacks; some reported more than a 60%reduction. Spain reported a 40% reduction in emergency procedures for heart attacks during the last week of March compared with the period just before the pandemic. So, any rise in heart attacks or strokes should be evident by now.

Some of the excess capacity is indeed by design. Many elective procedures are canceled, and many visits are done via telemedicine. As a result, many people with urgent health problems may decide to remain at home rather than call for help. And when they do finally seek medical attention, it is often only after their condition has worsened. Doctors from Hong Kong reported an increase in patients coming to the hospital late during a heart attack, when treatment is less likely to be lifesaving.

How This May be Affecting Your Cortisol

Remember that any perceived stress will inappropriately raise cortisol (read here). Despite all the doomsday scenarios on the media, people are finding ways to decrease stress and therefore decrease the amount of perceived stress, and this helps cortisol regulation. As more people are at home and waking up with the sun, and seeing the sun rise, spending time with the kids, staying off of the road, work related stress is down, decreased pollution, finishing projects at home – all of these things are very important and probably doing more for your health than you know. Children openly state they are happier with parents at home, and this undoubtedly has a big impact. People are also amazed that many barriers are suddenly being overcome, politically and in society.

Many things once thought not possible are happening. For example, in medicine telemedicine is being utilized despite regulations; HIPAA regulations are being relaxed. In politics, congress is learning how to get things done via video conferencing and primaries are being cancelled and rescheduled. In finance, loans are being modified, payments delayed, or even being forgiven. Insurance is being offered to more people. Prisoners being release for less violent crimes, and much more. The point is there is much change, and some of it with positive effects. Who knows, someone will do a retrospective analysis and find this to be entirely untrue but read on and see how this can fit in the cortisol puzzle.