The coronavirus disease 2019 (COVID-19) pandemic has impacted cardiovascular (CV) outcomes and care globally, although to date, there is limited information describing the Canadian experience. In Sweden, which has a publicly supported and widely accessible healthcare system like Canada, COVID-19 has been identified as a risk factor for the subsequent occurrence of acute myocardial infarction (MI) and ischemic stroke, particularly in the first 2 weeks post-infection. The Swedish observations are consistent with previous studies in the pre-COVID-19 era where a transient increase in the risk of MI and stroke has been observed in association with influenza, pneumonia, acute bronchitis, and other chest infections. Thus, in addition to acute CV complications of COVID-19 itself—like myocarditis, pericarditis, decompensated heart failure (HF), and pulmonary embolism—CV implications of the pandemic will likely extend beyond direct, infection-related CV damage.

In England and the United States, several studies have also described significant early decreases in CV testing (e.g., exercise stress tests, echocardiography, nuclear imaging, coronary artery calcium scoring, coronary computed tomographic angiography, percutaneous coronary intervention, coronary artery bypass graft surgery, and transcatheter aortic valve replacement), with disproportionate impacts on older, female, and non-white patients.  While in some jurisdictions it appears that these reductions were only temporary, concern remains that the public health response to the pandemic—meant to mitigate morbidity and mortality from acute COVID-19—may have the unintended consequence of increasing CV risk in much larger proportions of the general population.

We therefore undertook an observational study aimed at characterizing trends in the use of important biomarkers of atherosclerotic cardiovascular disease (ASCVD) risk—troponin and low-density lipoprotein cholesterol (LDL-C), the use of invasive cardiac procedures, and major adverse cardiovascular events (MACE) prior to and during the COVID-19 pandemic in the province of Alberta.

Impact on ASCVD Testing