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Heart Disease and COVID-19: How to Reduce Your Risks

Updated on Jun 30, 2022 | COVID-19, Featured, Your Health

During the pandemic, you may be exercising less, limiting your trips outside, and no longer eating a healthy diet, and this may be taking its toll. Some doctors say 25 percent of their patients have gained up to 20 pounds, and that can be leading to decline in mental health.

As a result, during this difficult period, experts at Mount Sinai are encouraging a focus on exercise, mental health, and nutrition, especially for those already at risk for heart disease, and they are sharing some tips on heart disease prevention to lower the risk of heart attack, stroke, and COVID-19.

Icilma Fergus, MD

“It is critical to stay physically fit and in your best personal health to combat heart disease, COVID-19 infection and the post-COVID effects,” says Icilma Fergus, MD, Director of Cardiovascular Disparities at The Mount Sinai Hospital. “During this pandemic some patients have expressed they’re dealing with stress, anxiety, insomnia, and depression. We discuss techniques to improve their mental and emotional wellness, which carries over to their cardiovascular health.”

Doctors say participating in home-exercise programs, taking a short walk, dancing, stretching, and even house cleaning will get you moving and make a difference.

“Keeping a good mental outlook is also key and it’s important for people to find ways to ensure that this happens by staying active, meditating, or simply doing things that make them happy,” says Dr. Fergus.

Tips for Lowering Heart Disease Risk

• Know your family history.

• Be aware of five key numbers cited by the American Heart Association: blood pressure, total cholesterol, HDL (or “good”) cholesterol, body mass index, and fasting glucose levels.

• Maintain a healthy diet, eating nutrient-rich food and eliminating sweets. Limit alcohol consumption to no more than one drink per day. Quit smoking. Watch your weight and exercise regularly.

• Learn the warning signs of heart attack and stroke, including chest discomfort; shortness of breath; pain in arms, back, neck, or jaw; breaking out in a cold sweat; and lightheadedness.

According to the American Heart Association, about one in three people with COVID-19 has cardiovascular disease, making it the most common underlying health condition. COVID-19 patients with underlying conditions are six times more likely to be hospitalized and 12 times more likely to die than patients without any chronic health problems.

Nearly half of adults in the United States—more than 121 million people—have some type of cardiovascular disease. It is the leading cause of death among men and women in the United States; nearly 650,000 die from it every year. Yet heart disease is preventable 80 percent of the time.

COVID-19’s Impact on the Heart and Recovery

COVID-19 can cause an inflammatory response in the body, along with clotting that can impact the heart and how it functions. Mount Sinai researchers discovered that some hospitalized COVID-19 patients have structural damage after cardiac injury that can be associated with deadly conditions including heart attack, pulmonary embolism, heart failure, and myocarditis, or inflammation of the heart.

Non-hospitalized COVID-19 patients can also experience complications including heart rhythm disorders, hypertension, myocarditis, and chest pain that feels similar to a heart attack. Cardiologists say it’s important for COVID-19 survivors—even without cardiac symptoms—to have a heart exam two to three weeks after recovery, as there could be residual effects that may go undetected and lead to future health problems.

“For anyone who developed heart issues post-COVID-19, exercise should be delayed two to three weeks after resolution of symptoms including chest pain, palpitations, and shortness of breath. Remember to ‘go slow’ as recovery from this illness is not a sprint; it is a marathon,” says Maryann McLaughlin, MD, Director of Cardiovascular Health and Wellness at Mount Sinai Heart. “Anyone who has been diagnosed with myocarditis needs to be under a physician’s direction when deciding to exercise, and competitive athletes may need three months to recover from the illness before returning to full routine.”

Recovered COVID-19 patients with a history of heart attack, coronary artery disease, or cardiac stents, should get a monitored stress test before getting back to a full workout. Anyone who had chest pain while sick with COVID-19 should talk to their doctor about evaluation with an echocardiogram or other cardiac imaging.

High-Risk Groups and COVID-19 Vaccinations

Everyone is at risk of heart disease, but people are more susceptible to getting the disease if they have cardiovascular risk factors including high cholesterol, high blood pressure, being overweight, and using tobacco. Age is also a factor, specifically for women over 65 and men older than 55, along with those with a family history of heart disease and people who sleep less than six hours a night.

Certain minority groups including African Americans and Latinos are also at higher risk due to genetic predisposition, diet, lifestyle factors, and socio-economic factors. However, illness in any population can be prevented by taking simple steps towards a healthier lifestyle.

Mount Sinai cardiologists encourage those in these high-risk groups to get a COVID-19 vaccine when they qualify under state distribution guidelines.

“We have noticed some patients in these high-risk minority groups have been reluctant to get vaccinated, fearing it’s not safe. What is important for them to understand is that tremendous scientific advancements have led to the safe development of COVID-19 vaccines and we are encouraging them to get vaccinated,” says Johanna Contreras, MD, Director of Heart Failure and Transplantation at Mount Sinai Morningside.

The Heart and Soul of Mount Sinai Queens

Updated on Jun 30, 2022 | Community, Featured

Nurses are the heart and soul of Mount Sinai Queens. To honor their commitment and passion, Mount Sinai Queens celebrated National Nurses Week last May 6-12. Though they were not able to celebrate in traditional ways, the nurses gathered for a group photo in front of the hospital. A news photographer happened to be walking by and snapped a photo. That photo would later appear in a number of print and broadcast features, and most recently editors at The Atlantic magazine selected the photo as one of its Hopeful Images from 2020. Mount Sinai photo credit: Andrew Romanov

Mount Sinai Researchers Describe Viral Sanctuaries in the Gastrointestinal Tract of COVID-19 Patients

Updated on Jun 30, 2022 | COVID-19, Featured, Research

A new study published in the journal Nature by researchers at Mount Sinai in collaboration with two other labs at Rockefeller University and co-investigators from the California Institute of Technology and Weill Cornell Medicine describes for the first time a persistence of SARS-CoV-2 in the intestines long after clinical resolution.

The study, entitled “Evolution of antibody immunity to SARS-Cov-2” and published online January 18, 2021, suggests that the memory B cell response to SARS-Cov-2 evolves between 1.3 and 6.2 months after infection in a manner that is consistent with antigen persistence.

Saurabh Mehandru, MD

The authors studied intestinal biopsies obtained from asymptomatic individuals four months after the onset of COVID-19.

Minami Tokuyama, a medical student at the Icahn School of Medicine at Mount Sinai, and other members of the Mehandru Lab at the School of Medicine discovered that SARS-CoV-2 antigens persisted in the lining cells (epithelium) of the intestines long after (3-4 months post infection) resolution of clinical symptoms. The presence of such sanctuary sites could potentially enable continued maturation of the antibody response as was independently discovered by the Nussenzweig Lab at Rockefeller University.

“This finding is significant because it suggests that the memory B cell response does not wane after six months, providing reassurance that those who have previously been infected with the virus will likely mount a vigorous response if they are exposed a second time,” says study author Saurabh Mehandru, MD, Associate Professor of Gastroenterology at the Icahn School of Medicine and Director of the Mehandru Lab.

“Additionally, the presence of viral sanctuaries within the body needs to be better understood in COVID-19 patients with chronic symptoms, or ‘long haulers,’ which could help in identifying novel opportunities for the treatment of this group of patients,” says Dr. Mehandru.

Mount Sinai Launches Global FREEDOM COVID Trial to Study Anticoagulant Therapies

Updated on Jun 30, 2022 | COVID-19, Featured, Research

Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.

Building on treatment protocols developed at the height of the COVID-19 pandemic, Mount Sinai Heart has launched the global FREEDOM COVID Anticoagulation Trial to determine the most effective dosage and regimen of anticoagulant therapy in improving the survival rate of hospitalized COVID-19 patients.

“While vaccines are being used and clinical trials are underway, there is an urgent need to determine how to best treat the next hundreds of thousands of COVID-19 patients around the world,” says Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital, and principal investigator of the FREEDOM trial. “This is a coordinated international effort, launched as an investigator-led trial to speed up the process.”

In March 2020, during the early days of the pandemic, Dr. Fuster closely observed patients with blood clots in their legs who had been admitted with COVID-19. After hearing from colleagues in China of other cases of small, pervasive, and unusual clotting that had triggered myocardial infarctions, strokes, and pulmonary embolisms, he initiated decisive action. “We became one of the first medical centers in the world to treat all COVID-19 patients with anticoagulant medications,” says Dr. Fuster, a pioneer in the study of atherothrombotic disease. “It was a decision that we believe saved many lives.”

That early protocol—based largely on intuition, Dr. Fuster says—led to groundbreaking research and insights by Mount Sinai into the role of anticoagulation in the management of COVID-19-infected patients. That work includes a study published in August 2020 in Journal of the American College of Cardiology that showed a 50 percent higher chance of survival compared to patients given no anticoagulant. The analysis was conducted by the Mount Sinai COVID Informatics Center.

Dr. Fuster says, “While our study was observational, it helped us design the large-scale FREEDOM COVID Anticoagulation Trial in partnership with more than 100 sites in 14 countries in order to reach 3,600 patients.” The prospective study will be randomized to investigate the effectiveness and safety of the anticoagulants enoxaparin and apixaban in patients age 18 and older who have been hospitalized with confirmed COVID-19, but are not in an ICU or intubated. The trial is currently enrolling and set for completion in June 2021.

Clotting in organs including the lungs, brain, and heart can be a complication of COVID-19, autopsies have shown. And anticoagulation therapies are associated with better outcomes in hospitalized patients with the virus. The FREEDOM clinical trial will evaluate different regimens.

The FREEDOM trial is based on months of clinical observation and pathology work conducted as deaths from the COVID-19 pandemic mounted globally in spring 2020 and thromboembolism emerged as an important disease manifestation. Autopsy studies at Mount Sinai demonstrated a high incidence of macrothrombi and microthrombi, prompting the suggestion that in-hospital use of blood thinners could be beneficial to COVID-19 patients. To help clarify the pivotal questions of anticoagulant choice, dosing, and treatment duration, Mount Sinai began an observational study in May 2020 of 4,389 COVID-19-positive patients who were admitted to five hospitals in the Mount Sinai Health System.

“In this observational study, anticoagulation was associated with improved outcomes, and bleeding rates appeared to be low,” says corresponding author Anu Lala, MD, Assistant Professor of Medicine (Cardiology), and Director of Heart Failure Research at the Icahn School of Medicine at Mount Sinai. “As a clinician who has treated COVID-19 patients on the front lines, the importance of having answers as to what the best treatment for these patients entails is immeasurable. Ultimately, clinical trials are what will inform those answers.”

Researchers looked at six different anticoagulant regimens, including oral and intravenous dosing. They found that both therapeutic and prophylactic doses of anticoagulants were associated with significantly improved in-hospital survival, and with a 30 percent reduced risk of admission to an ICU or intubation. The researchers used a hazard score to estimate risk of death, which took relevant risk factors into account before evaluating the effectiveness of anticoagulation, including age, ethnicity, pre-existing conditions, and whether the patient was already on blood thinners.

Separately, the researchers looked at autopsy results of 26 COVID-19 patients and found that 11 of them (42 percent) had blood clots—pulmonary, brain, and/or heart—that were never suspected in the clinical setting. These findings suggest that treating COVID-19 patients with anticoagulants as a preventive measure may be associated with improved survival.

Researchers were further encouraged by the finding that overall rates of major bleeding were low (3 percent or less), though slightly higher in the therapeutic group compared to the prophylactic and no-blood-thinner groups. This suggested to the team that clinicians should evaluate COVID-19 patients on an individual basis, weighing the risks and benefits of anticoagulant therapy.

“These observational analyses were done with the highest level of statistical rigor and provide important insights into the association of anticoagulation with critical in-hospital outcomes of mortality and intubation,” says first author Girish Nadkarni, MD, Co-Founder and Co-Director of the Mount Sinai COVID Informatics Center, and Clinical Director of the Hasso Plattner Institute for Digital Health at Mount Sinai.

The study also provided a strong rationale for the FREEDOM Trial, says co-author Zahi Fayad, PhD, Professor of Medicine (Cardiology), and Diagnostic, Molecular and Interventional Radiology, and Director of Mount Sinai’s BioMedical Engineering and Imaging Institute. “This work highlights the need to better understand the disease from a diagnostic and therapeutic point of view and the importance of conducting properly designed diagnostic and interventional studies.”

Ketamine Demonstrates Rapid Improvement in Patients With Post-traumatic Stress Disorder

Updated on Jun 30, 2022 | Featured, Research

Certain regions of the brain, such as the hippocampus, prefrontal cortex, and amygdala are involved in the stress response.

Ketamine, an anesthetic found to help individuals with treatment resistant depression at lower doses, has now shown additional promise in easing the symptoms of post-traumatic stress disorder (PTSD), according to researchers at the Icahn School of Medicine at Mount Sinai. Their study, published in The American Journal of Psychiatry, highlights the first randomized controlled trial to demonstrate that repeated intravenous infusions of ketamine are effective and safe for the treatment of chronic PTSD.

“We found a rapid improvement in PTSD symptoms, including a reduction in the intensity and number of memory intrusions and nightmares, decreased avoidance of trauma reminders, and increased ability to enjoy activities and feel closer to others,” says the study’s corresponding author, Adriana Feder, MD, Associate Professor of Psychiatry at the Icahn School of Medicine. “Some individuals in the trial had an amazing response and others had a very clear response.”

Adriana Feder, MD

The randomized controlled trial involved 30 participants, with half receiving ketamine and half receiving midazolam, the psychoactive placebo control. Participants in the trial who were administered six infusions of intravenous ketamine over two consecutive weeks reported feeling less panic, more at peace, and better able to handle negative thoughts.

Ketamine’s potential efficacy for PTSD was first outlined in 2014, in a proof-of-concept study led by Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai and President of Academic Affairs for the Mount Sinai Health System. Participants in the 2014 study received a single infusion of either ketamine or the psychoactive placebo control, midazolam.

Dr. Charney says, “The data presented in our current study replicates and builds upon our initial findings about ketamine for PTSD and indicates that in addition to being rapid, ketamine’s effect can be maintained over several weeks.”

Mount Sinai’s research into an effective treatment for PTSD is particularly relevant now, during this time of heightened societal “trauma associated with the COVID-19 pandemic,” says Dr. Feder. Front-line medical workers face unprecedented emotional challenges in treating scores of severely ill patients with COVID-19, and people have experienced the sudden and unexpected loss of a loved one to the disease. Domestic violence is also on the rise.

PTSD affects roughly 6 percent of the U.S. population. Severity of trauma ranges by type and cumulative exposure, with the highest PTSD burden occurring among survivors of interpersonal violence. Only two medications—the selective serotonin reuptake inhibitors sertraline and paroxetine—are approved for the treatment of PTSD by the U.S. Food and Drug Administration (FDA) and at least one-third of people with the disorder do not respond to them. For many others, these medications, which can take weeks or months to work, often result in partial improvement in symptoms.

Dennis S. Charney, MD

Participants in Mount Sinai’s study had moderate to severe PTSD and had experienced the disorder an average of 15 years. Almost half reported sexual assault or molestation as their primary trauma. Others reported physical assault or abuse, witnessing a violent assault or death, having experienced the terrorist attacks of 9/11, or combat exposure.

Ketamine has been approved by the FDA for use as an anesthetic since 1970. In 2019, esketamine—one of the two mirror-image molecules or enantiomers of ketamine—was FDA-approved for administration in the form of nasal spray (Spravato®) in conjunction with an oral antidepressant for treatment-resistant depression, and more recently for major depressive disorder with acute suicidal ideation or behavior.

While the mechanism of action underlying its rapid-onset effect is incompletely understood, ketamine acts as an NMDA (N-methyl-D-aspartate) glutamate receptor antagonist in the brain, triggering a series of complex biological processes. Ketamine-induced changes in glutamate signaling are thought to increase neuroplasticity by reversing atrophied connections between neurons in the brain, resulting in more effective responses to stress.

“Now that we’ve shown that repeated infusions of ketamine can rapidly improve PTSD symptoms, a response maintained for several weeks, we would like to study how to maintain this robust response over a longer period of time, such as months or potentially years,” says Dr. Feder. Findings from preclinical studies suggest that ketamine might enhance the use of fear extinction learning and Dr. Feder and colleagues plan to evaluate the efficacy of adding trauma-focused psychotherapy to a course of ketamine infusions in their next phase of research.

Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) shows significantly better improvement in PTSD symptoms with ketamine compared with midazolam, the placebo.

Drs. Charney and Feder are co-inventors on an issued patent in the United States and several issued patents outside the United States, filed by the Icahn School of Medicine at Mount Sinai (ISMMS) for the use of ketamine as therapy for posttraumatic stress disorder; this intellectual property has not been licensed.

Dr. Charney is a co-inventor on several issued U.S. patents and several pending U.S. patent applications filed by the Icahn School of Medicine at Mount Sinai (ISMMS) related to pharmacologic therapy for treatment-resistant depression, suicidal ideation and other disorders. ISMMS has entered into a licensing agreement with Janssen Pharmaceuticals, Inc. and it has and will receive payments from Janssen under the license agreement related to these patents. As a co-inventor, Dr. Charney is entitled to a portion of the payments received by the ISMMS. Since SPRAVATO (esketamine) has received regulatory approval for treatment-resistant depression, ISMMS and Dr. Charney as its employee and a co-inventor, will be entitled to additional payments, under the license agreement.

NYEE Employees Receive the COVID-19 Vaccine

Updated on Jun 30, 2022 | Featured, Vaccines

George Wanna, MD, Chair of the Department of Otolaryngology at New York Eye and Ear Infirmary of Mount Sinai and Mount Sinai Beth Israel, was among the first employees to receive the vaccine.

When asked why he decided to get the vaccine he said, “I took the vaccine because I believe in science and in all the research that has been done.”

Other employees at NYEE agreed and said they were excited to receive the vaccine.

“I had COVID-19 in March 2020; my then-partner did not contract it from me, despite our close living quarters,” said Ellen M. Bonjorno, CPhT, a Pharmacy Technician at NYEE. “She and I were to be married in a big wedding on Memorial Day weekend, but were forced to change plans, and ended up being married on July 17, 2020, in a small outdoor ceremony attended by 12 of our local loved ones. I am especially happy to have my first dose of COVID-19 vaccine on board to help protect my (now) wife from ever becoming infected. We’re both over 60, so especially important to us. Hoping for a return to normalcy, and being able to hopefully take our previously planned European honeymoon in 2021.”

Jeanette Robles, Patient Coordinator in the Admitting Department at NYEE, said, “I got the vaccine for my family, some who have pre-existing conditions. We have been practicing social distancing since the pandemic started. I want to be able to hug my nieces someday soon.” She added: “I received the vaccine and I feel great. I’m not telling my family yet. Hopefully they will have an opportunity to get the vaccine soon. Then, I plan to tell them I already got the vaccine so they know how easy it was.”

Michele Miller, BSN, RN, CNOR, a Nurse Manager at NYEE, said, “As an essential health care provider, I felt it necessary to get the COVID-19 vaccine to help eradicate this virus and tackle this current deadly global health care crisis. We are fortunate enough to live in a country that uses evidenced-based science to develop ways to heal and protect the human race. The development of this vaccine is truly a remarkable scientific gift.”

Gene Harrison, Associate Director, Operations and Infrastructure Information Technology at NYEE, said, “As someone who works in health care, I believe it is critical that we set the example to show that these vaccines are safe and effective.”

Lauren Kaplan, AuD, CCC-A, a Pediatric Audiologist at the Ear Institute at NYEE said, “I decided to get the COVID-19 vaccine because I believe in the power of science. Although not an instant ticket back to pre-COVID ways of life, the vaccine is the first big step in that direction, and I want to be part of the solution. To me, the benefits outweigh the risks.”