Does COVID-19 increase stroke risk?
Now that more than a year has passed since the COVID-19 pandemic began in the United States, NewYork-Presbyterian's stroke specialists clearly understand the link between infection with the novel coronavirus and the risk of stroke. Data from the American Heart Association (AHA) COVID-19 Cardiovascular Disease Registry — which includes data on more than 40,000 COVID-19 patients in multiple hospitals and growing — are helping.
Researchers, including investigators from Weill Cornell Medicine and Columbia University, found that the incidence of stroke among patients hospitalized for COVID-19 is about 1.4% and that the risk of ischemic stroke (an obstruction in blood flow to the brain, usually due to a clot) is seven times higher in people hospitalized for COVID-19 compared with people hospitalized for the flu. People hospitalized with COVID-19 and stroke in 2020 spent twice as long in the hospital and were more than twice as likely to die while in the hospital as patients without stroke. These findings were reported at the International Stroke Conference in March 2021.
Call 9-1-1 immediately if you are experiencing any of these sudden stroke symptoms:
- F — Facial drooping or feeling numb in the face
- A — Arm weakness
- S — Speech difficulties
- T — Time to call 9-1-1
Other possible stroke signs:
- Balance or coordination problems
- Loss of vision in one or both eyes
How COVID-19 can elevate stroke risk
There are several factors at play that may raise stroke risk. Doctors have learned that COVID-19 is not just a respiratory illness but one that affects blood vessels throughout the body and may harm multiple organ systems by:
- Causing inflammation. Infections and inflammation are independent risk factors for stroke. COVID-19 causes widespread inflammation throughout the body.
- Promoting the development of blood clots. The novel coronavirus is known to activate the blood clotting system, leading to blood clots in the carotid arteries (which supply oxygen-rich blood to the brain) and smaller blood vessels deep in the brain and throughout the body. These blood clots can also cause deep vein thrombosis, heart attacks, and pulmonary embolism.
- Triggering cardiac events. COVID-19 causes damage to the heart, resulting in cardiomyopathy (a weakening of heart function), heart attack, and abnormal heart rhythms. All of these factors can lead to a stroke.
- Stressing the body. COVID-19 can cause severe critical illness, which can lead to multiple organ failure, including kidney failure. This stress on the body places patients at higher risk for stroke.
- Shared risk factors. The same factors that place patients with COVID-19 at increased risk for more severe disease — older age, type 2 diabetes, obesity, heart rhythm abnormalities, and high blood pressure — are also known risk factors for stroke. Columbia and Weill Cornell researchers also found that COVID-19 patients with ischemic stroke were more likely to be male and of African descent. COVID-19 has disproportionately affected communities of color; the findings suggest that black Americans may also have a higher risk of ischemic stroke after contracting the virus.
Don't ignore stroke symptoms out of fear
Researchers who examined data from the AHA Stroke Registry spotted a 20%-30% decline in the number of people coming to the hospital with stroke symptoms during the earliest months of the pandemic. Many people were afraid that going to the hospital would raise their risk of contracting the virus. Others were concerned that hospitals were too busy treating people with COVID-19 and would not have the space or resources to care for someone with a stroke.
These assumptions are not only wrong but could be life-threatening. Here's why:
- Time is brain. Stroke is a medical emergency. You'll have the best chance of a good outcome if you are treated within four hours of the beginning of stroke symptoms. The longer you wait, the more brain tissue may die. Prompt treatment can prevent death and long-term brain damage and lower your risk of a second stroke.
- Hospitals are taking precautions. Patients with and without COVID-19 are separated. All surfaces and equipment are thoroughly cleaned. Hospital workers wear adequate PPE. And healthcare workers can be vaccinated.
- Stroke care has been exceptional despite the pandemic. Analysis of data from the AHA Stroke Registry showed that even though many hospitals appeared overwhelmed caring for people with COVID-19, they maintained the same high quality of stroke care they provided before the pandemic — a testament to the stroke teams and systems put into place to ensure that people with stroke receive prompt effective care.
The "Don't Die of Doubt" Campaign
The AHA has launched the "Don't Die of Doubt" campaign to spread this message far and wide:
Hospitals are still the safest place for you to be when a medical emergency strikes.
Don't sit in doubt — call 9-1-1 and get the care you need immediately.
Reducing the risk of stroke
Doctors now know more about how to treat COVID-19 and reduce stroke risk, such as judicious use of blood thinners in patients at risk. Investigators are currently analyzing data from the AHA COVID-19 Cardiovascular Disease Registry to identify predictors of stroke risk among people hospitalized for COVID-19 to improve care further and reduce the chance of a stroke.
People who have had a stroke or COVID-19 can take these steps to stay healthy:
- Getting the COVID-19 vaccine. Being vaccinated will not only help you but enable you to lower the impact of the virus in your community. It may also reduce your risk of stroke by preventing COVID-19.
- Seeing your doctor for follow-up care. If you cannot see your doctor in person, telehealth visits are an excellent way to stay connected with your physician.
- Continue to take precautions. Even if you are vaccinated, continue to wear a mask when in a public place, maintain social distance from those around you, and practice good hand hygiene to reduce the chance of spreading the virus.