COVID-19 & CVD The novel coronavirus was first detected in Wuhan City, Hubei province, China in December 2019 and since then rapidly spread across the world. On 11 March, the World Health Organization (WHO) declared COVID-19 a pandemic. As a global organization representing the cardiovascular community, WHF is committed to offering the latest evidence of the outbreak and ensuring everyone is aware of the necessary measures to protect themselves and others in order to slow the spread of the disease. Learn more about the WHF Global Study on CVD and COVID-19.   Signs & symptoms Symptoms of the infection may appear 2-14 days after exposure and include: Sore throat Cough Fever If you develop emergency warning signs, get medical attention immediately. Warning signs may include: Difficulty breathing or shortness of breath Persistent pain or pressure in the chest New confusion or inability to arouse Bluish lips or face Research suggests that some individuals are more vulnerable to the worst outcomes of the virus: Older adults People who have serious chronic medical conditions like diabetes or heart disease General recommendations Maintain at least 1-metre distance between yourself and anyone who is sick. Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing. If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol. Clean and disinfect your home to remove germs. Stay informed on the latest developments about COVID-19. Recommendations for vulnerable populations People of all ages can be infected by the new coronavirus. However, the virus poses a particular risk to people over the age of 60 and those with underlying medical conditions, including: Cardiovascular disease Hypertension Diabetes Chronic respiratory disease Cancer To avoid infection, we recommend you to: Continue to take your medication and follow medical advice Secure a one month supply of your medication or longer if possible Keep a distance of at least one metre from people with a cough, cold or flu Wash your hands often with soap and water for at least 20 seconds Stay at home if possible Follow the instructions of the Department of Health and local authorities in your country Remain aware of your health state. If you experience severe symptoms (shortness of breath, fever), call your doctor or a hospital immediately. Explain to them that you are calling in relation to the new coronavirus and that you are at high risk. Look after your mental health and well-being too. If you need to stay home for a prolonged period, try maintaining a daily routine that prioritizes taking care of yourself. Considering the greater risk for populations in impoverished settings, WHF has developed a series of guidelines on COVID-19 prevention and control in low-income countries. Recommendations for healthcare professionals A study published in The Lancet on 14 March 2020 reviewed the psychological effects of quarantines during disease outbreaks. The report takes information from another study published in 2004 during the SARS outbreak, which revealed that quarantined hospital staff was more likely to report exhaustion and irritability, anxiety and depression. To protect the mental health of these professionals, China’s National Health Commission released guidelines for psychological care during the pandemic and WHO shared several mental health tips for healthcare practitioners, which includes: Ensure rest during work or between shifts, eat sufficient and healthy food and engage in physical activity. Avoid using unhelpful coping mechanisms such as tobacco or alcohol. Some workers may experience avoidance by their family or community due to stigma or fear. If possible, stay connected with your loved ones. Turn to your colleagues and your manager for social support. Team leaders should provide good quality communication and accurate information updates to all staff. Ensure you initiate, encourage and monitor work breaks. Vaccination against COVID-19 WHF regards the vaccine as a critical tool in our fight to ward off the disease and focus on managing and preventing the heart conditions that further complicate the lives of those with COVID-19. In supporting the global effort to address the pandemic, WHF reiterates that successful vaccine roll-out must include those most vulnerable, either because of health risks, on-the-job exposure, or socioeconomic status, a particular concern in low and middle-income countries.

Cholesterol High cholesterol causes 3.6 million deaths every year. It is a major a risk factor for heart disease and stroke in both high- and low-income countries. A healthy diet, regular exercise and medication can help reduce high cholesterol. Cholesterol is a waxy, fat-like substance found in your blood. The liver either makes cholesterol or uses cholesterol obtained from other sources: dietary cholesterol and saturated fat, cholesterol carried in the blood, or by reabsorbing bile from the gastrointestinal tract. Cholesterol is crucial to the healthy functioning of the body, which needs it to build healthy cells and make vitamins and other hormones. But too much cholesterol can lead to serious problems, including heart disease and stroke. High blood cholesterol is one of the major controllable risk factors for heart disease, heart attack and stroke. HDL (Good), LDL (Bad) Cholesterol and Triglycerides Cholesterol is carried through your blood attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. There are different types of cholesterol, based on what the lipoprotein carries: low-density lipoprotein (LDL) and high-density lipoprotein (HDL): LDL is sometimes called bad cholesterol because it can build up inside our arteries, causing them to harden and narrow (a process called atherosclerosis) and limiting blood flow. This can ultimately lead to a heart attack or stroke. HDL is often referred to as “good” cholesterol, because it carries unnecessary cholesterol away from our arteries and back to our liver, where it’s broken down and eliminated from the body. A healthy level of HDL cholesterol can protect against heart attack and stroke. A third component, known as triglycerides, also plays a role in our cholesterol health. They are the most common type of fat in our bodies, and they store excess energy, or fat, from our diet. Being overweight, eating a lot of fatty and sugary foods or drinking too much alcohol may lead to raised blood triglyceride levels. Triglyceride levels may be high despite relatively normal levels of good cholesterol and non-HDL cholesterol. A high triglyceride level, combined with low HDL and high LDL, can increase the risk of cardiovascular disease. What is dyslipidaemia? Dyslipidaemia is an all-encompassing term which refers to the presence of non-optimal levels of blood lipids. In clinical practice guidelines, it is typically characterized by raised total cholesterol and/or low-density lipoprotein cholesterol. The definition is also often extended to include nonoptimal levels of high-density lipoprotein cholesterol, triglyceride, apolipoprotein B and apolipoprotein A1. Familial Hypercholesterolemia Familial hypercholesterolemia (FH) is a genetic condition that causes high cholesterol and affects approximately 34 million people worldwide, or one in 200-250 people. If left untreated, FH leads to early heart attacks and heart disease. Individuals with FH have a high amount of LDL cholesterol or ‘bad cholesterol’ due to a mutation in one of several genes that control how the liver uses cholesterol. As a result, cholesterol accumulates in the bloodstream and can ultimately build up in the arteries’ walls. Patients may develop fatty skin deposits, known as xanthomas, on their body or cholesterol deposits may also be visible on the eyelids, a condition called xanthelasmas. FH is inherited. The number of mutations that are inherited determine the type of FH an individual has. One inherited mutation – called Heterozygous Familial Hypercholesterolemia (HeFH) – means that one abnormal mutation is passed down to a child, typically from one parent. Two inherited mutations – called Homozygous Familial Hypercholesterolemia (HoFH) – happen when a mutation for HeFH is passed on from each parent to their child. This results in the more rare and severe form of FH. Hypercholersterolemia and Familial Hypercholesterolemia are largely silent diseases; they cause no symptoms. As a result, they too often remain unnoticed. When diagnosed, treatment is not systematic, and patients have poorly controlled cholesterol levels. FH remains mostly underdiagnosed and undertreated due to low awareness, both among the public and among health professionals – only 10% of those affected know about their condition and are adequately treated. Lipoprotein(a) Lipoprotein(a), often abbreviated as Lp(a), is a type of lipoprotein, composed of proteins and fats, found in the blood. Like LDL (low-density lipoprotein), often referred to as “bad cholesterol”, Lp(a) contains cholesterol within its structure. Lp(a) can increase the risk of heart disease when present in elevated levels. High levels of Lp(a) are inherited and affect 1 in 5 people. Risk factors High cholesterol can be inherited, but it’s often the result of unhealthy lifestyle choices, such as inactivity, smoking and an unhealthy diet. Metabolic conditions such as type 2 diabetes can also influence an individual’s cholesterol and triglyceride levels. Behavioural risk factors Unhealthy diet: A diet high in saturated fat (found, for example, in animal products) and trans fats (found in various industrially processed foods) can lead to an increase in cholesterol levels. Excess sugar and starch intake contributes to high triglycerides. Physical inactivity: Being physically inactive can have a detrimental effect on non-HDL cholesterol levels. regular physical activity as been shown to have a beneficial impact by reducing non-HDL cholesterol concentrations. Smoking: Cigarette smoking damages the walls of the blood vessels, making them more likely to accumulate fatty deposits. Smokers are 2-4 times more likely to develop heart disease than non-smokers. Conversely, smoking cessation typically leads to an increase in HDL cholesterol levels. Associated conditions Obesity: The typical dyslipidaemia of obesity consists of increased triglycerides, decreased HDL cholesterol with HDL dysfunction, and normal or slightly increased non-HDL cholesterol. Diabetes: High blood sugar reflects in part greater insulin insensitivity which contributes to higher levels of very low-density lipoprotein (VLDL) production by the liver and in turn lower HDL cholesterol. High blood sugars from Diabetes may also directly damage the lining of the blood vessels. Non-modifiable risk factors Heredity: The quantity of cholesterol produced by the body is partly genetically determined. Familial hypercholesterolemia (FH) leads to high cholesterol and, if untreated, to early heart attacks and heart disease. Each child of an individual with FH has a 50% chance of inheriting the disorder. There are many genes that impact cholesterol levels by small increments; having a lot of these genes that raise

Chagas Disease Chagas disease, also known as American trypanosomiasis, is a neglected tropical disease caused by a group of parasites called Trypanosoma cruzi. First discovered more than 100 years ago, the disease continues to affect more than seven million people worldwide and is one of the most prevalent public health problems in Latin America. If left untreated, Chagas can cause irreversible damage to the heart and other vital organs. About Chagas Disease Chagas disease is found mainly in endemic areas of 21 continental Latin American countries. The most common way people are infected with Chagas is through the blood-sucking triatomine bugs, also known as ‘kissing bugs’ (or vinchuca, barbeiro, pito, chinche, chipo in different Latin American countries). The bugs typically live in wall or roof cracks of poorly constructed homes made of materials such as mud, straw and palm thatch. They come out at night to feed on people’s blood while they’re sleeping, then defecate close to the bite. Their faeces contain the parasite, which can then enter the person’s body when they inadvertently smear the bug’s waste into the bite or another skin break, the eyes or the mouth. The parasite can also be transmitted from mother to child during pregnancy or childbirth, through contaminated food and beverages, blood transfusions, organ transplants or laboratory accidents. Once entirely confined to the continental part of Latin America, in the last decades Chagas has been increasingly detected in the United States of America, Canada, many countries in Europe and some countries in Africa, the Middle East and the Western Pacific. The epidemiological pattern of Chagas has also changed from a rural to a mostly urban disease, mainly due to population mobility, urbanization and emigration. Around 12,000 people die every year due to complications from Chagas disease, with only 1 in 10 being diagnosed. Of these, only a small percentage receive treatment. With an estimated 75 million individuals at risk of infection, Chagas remains a profound public health issue with significant social and economic burdens in Latin America and beyond. Chagas Disease Signs & Symptoms There are two main stages of the disease: an acute phase and a chronic phase. In the acute phase, which lasts about two months, symptoms generally start to develop about one to two weeks following the bite. These are generally mild and unspecific, and may include fever, fatigue, body aches, headache, rash, loss of appetite, diarrhoea and vomiting. In people bitten by a triatomine bug, characteristic first visible signs of infection, such as a skin lesion or a purplish swelling of the lids of one eye (the so-called Romaña sign), can help in the diagnosis of new cases. In the chronic phase, about 70-80% of people may not show any symptoms at all. However, in about 20-30% of people, the disease progresses, mainly affecting the heart or gastro-intestinal organs. This occurs 10 to 20 years after the initial infection. In the heart, the disease can cause enlargement of the heart muscle, leading to heart failure. Other common problems are arrythmias and sudden cardiac arrest. In the gastro-intestinal system, there can be enlargement of the colon or the oesophagus, leading to digestive problems. Chagas Disease Treatment Treatment is urgently indicated for anyone during the acute phase and for those in whom the infection has been reactivated. In these situations, treatment is almost 100% effective, and the disease can be completely cured. During the acute phase, Chagas disease can be treated with two antiparasitic medicines: benznidazole* and nifurtimox*. Both medicines are nearly 100% effective in curing the disease if given soon after infection, including the cases of congenital transmission. The efficacy of both diminishes, however, the longer a person has been infected, and the risk of adverse reactions increases with age. Once Chagas disease reaches the chronic phase, medications won’t cure the disease, but they may help slow the progression of the disease and its most serious complications. Adults, especially those with the indeterminate form of the disease, should be offered treatment, but its potential benefits in preventing or delaying the development of Chagas disease should be weighed against the long duration and frequent adverse events. During the late chronic phase, when cardiac or digestive manifestations may occur, additional lifelong medical treatment and surgery are usually indicated. *Benznidazole and nifurtimox should not be taken by pregnant women or by people with kidney or liver failure. Nifurtimox is also contraindicated for people with a background of neurological or psychiatric disorders. Chagas Disease Prevention & Control In areas of Mexico, Central America, and South America, where the Trypanosoma cruzi parasite is present in triatomine bugs, improved housing and spraying insecticide inside housing to eliminate the bugs has significantly decreased the spread of Chagas disease. Screening of blood donations for Chagas is another important public health tool to help prevent spreading the disease through blood transfusions. Early detection and treatment of new cases, including mother-to-baby (congenital) cases, will also help reduce the burden of disease. In other regions where Chagas disease is now found but is not widespread, control strategies should focus on preventing transmission from blood transfusion, organ transplantation, and mother to child.