Tuesday, June 16, 2020

Use of unproven COVID-19 therapies by African American patients poses risks


News Release 15-Jun-2020

Nearly one out of every 10 African Americans has a genetic variant that puts them inherently at an increased risk for ventricular arrhythmias and sudden cardiac death. Writing in the journal Heart Rhythm, the official publication of the Heart Rhythm Society and the Cardiac Electrophysiology Society, published by Elsevier, investigators observe that along with socioeconomic and cultural factors, this genetic risk factor may contribute to the racial health disparities that have been documented in victims of the COVID-19 pandemic. They also note that the unwanted effects of therapies such as hydroxychloroquine may put African Americans with the variant at increased risk of drug-induced ventricular arrhythmias. Therefore, they urge particular caution.


The investigators note that the proarrhythmic potential associated with p.Ser1103Tyr-SCN5A can be enhanced by drugs that can cause irregular heartbeat (QTc-prolonging medications), including some antiarrhythmic drugs but also, importantly, some antibiotics and antifungal medications.

Direct and/or indirect myocardial injury or stress has emerged as a prominent, prognostic feature in COVID-19. Acute myocardial injury in patients with COVID-19 may be caused by a direct SARS-CoV-2 myocardial infection; the exaggerated immune response known as the cytokine storm; or hypoxia, dangerously low levels of oxygen and high levels of carbon dioxide in the blood. African American infants with the p.Ser1103Tyr-SCN5A variant are over-represented in sudden infant death syndrome, and mechanisms underlying hypoxia may be responsible. The profound hypoxia observed in many COVID-19 patients, raises reasonable concern that p.Ser1103Tyr-SCN5A could produce a similar, African-American susceptibility to ventricular arrhythmia and sudden cardiac death from the SARS-CoV-2 infection.

Taken together, the data suggest that one in 13 African Americans may be at substantially increased risk for potentially lethal ventricular arrhythmia during the COVID-19 pandemic. Whether population-specific genetic risk factors are contributing to the spike in sudden deaths and racial health disparities observed in COVID-19 epicenters remains to be proven, and given the lack of banked DNA in these epicenters, the investigators question whether the speculation may even be testable.


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