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By Nancy Lapid, Health Science Editor

Hello Health Rounds readers! Today we return to the mysteries of COVID-19 with research that yields new clues as to why the risk for serious heart problems is elevated after an infection. We also feature a study that found certain types of carbohydrates promote less weight gain in middle age than others. And we highlight a promising experimental drug delivered by nasal spray that helps control dangerously rapid heartbeats.

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The virus that causes COVID-19 induces an immune response in coronary artery plaques that increases inflammation and may explain why heart attack risk remains elevated for months after an infection, researchers say. REUTERS/Dado Ruvic

Scientists have uncovered new clues to explain the elevated risk of heart attack and stroke during the year after a bout of COVID-19.

The coronavirus appears to induce a dangerous immune response in fatty deposits, or plaques, lining the arteries, according to a report published on Thursday in Nature Cardiovascular Research.

“The virus creates a highly inflammatory environment that could make it easier for plaque to grow, rupture, and block blood flow to the heart, brain, and other key organs,” study leader Natalia Eberhardt of NYU Langone Health in New York City said in a statement.

Eberhardt and colleagues studied 27 heart artery tissue samples from autopsies of eight patients with known heart disease who died of COVID-19 in 2020 and 2021.

In addition to infecting the artery tissues, the virus also invaded immune cells called macrophages, which normally protect the heart by engulfing fatty molecules.

In response to the virus, the macrophages released high amounts of inflammatory proteins, including interleukin-1 beta and interleukin-6, which are known to be associated with heart attacks, the researchers found.

They also found higher levels of inflammation in the plaque-covered artery tissue from the autopsied individuals than in plaque-covered tissue collected during heart procedures on patients without COVID-19.

Moreover, macrophages rich in engulfed fat were invaded more frequently by the virus, and for longer periods, than those containing less fat, researchers found.

“These results shed light onto a possible connection between preexisting heart issues and long COVID symptoms,” study senior author Dr. Chiara Giannarelli, also of NYU Langone Health, said in a statement.

“The immune cells most involved in atherosclerosis may serve as a reservoir for the virus, giving it the opportunity to persist in the body over time.”

Read more about COVID-19 and the heart on Reuters.com

• Higher risk of heart complications from COVID-19 than vaccines
• Risk of new heart problems jumps after COVID

Not all carbohydrates are the same when it comes to weight gain in middle age, new findings suggest.

While increased consumption of carbs from refined grains, starchy vegetables, and sugary drinks was linked with greater weight gain, researchers found more fiber and carbohydrate from whole grains, fruit, and non-starchy vegetables was linked to less weight gain.

For their study, the researchers tracked 136,432 healthcare professionals under age 66 for 24 years.

On average, study participants gained 1.5 kilograms (3.3 pounds) every four years.

During those four-year periods, a 100 grams-per-day increase in starch was associated with 1.5 kg of weight gain, while a similar increase in sugar intake led to a gain of 0.9 kg (2 lb).

By comparison, the same 100 g/day increase in fiber was associated with 0.8 kg less weight gain, according to a report published on Wednesday in The BMJ.

For every 100 g/day increase in intake of carbs from non-starchy vegetables such as broccoli, carrots, and spinach, participants gained 3 kg (6.6 lb) less weight. For the same amount of grains it was 0.4 kg less weight gained and 1.6 kg for fruit.

The associations were stronger among participants with excessive body weight and among women, the researchers said. However, they noted, observational studies in which participants self-report their food intake, are not always reliable.

Still, they said, the findings “highlight the potential importance of carbohydrate quality and source for long-term weight management, especially for people with excessive body weight.”

An experimental self-administered nasal spray developed by Milestone Pharmaceuticals could safely and quickly allow patients to control abnormally rapid, irregular heartbeats without medical supervision, a new study suggests.

In most cases, the calcium-channel blocking drug etripamil normalized heart rates within 30 minutes after the onset of a condition in which heart beats more than 100 times per minute, known as paroxysmal supraventricular tachycardia (PSVT), researchers reported on Wednesday in the Journal of the American Heart Association.

The typical treatment for PSVT involves performing physical actions known as vagal maneuvers to slow the heart rate. For example, patients are instructed to attempt to exhale while keeping their nose and mouth closed. In cases where vagal maneuvers are not effective, etripamil may be used to reduce the need for emergency medical services, the researchers said.

“This is a potential new and exciting option for patients to safely self-treat their rapid heartbeat … (and) avoid emergency room visits and medical interventions,” study leader Dr. James Ip of Weill Cornell Medicine at New York-Presbyterian Hospital said in a statement.

His team tested the spray in 169 adults who had experienced an average of 9.7 PSVT episodes in the previous year and were taking medication to prevent rapid heartbeats. Many had gone to emergency departments for this problem in the past.

During the study, when symptoms began, patients applied a patch that monitored their heart rate for the next five hours.

Overall, 105 patients self-medicated with the nasal spray at least once. Among 181 treated episodes, heart rates normalized within 30 minutes in about 60% and within an hour in 75%.

The most common side effects were mild-to-moderate nasal congestion, discomfort, or a runny nose.

Based on feedback from the U.S. Food and Drug Administration, Milestone Pharmaceuticals has said it expects to file it application seeing approval for etripamil next month.

This newsletter was edited by Bill Berkrot. Additional reporting by Shawana Alleyne-Morris.

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