Are COVID-19 Vaccines for People With Cardiovascular Concerns?

Factual information can help curb anxiety and uncertainty — and understanding the COVID-19 vaccines to make an informed decision is no different. 

Purvi Parwani, a cardiologist at the Loma Linda University International Heart Institute in Loma Linda, California, United States, offers information and guidance about the COVID-19 vaccines for people with cardiovascular risk factors and those with a history of cardiovascular complications.

COVID-19 vaccines are safe for people with cardiovascular risk factors, long-term heart and circulatory conditions, or a history of heart attacks, and for stroke survivors, Parwani says. Because patients with such issues are at higher risk of severe COVID-19 infection, she urges patients to get two matching doses of whichever vaccine is offered, as soon as possible.

When it comes to getting vaccinated, benefits far outweigh the risks for people with cardiovascular issues, Parwani says. While the COVID-19 vaccines carry extremely rare risks of allergic reactions such as anaphylaxis, she says there is a high risk of contracting COVID-19 in southern California in particular, due to the high positivity rate. Contracting COVID-19, she says, could lead to life-threatening complications in patients with cardiovascular concerns.

Many organizations have expressed support for the COVID-19 vaccine: the U.S. Food and Drug Administration (FDA) approved the Pfizer-BioNTech and Moderna vaccines; the U.S. Centers for Disease Control and Prevention (CDC) recommends vaccination; and a recent statement by the American Heart Association (AHA) encourages cardiovascular patients to take the vaccine.

“Top cardiovascular organizations in the country, my colleagues, and myself all believe in the scientific integrity, rigor, and hard work that went into the development of both the vaccines,” Parwani says. “We are always concerned about our patients and want the best for them.”

Participants for the vaccine trials included those over 65 years old and people with cardiovascular conditions or risk factors such as diabetes, high blood pressure, chronic obstructive pulmonary disease (COPD), and a history of heart attacks.

“Millions of people have been vaccinated so far, and we haven’t seen any dangerous trends in either of the two vaccines,” she says. “Both are efficient and deemed to be safe.”

Parwani says common side effects of the COVID-19 vaccine, similar to those observed with flu vaccinations, include pain at the injection site, extreme muscle pain, headaches, chills, joint pains, and fever. These expected side effects should subside within 72 hours of getting each dose. There is no evidence so far to suggest that patients with cardiovascular issues have more side effects than the general population, she says. She also reports that older people generally experience fewer side effects than younger people.

People who have previously been infected with COVID-19 should still get the vaccine, according to Parwani. The suspected timing for immunity from the virus to wear off after infection is about 90 days, after which the risk of getting another COVID infection returns. Those who have been infected should wait until symptoms end and — by medical guidelines or physician’s order — they are able to discontinue isolation to obtain the vaccine.

Parwani imparts 10 tips tailored to patients with cardiovascular concerns:

• Realize that anxiety about the vaccination is widespread throughout the community and prevalent in many individuals. Know that the anxiety about vaccination, not the vaccine itself, could be responsible for some symptoms. Try to relax before you go for your vaccination.
• If you have significant cardiovascular complications and are anxious about what will happen after vaccination, ensure you book an appointment for vaccination at a clinical facility.
• Follow the protocol of waiting up to 30 minutes in the area after vaccination to recognize any immediate side effects.
• Take all your medications, such as any beta-blockers or blood thinners, before attending your vaccination appointment if you have a cardiovascular complication like angina or difficult cardiac chest pain and atrial fibrillation. If you are concerned that anxiety could trigger chest pain, carry a nitroglycerin pill in your pocket in case you need to take it.
• Expect a bit of bruising or bleeding around where the needle went into your arm if you are on blood thinners or anticoagulants.
• Check your International Normalized Ratio (INR) regularly if you are on medication like Coumadin or Warfarin to ensure you are within the normal range. If your INR number is very high, you may be at bleeding risk, which could be an issue for vaccination. Discuss the matter with your doctor before getting vaccinated.
• When you go to your vaccination appointments, let the person administering the shot know which medicines you are on and expect potential bleeding. They may have to press on your injection site a bit more than other people, but the bleeding should stop.
• Feel free to discuss everything with your cardiologist before going in for vaccine injections. Talking about it with someone you trust can go a long way.
• Be prepared for the second dose of the vaccine to have stronger or more side effects than the first dose. Make sure that you get enough rest for at least 24 hours following each dose.
• Plan the timing of your vaccination appointment. Scheduling on a Friday could be advantageous for not having to miss work. On the other hand, if you have significant cardiovascular issues, consider going during the week if you need to seek advice from your doctor a day or two later should you experience any side effects.   

Most important, Parwani says, is that everyone must continue COVID-19 safe practices after vaccination such as wearing a mask, washing hands, and social distancing to protect others — especially those who are at risk — since it’s not yet known whether people who are vaccinated can still transmit COVID-19.

The original version of this commentary was posted on the Loma Linda University Health news site.