Pre-existing cardiovascular disease rather than cardiovascular risk factors drives mortality in COVID-19.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968539 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2261 (Electronic) Linking ISSN: 14712261 NLM ISO Abbreviation: BMC Cardiovasc Disord Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

COVID-19*/mortality ; COVID-19*/physiopathology ; COVID-19*/therapy ; Cardiovascular Diseases*/complications ; Cardiovascular Diseases*/diagnosis ; Cardiovascular Diseases*/epidemiology ; Hospital Mortality* ; Venous Thromboembolism*/diagnosis ; Venous Thromboembolism*/epidemiology ; Venous Thromboembolism*/etiology; Diabetes Mellitus/*epidemiology ; Hypertension/*epidemiology; Age Factors ; Aged ; Cohort Studies ; Female ; Heart Disease Risk Factors ; Humans ; Male ; Mortality ; Outcome and Process Assessment, Health Care ; Risk Assessment/methods ; Risk Assessment/statistics & numerical data ; SARS-CoV-2/isolation & purification ; United Kingdom/epidemiology

Background: The relative association between cardiovascular (CV) risk factors, such as diabetes and hypertension, established CV disease (CVD), and susceptibility to CV complications or mortality in COVID-19 remains unclear.
Methods: We conducted a cohort study of consecutive adults hospitalised for severe COVID-19 between 1st March and 30th June 2020. Pre-existing CVD, CV risk factors and associations with mortality and CV complications were ascertained.
Results: Among 1721 patients (median age 71 years, 57% male), 349 (20.3%) had pre-existing CVD (CVD), 888 (51.6%) had CV risk factors without CVD (RF-CVD), 484 (28.1%) had neither. Patients with CVD were older with a higher burden of non-CV comorbidities. During follow-up, 438 (25.5%) patients died: 37% with CVD, 25.7% with RF-CVD and 16.5% with neither. CVD was independently associated with in-hospital mortality among patients < 70 years of age (adjusted HR 2.43 [95% CI 1.16-5.07]), but not in those ≥ 70 years (aHR 1.14 [95% CI 0.77-1.69]). RF-CVD were not independently associated with mortality in either age group (< 70 y aHR 1.21 [95% CI 0.72-2.01], ≥ 70 y aHR 1.07 [95% CI 0.76-1.52]). Most CV complications occurred in patients with CVD (66%) versus RF-CVD (17%) or neither (11%; p < 0.001). 213 [12.4%] patients developed venous thromboembolism (VTE). CVD was not an independent predictor of VTE.
Conclusions: In patients hospitalised with COVID-19, pre-existing established CVD appears to be a more important contributor to mortality than CV risk factors in the absence of CVD. CVD-related hazard may be mediated, in part, by new CV complications. Optimal care and vigilance for destabilised CVD are essential in this patient group. Trial registration n/a.

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MR/R016372/1 United Kingdom MRC_ Medical Research Council; MC_PC_17214 United Kingdom MRC_ Medical Research Council; CH/1999001/11735 and RE/18/2/34213 United Kingdom BHF_ British Heart Foundation; 171 United Kingdom ALZS_ Alzheimer's Society

Keywords: COVID-19; Cardiovascular disease; Cardiovascular risk factors; Diabetes; Hypertension

Date Created: 20210704 Date Completed: 20210712 Latest Revision: 20240402

20240402

PMC8254437

10.1186/s12872-021-02137-9

34217220