Abstract
Contrasting data have been published about the impact of cardiovascular disease on Covid-19. A comprehensive synthesis and pooled analysis of the available evidence is needed to guide prioritization of prevention strategies. To clarify the association of cardiovascular disease with Covid-19 outcomes, we searched PubMed up to 26 October 2020, for studies reporting the prevalence of cardiovascular disease among inpatients with Covid-19 in relation to their outcomes. Pooled odds-ratios (OR) for death, for mechanical ventilation or admission in an intensive care unit (ICU) and for composite outcomes were calculated using random effect models overall and in the subgroup of people with comorbid diabetes. Thirty-three studies enrolling 52,857 inpatients were included. Cardiovascular disease was associated with a higher risk of death both overall (OR 2.58, 95% confidence intervals, CI 2.12–3.14, p < 0.001, number of studies 24) and in the subgroup of people with diabetes (OR 2.91, 95% CI 2.13–3.97, p < 0.001, number of studies 4), but not with higher risk of ICU admission or mechanical ventilation (OR 1.35, 95% CI 0.73–2.50, p = 0.34, number of studies 4). Four out of five studies reporting OR adjusted for confounders failed to show independent association of cardiovascular disease with Covid-19 deaths. Accordingly, the adjusted-OR for Covid-19 death in people with cardiovascular disease dropped to 1.31 (95% CI 1.01–1.70, p = 0.041). Among patients hospitalized for Covid-19, cardiovascular disease confers higher risk of death, which was highly mitigated when adjusting the association for confounders.
Highlights
Since its spread in late 2019, Coronavirus disease 2019 (Covid-19) caused more than 1 million deaths
In this systematic review and meta-analysis, we searched PubMed for the term “covid-19” looking for observational studies published in English language up to 26 October 2020, reporting original clinical data about history of cardiovascular disease in Covid-19 inpatients aged > 18 years old with and without at least one outcome among death, mechanical ventilation, admission in an intensive care unit (ICU), or a composite outcome with at least one of the above
We identified 638 articles in the published literature according to the search strategy used for this systematic review and meta-analysis (Fig. 1)
Summary
Since its spread in late 2019, Coronavirus disease 2019 (Covid-19) caused more than 1 million deaths. Cardiometabolic risk factors, such as hypertension and diabetes are among the most frequent comorbidities in patients hospitalized for Covid-19. The mounting literature describing clinical features of patients with Covid-19 initially suggested that pre-existing cardiovascular disease is an important risk factor for severe disease and death [1]. Our group and others failed to show significant associations between history of cardiovascular disease and poor Covid-19. Internal and Emergency Medicine (2021) 16:1975–1985 increases the risk of poor Covid-19 outcomes in the highrisk group of people with diabetes mellitus, which may be considered a cardiovascular equivalent
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