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

Kevin O'Gallagher,Alexandros Papachristidis,James T H Teo,Rosita Zakeri,Richard J B Dobson,Anthony Shek,Ajay M Shah,Rebecca Bendayan,Daniel M Bean

doi:10.1186/s12872-021-02137-9

Abstract

BackgroundThe 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.MethodsWe 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.ResultsAmong 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.ConclusionsIn 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.

Highlights

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
CVD was more prevalent with increasing age, while Cardiovascular risk factors (RF)-CVD was most common between 50–70 years (Additional file 3: Fig. S1A)
We investigated the inter-relationship between CVD, CV risk factors, CV complications and mortality among 1721 consecutive patients hospitalised due to COVID-19

Summary

Introduction

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. Cardiovascular (CV) risk factors such as hypertension and diabetes, and chronic CV diseases (CVD), including ischaemic heart disease and heart failure, are highly prevalent among patients admitted to hospital with severe novel coronavirus disease 2019 (COVID-19) [1,2,3,4,5]. O’Gallagher et al BMC Cardiovasc Disord (2021) 21:327 individuals [8] It remains unclear whether an increased susceptibility to severe COVID-19 in patients with CV risk factors is driven by co-existent CVD, or whether patients with CV risk factors without established CVD have a severe course. While patients with pre-existing CVD may be at increased risk of CV complications [14, 15], it is not clear the extent to which these represent recurrent or decompensated CVD rather than de novo complications, nor whether the risk applies to patients with CV risk factors

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