The effect of vascular risk factor burden on the severity of COVID-19 illness, a retrospective cohort study

Houwei Du,Huayao Huang,Xiaoping Xu,Limin Chen,Rongxiang Cao,Nan Liu,Xiaoqing Li,Ronghua Chen,Chen Li,Zhaomin Zheng ,Hanhan Lei,Hailong Lin,Gareth Ambler,Yun Luo ,David J Werring,Zhenghui Huang,Xiaoling Chen,Zhanzheng Zhao ,Yu Lin,Xiaobin Pan,Yixian Zhang,Lei Gao,Sangru Wu,Ke-Xu Lin ,Junnian Chen,Pincang Xia,Mingxu Huang,Feifei Lin,Chao Chen

doi:10.1186/s12931-020-01510-0

Abstract

BackgroundPatients with cardiovascular comorbidities are at high risk of poor outcome from COVID-19. However, how the burden (number) of vascular risk factors influences the risk of severe COVID-19 disease remains unresolved. Our aim was to investigate the association of severe COVID-19 illness with vascular risk factor burden.MethodsWe included 164 (61.8 ± 13.6 years) patients with COVID-19 in this retrospective study. We compared the difference in clinical characteristics, laboratory findings and chest computed tomography (CT) findings between patients with severe and non-severe COVID-19 illness. We evaluated the association between the number of vascular risk factors and the development of severe COVID-19 disease, using a Cox regression model.ResultsSixteen (9.8%) patients had no vascular risk factors; 38 (23.2%) had 1; 58 (35.4%) had 2; 34 (20.7%) had 3; and 18 (10.9%) had ≥4 risk factors. Twenty-nine patients (17.7%) experienced severe COVID-19 disease with a median (14 [7–27] days) duration between onset to developing severe COVID-19 disease, an event rate of 4.47 per 1000-patient days (95%CI 3.10–6.43). Kaplan-Meier curves showed a gradual increase in the risk of severe COVID-19 illness (log-rank P < 0.001) stratified by the number of vascular risk factors. After adjustment for age, sex, and comorbidities as potential confounders, vascular risk factor burden remained associated with an increasing risk of severe COVID-19 illness.ConclusionsPatients with increasing vascular risk factor burden have an increasing risk of severe COVID-19 disease, and this population might benefit from specific COVID-19 prevention (e.g., self-isolation) and early hospital treatment measures.

Highlights

Patients with cardiovascular comorbidities are at high risk of poor outcome from Coronavirus disease 2019 (COVID)-19
Patients with increasing vascular risk factor burden have an increasing risk of severe COVID-19 disease, and this population might benefit from specific COVID-19 prevention and early hospital treatment measures
The coronavirus disease 2019 (COVID-19) is a highly infectious viral respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first reported in December 2019 in Wuhan, China [1]

Summary

Introduction

Patients with cardiovascular comorbidities are at high risk of poor outcome from COVID-19. How the burden (number) of vascular risk factors influences the risk of severe COVID-19 disease remains unresolved. Our aim was to investigate the association of severe COVID-19 illness with vascular risk factor burden. Cardiovascular risk factors, including ischemic heart disease, hypertension and diabetes, are common in patients with COVID-19 infection, and associated with mortality [3, 4]. Most previous studies showed an association between vascular risk factors (such as hypertension and diabetes) and COVID-19 severity [7]. Little is known about how patients stratified by burden of vascular risk factors differ from each other, and whether the number of vascular risk factors is associated with COVID-19 disease severity. We investigated the association between the number of vascular risk factors and severe COVID-19 disease in this observational retrospective study

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