Journal
BMC CARDIOVASCULAR DISORDERS
Volume 21, Issue 1, Pages -Publisher
BMC
DOI: 10.1186/s12872-021-02137-9
Keywords
COVID-19; Cardiovascular disease; Cardiovascular risk factors; Hypertension; Diabetes
Categories
Funding
- British Heart Foundation [CH/1999001/11735, RE/18/2/34213]
- National Institute for Health Research Biomedical Research Centres (NIHR BRCs) at Guy's & St Thomas' NHS Foundation Trust and South London [IS-BRC-1215-20006]
- Maudsley NHS Foundation Trust [IS-BRC-1215-20018]
- King's College London
- King's Prize Fellowship
- Fondation Leducq
- MRC Clinical Training Fellowship - King's Medical Research Trust [HDRUK MR/S00310X/1]
- Medical Research Council (MRC) Skills Development Fellowship programme [MR/R016372/1]
- NIHR SLAM BRC
- Health Data Research UK
- UK Research and Innovation (UKRI) London Medical Imaging & Artificial Intelligence Centre for Value Based Healthcare
- BigData@Heart Consortium [116074]
- European Union
- NIHR BRC and Research Informatics Unit at University College London Hospitals
- NIHR Applied Research Collaboration South London at KCHFT
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This study found that pre-existing established CVD in COVID-19 patients may be more closely associated with mortality compared to CV risk factors. Patients with CVD are more likely to experience CV complications.
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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