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Cardiovascular risk factors and COVID-19 outcomes in hospitalised patients: a prospective cohort study
Didier Collard1, Nick S Nurmohamed1,2, Yannick Kaiser1
1Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Insights
The accumulation of cardiovascular disease risk factors like hypertension and diabetes significantly increases short-term mortality risk in hospitalized COVID-19 patients, independent of age and sex. These findings highlight the critical impact of these conditions on COVID-19 outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- Cardiovascular disease (CVD) risk factors, including hypertension and diabetes, are prevalent in COVID-19 patients.
- The impact of these CVD risk factors on the clinical course and outcomes of COVID-19 remains largely unknown.
Purpose of the Study:
- To evaluate the time-to-event relationship between hypertension, dyslipidemia, and diabetes with COVID-19 outcomes.
- To determine if pre-existing CVD risk factors influence mortality and intensive care unit (ICU) admission in hospitalized COVID-19 patients.
Main Methods:
- Analysis of data from the prospective Dutch CovidPredict cohort study.
- Inclusion of 1604 adult patients admitted for COVID-19 infection across eight hospitals.
- Utilized Kaplan-Meier and Cox regression analyses to assess the association between CVD risk factors (antihypertensives, lipid-lowering therapy, antidiabetics) and major outcomes (21-day mortality, ICU admission, ICU mortality).
Main Results:
- A total of 1604 patients were included, with 45% using antihypertensives, 34.7% lipid-lowering therapy, and 22.1% antidiabetics.
- After 21 days, 19.2% of patients experienced mortality or palliative discharge.
- The presence of two or more CVD risk factors was associated with increased mortality risk (HR 1.52), and the use of two or more antidiabetics (HR 2.09) or antihypertensives (HR 1.46) independently predicted mortality, adjusted for age and sex.
Conclusions:
- The cumulative effect of hypertension, dyslipidemia, and diabetes leads to a stepwise increase in short-term mortality risk for hospitalized COVID-19 patients.
- This increased risk is independent of patient age and sex.
- Further research is warranted to understand how these CVD risk factors disproportionately affect COVID-19 patient outcomes.
Objectives:
Recent reports suggest a high prevalence of hypertension and diabetes in COVID-19 patients, but the role of cardiovascular disease (CVD) risk factors in the clinical course of COVID-19 is unknown. We evaluated the time-to-event relationship between hypertension, dyslipidaemia, diabetes and COVID-19 outcomes.
Design:
We analysed data from the prospective Dutch CovidPredict cohort, an ongoing prospective study of patients admitted for COVID-19 infection.
Setting:
Patients from eight participating hospitals, including two university hospitals from the CovidPredict cohort were included.
Participants:
Admitted, adult patients with a positive COVID-19 PCR or high suspicion based on CT-imaging of the thorax. Patients were followed for major outcomes during the hospitalisation. CVD risk factors were established via home medication lists and divided in antihypertensives, lipid-lowering therapy and antidiabetics.
Primary And Secondary Outcomes Measures:
The primary outcome was mortality during the first 21 days following admission, secondary outcomes consisted of intensive care unit (ICU) admission and ICU mortality. Kaplan-Meier and Cox regression analyses were used to determine the association with CVD risk factors.
Results:
We included 1604 patients with a mean age of 66±15 of whom 60.5% were men. Antihypertensives, lipid-lowering therapy and antidiabetics were used by 45%, 34.7% and 22.1% of patients. After 21-days of follow-up; 19.2% of the patients had died or were discharged for palliative care. Cox regression analysis after adjustment for age and sex showed that the presence of ≥2 risk factors was associated with increased mortality risk (HR 1.52, 95% CI 1.15 to 2.02), but not with ICU admission. Moreover, the use of ≥2 antidiabetics and ≥2 antihypertensives was associated with mortality independent of age and sex with HRs of, respectively, 2.09 (95% CI 1.55 to 2.80) and 1.46 (95% CI 1.11 to 1.91).
Conclusions:
The accumulation of hypertension, dyslipidaemia and diabetes leads to a stepwise increased risk for short-term mortality in hospitalised COVID-19 patients independent of age and sex. Further studies investigating how these risk factors disproportionately affect COVID-19 patients are warranted.
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