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A meta-analysis on the risk factors adjusted association between cardiovascular disease and COVID-19 severity
Jie Xu1, Wenwei Xiao1, Xuan Liang1
1Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China.
Insights
Pre-existing cardiovascular disease (CVD) significantly increases the risk of adverse outcomes in patients with coronavirus disease 2019 (COVID-19). This meta-analysis confirms CVD as an independent risk factor for poor outcomes in COVID-19 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiovascular disease (CVD) is a common comorbidity in patients with coronavirus disease 2019 (COVID-19).
- The association between CVD and adverse outcomes in COVID-19 patients is suspected but remains controversial.
- Understanding this relationship is crucial for managing COVID-19 patients with pre-existing conditions.
Purpose of the Study:
- To quantitatively assess the correlation between pre-existing cardiovascular disease and adverse outcomes in COVID-19 patients.
- To determine if CVD is an independent risk factor for adverse outcomes in the context of COVID-19.
- To synthesize evidence from multiple studies using a meta-analysis approach.
Main Methods:
- A comprehensive quantitative meta-analysis was conducted using adjusted effect estimates.
- Data were systematically searched from multiple databases (PubMed, Web of Science, MedRxiv, Scopus, Elsevier ScienceDirect, Cochrane Library, EMBASE) up to January 7, 2021.
- Pooled odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, alongside heterogeneity and publication bias assessments.
Main Results:
- The meta-analysis included 203 studies with over 24 million cases.
- COVID-19 patients with pre-existing CVD showed a significantly higher tendency towards adverse outcomes (pooled OR = 1.41, pooled HR = 1.34).
- Subgroup analyses confirmed the significant association across various demographics, study designs, and outcome types.
Conclusions:
- Pre-existing cardiovascular disease is an independent risk factor for adverse outcomes in COVID-19 patients.
- These findings highlight the importance of considering CVD status in the clinical management and risk stratification of COVID-19 patients.
- Further research may focus on specific interventions to mitigate risks for this vulnerable population.
Background:
Cardiovascular disease (CVD), one of the most common comorbidities of coronavirus disease 2019 (COVID-19), has been suspected to be associated with adverse outcomes in COVID-19 patients, but their correlation remains controversial.
Method:
This is a quantitative meta-analysis on the basis of adjusted effect estimates. PubMed, Web of Science, MedRxiv, Scopus, Elsevier ScienceDirect, Cochrane Library and EMBASE were searched comprehensively to obtain a complete data source up to January 7, 2021. Pooled effects (hazard ratio (HR), odds ratio (OR)) and the 95% confidence intervals (CIs) were estimated to evaluate the risk of the adverse outcomes in COVID-19 patients with CVD. Heterogeneity was assessed by Cochran's Q-statistic, I2test, and meta-regression. In addition, we also provided the prediction interval, which was helpful for assessing whether the variation across studies was clinically significant. The robustness of the results was evaluated by sensitivity analysis. Publication bias was assessed by Begg's test, Egger's test, and trim-and-fill method.
Result:
Our results revealed that COVID-19 patients with pre-existing CVD tended more to adverse outcomes on the basis of 203 eligible studies with 24,032,712 cases (pooled ORs = 1.41, 95% CIs: 1.32-1.51, prediction interval: 0.84-2.39; pooled HRs = 1.34, 95% CIs: 1.23-1.46, prediction interval: 0.82-2.21). Further subgroup analyses stratified by age, the proportion of males, study design, disease types, sample size, region and disease outcomes also showed that pre-existing CVD was significantly associated with adverse outcomes among COVID-19 patients.
Conclusion:
Our findings demonstrated that pre-existing CVD was an independent risk factor associated with adverse outcomes among COVID-19 patients.
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