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Cardiovascular disease and mortality sequelae of COVID-19 in the UK Biobank
Zahra Raisi-Estabragh1,2, Jackie Cooper3, Ahmed Salih3
1William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK zahraraisi@doctors.org.uk.
Insights
COVID-19 significantly increases cardiovascular event risk, especially for hospitalized patients. Non-hospitalized cases face higher risks of venous thromboembolism and death.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Epidemiology
Background:
- The long-term cardiovascular implications of COVID-19 remain a critical area of research.
- Understanding the spectrum of cardiovascular events post-infection is vital for patient management.
Purpose of the Study:
- To investigate the association between COVID-19 infection and the incidence of cardiovascular events.
- To compare risks between hospitalized and non-hospitalized COVID-19 cases and uninfected controls.
Main Methods:
- Utilized UK Biobank data from March 2020 to 2021, including 17,871 COVID-19 cases.
- Employed propensity score matching to create comparable groups based on key health and demographic factors.
- Applied Cox proportional hazards regression to analyze incident outcomes including myocardial infarction, stroke, heart failure, and death over a median follow-up of 141 days.
Main Results:
- Non-hospitalized COVID-19 cases showed increased risk for venous thromboembolism (VTE) and all-cause death.
- Hospitalized COVID-19 patients exhibited significantly elevated risks for all studied cardiovascular outcomes, notably VTE, heart failure, and stroke.
- Risks were highest within 30 days post-infection but persisted beyond this period.
Conclusions:
- Hospitalization due to COVID-19 is strongly linked to a broad range of incident cardiovascular events and mortality.
- While non-hospitalized individuals face elevated VTE risk, other cardiovascular-specific outcomes are less affected.
- The early post-infection period presents the highest risk for cardiovascular complications.
Objective:
To examine association of COVID-19 with incident cardiovascular events in 17 871 UK Biobank cases between March 2020 and 2021.
Methods:
COVID-19 cases were defined using health record linkage. Each case was propensity score-matched to two uninfected controls on age, sex, deprivation, body mass index, ethnicity, diabetes, prevalent ischaemic heart disease (IHD), smoking, hypertension and high cholesterol. We included the following incident outcomes: myocardial infarction, stroke, heart failure, atrial fibrillation, venous thromboembolism (VTE), pericarditis, all-cause death, cardiovascular death, IHD death. Cox proportional hazards regression was used to estimate associations of COVID-19 with each outcome over an average of 141 days (range 32-395) of prospective follow-up.
Results:
Non-hospitalised cases (n=14 304) had increased risk of incident VTE (HR 2.74 (95% CI 1.38 to 5.45), p=0.004) and death (HR 10.23 (95% CI 7.63 to 13.70), p<0.0001). Individuals with primary COVID-19 hospitalisation (n=2701) had increased risk of all outcomes considered. The largest effect sizes were with VTE (HR 27.6 (95% CI 14.5 to 52.3); p<0.0001), heart failure (HR 21.6 (95% CI 10.9 to 42.9); p<0.0001) and stroke (HR 17.5 (95% CI 5.26 to 57.9); p<0.0001). Those hospitalised with COVID-19 as a secondary diagnosis (n=866) had similarly increased cardiovascular risk. The associated risks were greatest in the first 30 days after infection but remained higher than controls even after this period.
Conclusions:
Individuals hospitalised with COVID-19 have increased risk of incident cardiovascular events across a range of disease and mortality outcomes. The risk of most events is highest in the early postinfection period. Individuals not requiring hospitalisation have increased risk of VTE, but not of other cardiovascular-specific outcomes.
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