Vaccinations, cardiovascular drugs, hospitalization, and mortality in COVID-19 and Long COVID
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Published on: January 8, 2020
Ashkan Dashtban1, Mehrdad A Mizani2, Laura Pasea1
1Institute of Health Informatics, University College London, London, UK.
Insights
Individuals with cardiovascular disease (CVD) face higher risks from COVID-19 and Long COVID (LC). Targeted COVID-19 vaccination and CVD prevention significantly reduce mortality and hospitalizations for these high-risk groups.
Area of Science:
- Public Health
- Epidemiology
- Infectious Disease Research
Background:
- Cardiovascular disease (CVD) and high cardiovascular risk are significant factors influencing outcomes of COVID-19 and Long COVID (LC).
- Understanding high-risk subgroups is crucial for effective public health interventions.
Purpose of the Study:
- To identify subgroups at highest risk for severe outcomes from COVID-19 and Long COVID (LC).
- To investigate the impact of cardiovascular disease (CVD), influenza, and COVID-19 vaccination on COVID-19 and LC outcomes.
- To assess the effectiveness of cardiovascular disease prevention strategies.
Main Methods:
- Utilized national, linked electronic health records from England (2020-2023) for individuals diagnosed with COVID-19 and LC.
- Compared all-cause hospitalization and mortality rates based on prior CVD, high CV risk, vaccination status (COVID-19/influenza), and use of CVD medications.
- Calculated population preventable fractions to quantify the impact of vaccination and CVD prevention.
Main Results:
- Individuals with COVID-19 and LC experienced significant hospitalization and mortality rates.
- COVID-19 vaccination (≥2 doses) substantially reduced the adjusted risk of mortality and hospitalization for both COVID-19 and LC.
- Cardiovascular disease prevention, including anticoagulants and lipid-lowering drugs, also demonstrated significant reductions in mortality and hospitalization for individuals with pre-existing CVD.
- Influenza vaccination showed a reduction in mortality but not hospitalization for COVID-19 and LC.
Conclusions:
- Pre-existing cardiovascular disease (CVD) and high cardiovascular risk are strongly associated with increased hospitalization and mortality in both COVID-19 and Long COVID (LC).
- Targeted COVID-19 vaccination campaigns and proactive cardiovascular disease prevention strategies are essential public health priorities for mitigating severe outcomes.
Objective:
To identify highest-risk subgroups for COVID-19 and Long COVID(LC), particularly in contexts of influenza and cardiovascular disease(CVD).
Methods:
Using national, linked electronic health records for England (NHS England Secure Data Environment via CVD-COVID-UK/COVID-IMPACT Consortium), we studied individuals (of all ages) with COVID-19 and LC (2020-2023). We compared all-cause hospitalization and mortality by prior CVD, high CV risk, vaccination status (COVID-19/influenza), and CVD drugs, investigating impact of vaccination and CVD prevention using population preventable fractions.
Results:
Hospitalization and mortality were 15.3% and 2.0% among 17,373,850 individuals with COVID-19 (LC rate 1.3%), and 16.8% and 1.4% among 301,115 with LC. Adjusted risk of mortality and hospitalization were reduced with COVID-19 vaccination ≥ 2 doses(COVID-19:HR 0.36 and 0.69; LC:0.44 and 0.90). With influenza vaccination, mortality was reduced, but not hospitalization (COVID-19:0.86 and 1.01, and LC:0.72 and 1.05). Mortality and hospitalization were reduced by CVD prevention in those with CVD, e.g., anticoagulants- COVID:19:0.69 and 0.92; LC:0.59 and 0.88; lipid lowering- COVID-19:0.69 and 0.86; LC:0.68 and 0.90. COVID-19 vaccination averted 245044 of 321383 and 7586 of 8738 preventable deaths after COVID-19 and LC, respectively.
Interpretation:
Prior CVD and high CV risk are associated with increased hospitalization and mortality in COVID-19 and LC. Targeted COVID-19 vaccination and CVD prevention are priority interventions.
Funding:
NIHR. HDR UK.
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