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Cardiovascular and mortality risks following COVID-19-related vs. non-COVID-19 COPD exacerbations
Brian K Kirui1, Huiqi Li1, Oskar Wallström2,3
1School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
COVID-19-related COPD exacerbations significantly increase short-term cardiovascular risks and mortality, especially moderate cases. Proactive cardiovascular care is crucial during respiratory outbreaks to mitigate these risks.
Area of Science:
- Cardiology
- Pulmonology
- Infectious Diseases
- Epidemiology
Background:
- COPD exacerbations, frequently triggered by viral infections like COVID-19, are linked to heightened cardiovascular risk.
- Previous research suggests a potential for increased cardiovascular and mortality risks associated with COVID-19-related exacerbations compared to non-COVID-19-related ones.
Purpose of the Study:
- To compare the 28-day risks of major adverse cardiovascular events (MACE), stroke, pulmonary embolism (PE), acute myocardial infarction (AMI), and all-cause mortality following COVID-19-related versus non-COVID-19-related COPD exacerbations.
- To assess how these risks varied across different phases of the COVID-19 pandemic.
Main Methods:
- A target trial emulation using Swedish national registers identified COPD exacerbations (moderate or severe) between March 2020 and June 2023.
- COVID-19-related exacerbations were defined by infection, hospitalization, or intensive care admission for COVID-19.
- Adjusted hazard ratios (aHRs) were estimated for key outcomes, stratified by exacerbation severity and COVID-19 variants.
Main Results:
- Among 266,273 exacerbations, 5,425 were COVID-19-related. Moderate COVID-19-related exacerbations showed increased risks for PE (aHR 2.26), overall cardiovascular events (1.94), MACE (1.88), and mortality (4.58).
- Severe COVID-19-related exacerbations were primarily associated with increased mortality (aHR 1.46).
- Cardiovascular risks peaked during pre-Alpha and Delta variants for moderate exacerbations; elevated mortality was observed for both moderate and severe cases during these periods.
Conclusions:
- COVID-19-related COPD exacerbations elevate short-term risks of MACE, cardiovascular events, and mortality, particularly in moderate cases.
- These risks showed some attenuation during the Alpha and Omicron variant periods.
- The findings underscore the necessity of proactive cardiovascular monitoring and care during respiratory infectious disease outbreaks.
Rationale:
COPD exacerbations, often triggered by viral infections like COVID-19, are associated with increased cardiovascular risk. We hypothesized that COVID-19-related exacerbations carry higher short-term cardiovascular and mortality risks than non-COVID-19-related exacerbations.
Objectives:
To compare 28-day risk of stroke, pulmonary embolism (PE), acute myocardial infarction (AMI), major adverse cardiovascular events (MACE) and all-cause mortality following COVID-19-related vs. non-COVID-19-related COPD exacerbations and assess variation across the pandemic.
Methods:
Using Swedish national registers, we identified COPD with moderate (treated with oral corticosteroids with/without antibiotics) or severe (hospitalized) exacerbations from March 2020 to June 2023. Exacerbations with infection, hospitalization or intensive care admission for COVID-19 were defined as COVID-19-related. A target trial was emulated and adjusted hazard ratios (aHRs) with 95% confidence intervals (CI) estimated for each outcome, stratified by exacerbation severity and COVID-19 variants.
Measurements And Main Results:
Among 266,273 exacerbations (87.2% moderate, 12.8% severe), 5,425 (2%) were COVID-19-related. COVID-19-related vs. non-COVID-19-related moderate exacerbations were associated with risk of PE (aHR 2.26, 95%CI 1.49-3.42), overall cardiovascular (1.94, 1.47-2.56), MACE (1.88, 1.28-2.76), and mortality (4.58, 4.06-5.17), but not significantly with AMI and stroke. Severe COVID-19-related exacerbations were only associated with higher mortality (1.46, 1.28-1.66). Cardiovascular risks were highest during pre-Alpha and Delta for moderate exacerbations. Mortality remained elevated for both moderate and severe exacerbations, particularly during the same periods.
Conclusions:
COVID-19-related exacerbations increased MACE, short-term cardiovascular and mortality risks, mainly for moderate exacerbations, with attenuation during Alpha and Omicron, highlighting the need for proactive cardiovascular care during respiratory outbreaks.
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