COVID-19 and patients at cardiovascular risk

July 22, 2024

Did you know that cardiovascular disease, especially chronic heart failure and previous heart attack or stroke, are associated with an increased risk of hospitalization and death from COVID-19?^1-8? In addition, COVID-19 can worsen existing heart conditions and cause new cardiovascular complications.^4.7.

Various studies highlight that people with high cardiovascular risk have an 8-fold increased risk of death. elderly and a 3-fold increased risk of hospitalization and admission to the intensive care unit (ICU) due to COVID-19.⁸.

But that’s not all. People with obesity, diabetes or kidney disease They are also at higher risk of severe COVID-19. In the case of obesity, it has been shown to be an independent risk factor associated with severe COVID-19.⁹ and that COVID-19 patients with a body mass index (BMI) >30 kg/m2 have a 1.6-fold higher risk of death than non-obese patients.⁹. Similarly, there is a direct association between elevated BMI and the risk of hospitalization, intensive care unit admission, need for invasive mechanical ventilation (IMV), and COVID-19-related death.^1,10,11.

On the other side, diabetes associated with an increased risk of hospitalization and death from COVID-19.^1,2,12-15Both patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) have an increased risk of developing severe COVID-19.^14,16especially those with poor glycemic control^1,13,16,17SARS-CoV-2 infection also impacts glycemic control in diabetes, with inflammation and altered immune response potentially involved mechanisms.^14,15,18.

Finally, patients with chronic kidney disease (CKD) have a worse prognosis due to COVID-19 than patients who do not have this comorbidity.^1,2,5,6,19. And there is an even greater risk of COVID-19-related hospitalization and death in patients with advanced CKD.^1.19.

In conclusion, it should be noted that the risk of death from COVID-19 increases with the number of comorbidities.^{20, 21}For all the reasons mentioned above, it is important to identify patients at cardiovascular risk for early treatment and help prevent the development of severe COVID-19 and its consequences.

References:

1. Nab L et al. Changes in COVID-19-related mortality in key demographic and clinical subgroups in England from 2020 to 2022: a retrospective cohort study using the OpenSAFELY platform. The Lancet Public Health. 2023 May;8(5):e364-e377.
2. Ko JY et al. Risk factors for coronavirus disease 2019 (COVID-19)-related hospitalization: COVID-19-associated hospitalization surveillance network and behavioral risk factor surveillance system. Clin Infect Dis. 2021 Jun 1;72(11):e695–e703.
3. 3. Vardavas SI et al. Predictors of mortality, intensive care unit admission, and hospitalization due to SARS-CoV-2: a systematic review and meta-analysis of cohort studies in Europe. Eur Respir Rev. 2022 Nov 2;31(166):220098.
4. Zhou S, et al. Pathological interactions and clinical complications between COVID-19 and cardiovascular diseases: a review in 2023. Cardiology. 2024;149(1):60–70.
5. 5. Zerbo O et al. Population-based risk assessment of severe COVID-19 disease outcomes. Influenza, other respiratory viruses. 2022 Jan;16(1):159–165.
6. Wo AD et al. Factors associated with severe COVID-19 disease among vaccinated adults treated in US Veterans Affairs hospitals. JAMA Network Open. 2022 Oct 3;5(10).
7. Shao HH, Yin RX. Pathogenic mechanisms of cardiovascular injury in COVID-19. Mol Med. 2024 Jun 19;30(1):92.
8. Warren-Gash S, Davidson JA, Strongman H, Herrett E, Smith L, Breyer J, Banerjee A. Severe COVID-19 outcomes by cardiovascular risk profile in England in 2020: a population-based cohort study. Lancet Reg Health Eur 27 Apr 2023: 100604.
9. Tadayon Najafabadi B et al. Obesity as an independent risk factor for COVID-19 severity and mortality. Cochrane Database Syst ed 2023 May 24;5(5):CD015201.
10. Kompaniets L et al. Body mass index and risk of COVID-19 hospitalization, intensive care unit admission, invasive mechanical ventilation, and death – United States, March-December 2020. MMWR Morb Mortal Wkly Rep. 2021 Mar 12;70(10):355- 361.
11. Gao M et al. Association between body mass index and COVID-19 disease severity in 6.9 million people in England: a community-based prospective cohort study. Lancet Diabetes Endocrinol. 2021 Jun;9(6):350–359
12. Ravshani A et al. Severe COVID-19 in people with type 1 and type 2 diabetes in Sweden: a nationwide retrospective cohort study. Lancet Reg Health Eur 2021 May;4:100105.
13. Magliano D.D., Boyko E.Yu.; IDF Diabetes Atlas Scientific Committee, 10th edition. IDF Diabetes ATLAS (Internet). 10th edition. Brussels: International Diabetes Federation; 2021. Chapter 4. COVID-19 and Diabetes. Available at: https://www.ncbi.nlm.nih.gov/books/NBK581933/.
14. Genza T, et al. Increased risk of COVID-19 infection in patients with diabetes mellitus – current issues in pathophysiology, treatment and prevention. Int J Environ Res Public Health. 2022 May 27; 19 (11): 6555.
15. Feldman EL et al. COVID-19 and diabetes: collision and collusion of two diseases. Diabetes. 2020 Dec;69(12):2549-2565.
16. Singh AK, Khunti K. COVID-19 and diabetes. Annu Rev Med. 2022 Jan 27;73:129-147.
17. Zhu L, She ZG, et al. Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes. Cell Metab. 2020 Jun 2;31(6):1068-1077.e3.
18. Dallavalasa S, et al. COVID-19: A diabetes perspective – pathophysiology and treatment. Pathogens. 2023 Jan 25;12(2):184.
19. Jdiaa SS, Mansour R, El Alayli A, Gautam A, Thomas P, Mustafa RA. COVID-19 and chronic kidney disease: an updated review of reviews. J Nephrol. 2022 Jan;35(1):69–85.
20. Lee AB et al. Network meta-analysis of the association between cardiometabolic risk factors and COVID-19 outcome severity. J Diabetes. 2023 Nov;15(11):968-977.
21. Centers for Disease Control and Prevention. Underlying Medical Conditions Associated with Increased Risk of Severe Illness from COVID: Information for Health Care Providers. Updated April 12, 2024. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html. Last accessed June 2024.

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