COVID-19 confers risk for death, CV events, especially in hospitalized patients
Compared with uninfected controls, patients hospitalized for COVID-19 had elevated risk for death and CV events, according to new data from the UK Biobank.
Patients with COVID-19 who were not hospitalized had elevated risk for death and venous thromboembolism, but not for other CV outcomes, compared with uninfected controls, according to the researchers.
Zahra Raisi-Estabragh, PhD, British Heart Foundation Clinical Research Training Fellow and cardiology specialty trainee at the William Harvey Research Institute, Queen Mary University of London, and colleagues prospectively compared 17,871 patients with COVID-19 from the UK Biobank, infected between March 1, 2020, and March 1, 2021, with 35,742 uninfected controls from the UK Biobank matched based on age, sex, deprivation, BMI, ethnicity, diabetes, prevalent ischemic heart disease, smoking, hypertension and high cholesterol.
The outcomes of interest were MI, stroke, HF, atrial fibrillation, VTE, pericarditis, all-cause death, CVD death and ischemic heart disease death. Mean follow-up was 141 days.
Elevated risks from COVID-19
Compared with controls, patients who had COVID-19 but were not hospitalized had elevated risk for VTE (HR = 2.74; 95% CI, 1.38-5.45; P = .004) and death (HR = 10.23; 95% CI, 7.63-13.7; P < .0001), but not for other CV outcomes.
However, compared with controls, patients hospitalized with COVID-19 as a primary diagnosis had elevated risk for all outcomes:
- MI, HR = 9.9; 95% CI, 3.36-29.1; P < .0001;
- stroke, HR = 17.5; 95% CI, 5.26-57.9; P < .0001;
- HF, HR = 21.6; 95% CI, 10.9-42.9; P < .0001;
- atrial fibrillation, HR = 14.9; 95% CI, 9.34-23.8; P < .0001;
- VTE, HR = 27.6; 95% CI, 14.5-52.3; P < .0001;
- pericarditis, HR = 13.6; 95% CI, 4.06-45.8; P < .0001;
- all-cause death, HR = 118.01; 95% CI, 73.32-189.95; P < .0001;
- CVD death, HR = 8.76; 95% CI, 2.51-30.5; P =.001; and
- ischemic heart disease death, HR = 14.1; 95% CI, 1.73-113.8; P = .013.
The elevated risks were similar in patients hospitalized with COVID-19 as a secondary diagnosis, the researchers wrote.
The risks were highest in the first 30 days, but remained elevated during the rest of follow-up, Raisi-Estabragh and colleagues wrote.
“The long-term sequelae of past COVID-19 exposure is emerging as a dominant public health concern,” the researchers wrote. “Our findings highlight the increased cardiovascular risk of individuals with past infection, which are likely to be greater in countries with limited access to vaccination and thus greater population exposure to COVID-19. Furthermore, the long-term cardiovascular consequences reported in our study may be relevant in the context of future pandemics of similar viral infections.”
‘Important contribution’
In a related editorial, David E. Newby, MD, British Heart Foundation Professor of Cardiology at the University of Edinburgh, U.K., and colleagues wrote: “[T]he proportionately greater breadth and increase in cardiovascular events seen with COVID-19 are exceptional and suggest more than a simple inflammatory effect. This has been hypothesized to relate to endothelial dysfunction or prothrombotic effects of COVID-19 in addition to typical cardiovascular risk factors and underlying previously unrecognized coronary or structural heart disease.”
They wrote that the study is an “important contribution to our greater understanding of the cardiovascular consequences of COVID-19. It provides a fuller and more complete appreciation of the breadth and degree of these associations that will inform how we now try to treat and to prevent the cardiovascular events associated with COVID-19 in the years to come.”
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