Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China

by:
Lucrecia M. Burgos

Patients with previous cardiovascular metabolic diseases may face a greater risk of developing into the severe condition and the comorbidities can also greatly affect the prognosis of the 2019 novel corona virus (2019-nCoV) disease (COVID-19). On the other hand, COVID-19 can, in turn, aggravate the damage to the heart, according to a meta-analysis in the Clinical Research in Cardiology Journal1.

The analysis included six studies with 1527 patients, all of the selected studies were published in 2020 with different sample patient sizes that ranged from 11 to 1099 patients.

In all of the studies, men were more likely to be infected than women and the most prevalent cardiovascular metabolic comorbidities were hypertension (17.1%, 95% CI 9.9–24.4%), cardiovascular diseases (CVD) (16.4%, 95% CI 6.6–26.1%), and diabetes (9.7%, 95% CI 6.9–12.5%).  The researchers compared the difference of the prevalence of these three diseases between severe patients and non-severe patients (or ICU vs non-ICU patients according to the data in the studies). The proportion of hypertension (RR = 2.03, 95% CI 1.54, 2.68) and CVD (RR = 3.30, 95% CI 2.03, 5.36) were both statistically significant higher in ICU/severe patients compared to non-ICU/severe patients. Diabetes accounted for 11.7% of ICU/severe cases, but 4.0% of non-ICU/severe cases, but without statistical significance P = 0.09.

Finally, they focused on the impact of the COVID-19 on the cardiac injury, only two studies that gave clear data were statistically analysed, and the data showed that 8.0% (95% CI 4.1–12.0%) patients might have suffered from an acute cardiac injury.

The authors note that due to the sample size and limited time so far, data collection is still incomplete, and most of the studies have not analysed comorbidities in death cases. So the relationship between cardiovascular metabolic diseases and COVID-19-induced death cannot be determined. In addition, the results should be interpreted with caution, since it presents considerable heterogeneity across the identified studies, and they did not conduct sensitivity and subgroup analysis.

The lack of widespread testing, national surveillance and standardized data collection, as well as the potential sampling bias in sicker, hospitalized patients with more comorbidities, has complicated efforts to accurately estimate the prevalence of cardiovascular and metabolic diseases in patients with COVID-192. Moreover, the prevalence of various cardiovascular comorbidities and their impact on clinical outcomes seem to vary considerably across different geographic locations3.

The mechanism of these associations remains unclear at this time. Potential explanations include CVD being more prevalent in those with advancing age, a functionally impaired immune system, proinflammatory state, elevated levels of ACE2, or a predisposition to COVID-19 for those with CVD4

The patients with pre-existing cardiovascular risk factors and CVD appear to have heightened vulnerability to develop COVID-19 and tend to have more severe disease with worse clinical outcomes. Continued monitoring of cardiovascular metabolic diseases as possible risk factors for poor prognosis should be considered.  Additional study is needed to understand the causal pathways that may increase vulnerability in this population and the potential mechanistic relationships between CVD and COVID-19 outcomes.

References:

  1. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020. DOI: https://doi.org/10.1007/s00392-020-01626-9.
  2. Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Bondi-Zoccai G, et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic. J Am Coll Cardiol. 2020: S0735-1097(20)34637-4. DOI: https://doi.org/10.1016/j.jacc.2020.03.031.
  3. Bansal M. Cardiovascular disease and COVID-19. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020. DOI: https://doi.org/10.1016/j.dsx.2020.03.013.
  4. Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease. Circulation. 2020. DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.046941.

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