COVID-19 Associated with High Prevalence of CV Risk Factors, Mortality

Preliminary data presented at the European Society of Cardiology (ESC 2020) Congress showed that patients hospitalized with coronavirus disease 2019 (COVID-19) tended to have a high cardiovascular (CV) risk baseline as well as high mortality and CV complications.

Furthermore, patients with CV disease and biomarkers had poor outcomes.

The study was co-led by Manan Pareek, MD, PhD and Avinainder Singh, MD, Msc, both current residents at Yale School of Medicine. Using the Yale New Haven Hospital COVID-19 Cardiovascular Registry, they conducted a prospective cohort study that included 1200 hospitalized patients positive with COVID-19. So far, they have analyzed the first 495 individuals.

The aim of the analysis was to determine the prevalence of CV risk factors, established CV disease, and associated medications. Additionally, they sought to identify risk factors for incident CV events and mortality.

In-hospital death from any cause was the primary endpoint. Secondary endpoints were CV outcomes, such as major adverse cardiovascular events (MACE), and non-CV outcomes, such as ICU admission, medical ventilation, and renal replacement therapy.

The median age of the assessed cohort was 68 years, with 46% being female.

The team found that certain CV risk factors, which included diabetes, hypertension, and hyperlipidemia, were present in at least 40% of the population. Additionally, 46% of the patients had a history of any CV disease, the most prevalent being coronary artery disease (CAD), heart failure, and atrial fibrillation.

They also noted that use of medications like antihypertensives, aspirin, and statins was frequent in the cohort.

Up to 18% of patients died in the hospital and 39% experienced a MACE after admission. Common CV events included atrial fibrillation (19%), myocardial infarction (17%), and acute decompensated heart failure (14%).

In terms of non-CV events, 35% patients were admitted to the ICU, 21% required medical ventilation, and 4% underwent new renal replacement therapy.

Pareek and team used a logistic regression to determine potential predictors of MACE. They found that associated independent variables were male sex, history of atrial fibrillation, use of a diuretic, oxygen therapy at admission, lower albumin, and higher troponin T.

The independent variables associated with in-hospital mortality were age, a history of ventricular tachycardia, use of P2Y12 inhibitors, lower platelet count, higher aspartate aminotransferase, lower albumin, and a higher troponin T. 

Overall, the results showed that about 1 in 5 patients died, 2 in 5 experienced a CV event, and 1 in 5 required mechanical ventilation.

The investigators acknowledged various limitations including the observational nature of the study as well as the limited event rate. Since all observed individuals were hospital patients, the population was generally older and had greater comorbidities and higher mortality rates compared with non-hospitalized patients.

“It's very easy to make the mistake of solely focusing on the virus, and attributing all signs and symptoms that these patients develop to a severe COVID-19 course," Pareek said in an interview with HCPLive®. “But the very high cardiovascular complication rate found in our study suggests that we have to be more vigilant in detecting and possibly treating these complications."

The study, "The Yale COVID-19 Cardiovascular Registry," was presented at ESC 2020.