Cardiovascular risk factors and outcomes in COVID-19: A hospital-based study in India

Abstract

Background & objectives Presence of cardiovascular (CV) risk factors enhance adverse outcomes in COVID-19. To determine association of risk factors with clinical outcomes in India we performed a study. Methods Successive virologically confirmed adult patients of COVID-19 at a government hospital were recruited at admission and data on clinical presentation and in-hospital outcomes were obtained. The cohort was classified according to age, sex, hypertension, diabetes and tobacco use. In-hospital death was the primary outcome. Logistic regression was performed to compared outcomes in different groups. Results From April to September 2020 we recruited 4645 (men 3386, women 1259) out of 5103 virologically confirmed COVID-19 patients (91.0%). Mean age was 46±18y, hypertension was in 17.8%, diabetes in 16.6% and any tobacco-use in 29.5%. Duration of hospital stay was 6.8±3.7 days, supplemental oxygen was in 18.4%, non-invasive ventilation in 7.1%, mechanical ventilation in 3.6% and 7.3% died. Unadjusted and age-sex adjusted odds ratio(OR) and 95% confidence intervals(CI) for in-hospital mortality, respectively, were: age ≥60y vs <40y, OR 8.47(95% CI 5.87–12.21) and 8.49(5.88–12.25), age 40-59y vs <40y 3.69(2.53–5.38) and 3.66(2.50–5.33), men vs women 1.88(1.41–2.51) and 1.26(0.91–1.48); hypertension 2.22(1.74–2.83) and 1.32(1.02–1.70), diabetes 1.88(1.46–2.43) and 1.16(0.89–1.52); and tobacco 1.29(1.02–1.63) and 1.28(1.00–1.63). Need for invasive and non-invasive ventilation was greater among patients in age-groups 40–49 and ≥60y and hypertension. Multivariate adjustment for social factors, clinical features and biochemical tests attenuated significance of all risk factors. Conclusion Cardiovascular risk factors, age, male sex, hypertension, diabetes and tobacco-use, are associated with greater risk of in-hospital death among COVID-19 patients.

Significance of myocardial injury on in-hospital clinical outcomes of in-hospital and COVID-19 patients

“…Similarly, a study done by Shi et al 10 reported 20 % incidence of myocardial injury and these patients had much higher mortality rate (51%). Sharma et al 11 reported 7.3% mortality in their study in patients with COVID-19, the mortality was twofold higher in patients with associated cardiovascular risk factors compared to COVID-19 patients without associated cardiac risk factors. These huge differences in the incidence and mortality of patients with acute cardiac injury could be related to differences in ethnicities of study populations, severity of disease, underlying baseline characteristics and comorbidities and may also be related to study period.…”

Lower COVID-19 incidence in Bulgaria in 2022 can be attributed to the Delta variant's belated intense spread.

“…Bulgaria is ranked rst for mortality of cardiovascular diseases -cardiovascular death rate measures 424.688 (EU range 86.06-424.688) 1 . Patients with such conditions have been reported of higher risk for severe COVID-19 disease 30 . Therefore, the bad general health of the Bulgarian population is an exacerbating factor and affects negatively CFR values causing them to soar.…”

Impact of COVID-19 on the cardiovascular health of women: a review by the Italian Society of Cardiology Working Group on ‘gender cardiovascular diseases’

“…Patients with old age (≥60 years), male sex, hypertension and diabetes mellitus have more than a 100 times higher risk for severe COVID-19 than those without these risk factors and a greater risk of in-hospital death. 18 , 19 The role of both age and sex regarding COVID-19 outcomes is still a matter of debate. Collard et al 20 showed that in a cohort of 1604 Dutch patients with a mean age of 66 ± 15 years (60.5% men), the association of hypertension, dyslipidaemia and diabetes leads to a stepwise increased risk of short-term mortality in hospitalized COVID-19 patients, independently of age and sex.…”

“…Since March 2020, the coronavirus disease (COVID- 19) pandemic has been continuing to spread across the globe and, although specific therapies and vaccines are now available, the onset of more contagious variants still presents today a persistent challenge for health systems because of the high number of infections, hospitalizations and deaths. During the past 2 years, population subgroups with higher vulnerability and comorbidities have been identified.…”

“…Several worldwide studies highlighted that many modifiable and nonmodifiable cardiovascular factors, such as older age, male sex, diabetes, overweight, hypertension, and depression, are strictly related to adverse outcomes in COVID-19 patients. Patients with old age (≥60 years), male sex, hypertension and diabetes mellitus have more than a 100 times higher risk for severe COVID-19 than those without these risk factors and a greater risk of in-hospital death 18,19 . The role of both age and sex regarding COVID-19 outcomes is still a matter of debate.…”