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COVID-19 infection is linked to an increased risk of cardiovascular incidents and death for those with no history of COVID-19, according to retrospective research.
The risk of adverse events and death is higher in other people hospitalized with COVID-19, but, among those who are not hospitalized, there is still an increased risk of venous thromboembolism (VTE) and mortality after infection.
Notably, the cases that posed the greatest threat to other people hospitalized for COVID were stroke, VTE, and heart failure, but increases were also seen in cases of atrial traumatic inflammation (AF), pericarditis, and myocardial infarction (MI), Zahra Raisi-Estabragh, Queen Mary University of London, UK, and colleagues reported.
The risk of cardiovascular events and mortality “almost exclusively limited to Americans requiring hospitalization and [] highest in the first 30 days after infection, but remained highest for an extended period thereafter,” the authors concluded. .
The findings appeared online Oct. 24 in the journal Heart.
The research team set out to assess dating between cardiovascular events and COVID-19 data from the UK Biobank.
They evaluated 35,742 uninfected controls matched through propensity score and 17,871 participants with a history of COVID-19. Women accounted for 55. 3% of the overall UK biobank cohort and their median age was 69 years. The researchers followed patients from March 2020 at the time of a cardiovascular event, until the patient’s death, or until March 2021.
Of the 17,871 COVID-19 cases included in the study, 14,304 required hospitalization, 866 patients diagnosed with COVID-19 were still hospitalized for other conditions, and 2701 required hospitalization for their COVID infection.
Researchers learned of COVID-19 cases with data from fitness records. They then compared the Biobank case propensity score with two uninfected controls based on high cholesterol, smoking, sex, age, ethnicity, diabetes, deprivation, smoking, body mass index, and hypertension. .
Death from ischemic center disease, VTE, all-cause mortality, pericarditis, cardiovascular mortality, myocardial infarction, atrial fibrillation, center failure and stroke were some of the incidents evaluated. During an average prospective follow-up period of 141 days, researchers calculated the relationships between COVID-19 and all Cox proportional hazards regression end results.
In out-of-hospital cases of COVID-19, they found a higher threat of death (hazard ratio [HR], 10,23; P < 0. 0001) and VTE incident (HR, 2. 74; P = 0. 004) compared to uninfected controls.
Patients hospitalized primarily for their COVID-19 infection (2701) had a greater threat to “all outcomes considered,” the authors write. ; P < 0. 0001) and central failure (HR, 21. 6; P < 0. 0001), however, superior threats were also observed for the AF incident, which is nearly 15 times larger, they note. Major pericarditis 14 times and MI greater 10 times fold in hospitalized patients with COVID to uninfected controls.
Finally, among patients hospitalized for other situations and diagnosed with COVID-19 as a secondary diagnosis (n=866), there is a greater threat to all incidents compared to those without infection. While their threat of death for any reason is lower than that of other people hospitalized primarily for COVID-19, the risk of death from cardiovascular or ischemic disease is higher, as is the incident risk of myocardial infarction and atrial fibrillation.
“Currently, the National Institute [for] Health and Care Excellence recommends prophylactic low molecular weight heparin for VTE prevention in hospitalized patients with COVID-19 and in patients who would otherwise be admitted to the hospital (p. e. g. , home hospital) for a minimum of 7 days,” the authors note, consistent with similar recommendations from the British Thoracic Society and the American Society of Hematology. “Our effects imply that the threat of VTE is also greater in people outside the hospital. “Writes.
Study limitations come with residual confounding of comorbidities that were not considered in the comparison method, lack of attention to the effects of cardiovascular medications, such as angiotensin-converting enzyme inhibitors or statins, and an conceivable underestimation of adverse cardiovascular risk given the relatively healthy. Cohort of UK biobanks, study authors note.
In addition, the study does not take into account other imaginable change factors, such as multiple exposures to infection, the effects of COVID-19 vaccines and new variants, the researchers added.
More research is needed to determine when cardiovascular risk increases after COVID-19, the study authors noted.
“Future studies are needed on whether express interventions are needed to mitigate the threat of venous thromboembolism related to COVID-19,” they conclude.
These findings are consistent with the literature, noted Anda Bularga, M. D. , David Newby, MD, PhD, and Andrew R. Chapman, MD, all of the University of Edinburgh, United Kingdom, in an accompanying editorial.
Prior to the COVID-19 pandemic, systemic inflammation due to respiratory tract infections was a known threat to stroke and myocardial infarction, with a fourfold greater threat reported in an assessment of five million patients within 3 days of diagnosis of decreased breathing. Tract infection, respiratory tract infection as documented in the U. K. General Practice Research Database, the editorialists noted.
Similar effects have been reported in many settings, such as infectious exacerbation of chronic obstructive pulmonary disease, where there is a remarkable risk of early cardiovascular events that is also higher in hospitalized patients, they added.
“The prothrombotic effects of COVID-19 raise the question of whether antithrombotic methods are needed to avoid this giant excess of events. “
Perhaps a broader question is whether the use of antithrombotic treatments, adding anticoagulant or antiplatelet therapies, deserves to be ed in all patients, they write.
“Clearly, the duration of the remedy is relevant, and that knowledge calls into question whether seven days of prophylactic anticoagulation is sufficient for COVID-19 patients,” the editorialists conclude.
Srihari S. Naidu, MD, a professor of medicine at New York Medical College in Valhalla, who was not involved in the study, commented on the effects for theheart. org | Medscape Cardiology.
“We want to be much more attentive to those patients, even after 30 days,” he said. greater due to a probably maximal inflammatory prothrombotic effect that has persistent consequences after 30 days. “
Naidu noted that long-term studies look at the most recent waves and variants of COVID-19. “I suspect the threat will be much less,” he added, COVID is now a milder disease. “
Heart. Published on October 24, 2022. Full text, Editorial
Naidu reported any applicable monetary relationships.
Ashley Lyles is an award-winning medical journalist. She is a graduate of New York University’s Science, Health, and Environmental Reporting Program. Previously, she studied professional writing at Michigan State University. His paintings have been published in media such as The New York Times Daily 360, PBS NewsHour, The Huffington Post. , Undark, The Root, Psychology Today, Insider and Tonic (Health through Vice), among other publications.
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