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Meta-Analysis
. 2020 Sep 22;15(1):64.
doi: 10.5334/gh.814.

The Relationship of COVID-19 Severity with Cardiovascular Disease and Its Traditional Risk Factors: A Systematic Review and Meta-Analysis

Kunihiro Matsushita  1   2 , Ning Ding  1   2 , Minghao Kou  1   2 , Xiao Hu  1   2 , Mengkun Chen  1   2 , Yumin Gao  1   2 , Yasuyuki Honda  1   2 , Di Zhao  1   2 , David Dowdy  1 , Yejin Mok  1   2 , Junichi Ishigami  1   2 , Lawrence J Appel  1   2
Affiliations
Meta-Analysis

The Relationship of COVID-19 Severity with Cardiovascular Disease and Its Traditional Risk Factors: A Systematic Review and Meta-Analysis

Kunihiro Matsushita et al. Glob Heart. .

Abstract

Background: Whether cardiovascular disease (CVD) and its traditional risk factors predict severe coronavirus disease 2019 (COVID-19) is uncertain, in part, because of potential confounding by age and sex.

Methods: We performed a systematic review of studies that explored pre-existing CVD and its traditional risk factors as risk factors of severe COVID-19 (defined as death, acute respiratory distress syndrome, mechanical ventilation, or intensive care unit admission). We searched PubMed and Embase for papers in English with original data (≥10 cases of severe COVID-19). Using random-effects models, we pooled relative risk (RR) estimates and conducted meta-regression analyses.

Results: Of the 661 publications identified in our search, 25 papers met our inclusion criteria, with 76,638 COVID-19 patients including 11,766 severe cases. Older age was consistently associated with severe COVID-19 in all eight eligible studies, with RR >~5 in >60-65 versus <50 years. Three studies showed no change in the RR of age after adjusting for covariate(s). In univariate analyses, factors robustly associated with severe COVID-19 were male sex (10 studies; pooled RR = 1.73, [95% CI 1.50-2.01]), hypertension (8 studies; 2.87 [2.09-3.93]), diabetes (9 studies; 3.20 [2.26-4.53]), and CVD (10 studies; 4.97 [3.76-6.58]). RR for male sex was likely to be independent of age. For the other three factors, meta-regression analyses suggested confounding by age. Only four studies reported multivariable analysis, but most of them showed adjusted RR ~2 for hypertension, diabetes, and CVD. No study explored renin-angiotensin system inhibitors as a risk factor for severe COVID-19.

Conclusions: Despite the potential for confounding, these results suggest that hypertension, diabetes, and CVD are independently associated with severe COVID-19 and, together with age and male sex, can be informative for predicting the risk of severe COVID-19.

Keywords: COVID-19; cardiovascular disease; meta-analysis; risk factors.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Figure 1
Figure 1
Flow chart of study selection.
Figure 2
Figure 2
Forest plots of unadjusted relative risk estimates of severe COVID-19 according to gender (A), smoking status (B) and (C) based on restrictive meta-analysis.
Figure 3
Figure 3
Forest plots of unadjusted relative risk estimates of severe COVID-19 according to hypertension (A), diabetes (B), and prior CVD (C) on restrictive meta-analysis.
Figure 4
Figure 4
Forest plots of adjusted relative risk estimates of severe COVID-19 according to prior CVD.
Figure 5
Figure 5
Meta-regression of unadjusted relative risk of severe COVID-19 for hypertension (A), diabetes (B), and CVD (C) by age difference between severe vs. non-severe COVID-19 based on restrictive meta-analysis.
See this image and copyright information in PMC

References

    1. Coronavirus COVID-19 Global Cases. https://coronavirus.jhu.edu/map.html. (Accessed 5 April 2020).
    1. Lauer SA, Grantz KH, Bi Q, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med. 2020. DOI: 10.7326/M20-0504 - DOI - PMC - PubMed
    1. Benjamin EJ, Virani SS, Callaway CW, et al. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation. 2018. - PubMed
    1. South AM, Tomlinson L, Edmonston D, Hiremath S, Sparks MA. Controversies of renin–angiotensin system inhibition during the COVID-19 pandemic. Nature Reviews Nephrology. 2020. DOI: 10.1038/s41581-020-0279-4 - DOI - PMC - PubMed
    1. Esler M, Esler D. Can angiotensin receptor-blocking drugs perhaps be harmful in the COVID-19 pandemic? J Hypertens. 2020; 38: 781–2. DOI: 10.1097/HJH.0000000000002450 - DOI - PubMed