Cardiovascular risk factors and COVID-19 outcomes in hospitalised patients: a prospective cohort study

Abstract

Objectives: Recent reports suggest a high prevalence of hypertension and diabetes in COVID-19 patients, but the role of cardiovascular disease (CVD) risk factors in the clinical course of COVID-19 is unknown. We evaluated the time-to-event relationship between hypertension, dyslipidaemia, diabetes and COVID-19 outcomes.

Design: We analysed data from the prospective Dutch CovidPredict cohort, an ongoing prospective study of patients admitted for COVID-19 infection.

Setting: Patients from eight participating hospitals, including two university hospitals from the CovidPredict cohort were included.

Participants: Admitted, adult patients with a positive COVID-19 PCR or high suspicion based on CT-imaging of the thorax. Patients were followed for major outcomes during the hospitalisation. CVD risk factors were established via home medication lists and divided in antihypertensives, lipid-lowering therapy and antidiabetics.

Primary and secondary outcomes measures: The primary outcome was mortality during the first 21 days following admission, secondary outcomes consisted of intensive care unit (ICU) admission and ICU mortality. Kaplan-Meier and Cox regression analyses were used to determine the association with CVD risk factors.

Results: We included 1604 patients with a mean age of 66±15 of whom 60.5% were men. Antihypertensives, lipid-lowering therapy and antidiabetics were used by 45%, 34.7% and 22.1% of patients. After 21-days of follow-up; 19.2% of the patients had died or were discharged for palliative care. Cox regression analysis after adjustment for age and sex showed that the presence of ≥2 risk factors was associated with increased mortality risk (HR 1.52, 95% CI 1.15 to 2.02), but not with ICU admission. Moreover, the use of ≥2 antidiabetics and ≥2 antihypertensives was associated with mortality independent of age and sex with HRs of, respectively, 2.09 (95% CI 1.55 to 2.80) and 1.46 (95% CI 1.11 to 1.91).

Conclusions: The accumulation of hypertension, dyslipidaemia and diabetes leads to a stepwise increased risk for short-term mortality in hospitalised COVID-19 patients independent of age and sex. Further studies investigating how these risk factors disproportionately affect COVID-19 patients are warranted.

Keywords: COVID-19; general diabetes; hypertension; intensive & critical care; ischaemic heart disease; vascular medicine.

Figure 1

Survival and time-to event analysis of cumulative cardiovascular risk factors on mortality, ICU admission and ICU mortality. Kaplan-Meier analysis of the combination of hypertension, dyslipidaemia and diabetes stratified into 0, 1 or more risk factors versus adverse clinical outcomes. (A) Depicts mortality. (B) ICU admission. (C) Depicts ICU mortality, for which a landmark analysis following ICU admission was performed. Log-rank test was used to test for differences between curves. ICU, intensive care unit; RF, risk factor.