Cardiovascular risk factors, cardiovascular disease, and COVID-19: an umbrella review of systematic reviews

Abstract

Aims: To consolidate evidence to determine (i) the association between cardiovascular risk factors and health outcomes with coronavirus 2019 (COVID-19); and (ii) the impact of COVID-19 on cardiovascular health.

Methods and results: An umbrella review of systematic reviews was conducted. Fourteen medical databases and pre-print servers were searched from 1 January 2020 to 5 November 2020. The review focused on reviews rated as moderate or high-quality using the AMSTAR 2 tool. Eighty-four reviews were identified; 31 reviews were assessed as moderate quality and one was high-quality. The following risk factors were associated with higher mortality and severe COVID-19: renal disease [odds ratio (OR) (95% confidence interval) for mortality 3.07 (2.43-3.88)], diabetes mellitus [OR 2.09 (1.80-2.42)], hypertension [OR 2.50 (2.02-3.11)], smoking history [risk ratio (RR) 1.26 (1.20-1.32)], cerebrovascular disease [RR 2.75 (1.54-4.89)], and cardiovascular disease [OR 2.65 (1.86-3.78)]. Liver disease was associated with higher odds of mortality [OR 2.81 (1.31-6.01)], but not severe COVID-19. Current smoking was associated with a higher risk of severe COVID-19 [RR 1.80 (1.14-2.85)], but not mortality. Obesity associated with higher odds of mortality [OR 2.18 (1.10-4.34)], but there was an absence of evidence for severe COVID-19. In patients hospitalized with COVID-19, the following incident cardiovascular complications were identified: acute heart failure (2%), myocardial infarction (4%), deep vein thrombosis (7%), myocardial injury (10%), angina (10%), arrhythmias (18%), pulmonary embolism (19%), and venous thromboembolism (25%).

Conclusion: Many of the risk factors identified as associated with adverse outcomes with COVID-19 are potentially modifiable. Primary and secondary prevention strategies that target cardiovascular risk factors may improve outcomes for people following COVID-19.

Keywords: COVID-19 Cardiovascular disease; Cardiovascular risk; Umbrella review.

Figure 1

PRISMA flow diagram.

Figure 2

Forest plot showing results of meta-analyses from reviews which investigated associations between cardiovascular disease or cardiovascular risk factors and mortality with COVID-19. Largest moderate- or high-quality review included, according to assessment with the AMSTAR 2 criteria. CI, confidence interval; OR, odds ratio; RR, relative risk.

Figure 3

Forest plot showing results of meta-analyses from reviews which investigated associations between cardiovascular disease or cardiovascular risk factors and severe COVID-19. Largest moderate- or high-quality review included, according to assessment with the AMSTAR 2 criteria. CI, confidence interval; NR, not reported; OR, odds ratio; RR, relative risk.