Cardiovascular complications in COVID‐19 patients with or without diabetes mellitus

Abstract

Introduction Coronavirus disease 2019 (COVID‐19) has become a major global crisis. Preliminary reports have, in general, indicated worse outcomes in diabetes mellitus (DM) patients, but the magnitude of cardiovascular (CV) complications in this subgroup has not been elucidated. Methods We included 142 patients admitted with laboratory‐confirmed COVID‐19 from April 1st to May 30th 2020; 71 (50%) had DM. We compared baseline demographics and study outcomes between those with or without DM using descriptive statistics. Multivariate logistic regression was used to estimate the adjusted odds ratio for the study outcomes in DM patients, compared to those without DM, stratified by age, sex and glycaemic control. CV outcomes of interest include acute myocarditis, acute heart failure, acute myocardial infarction, new‐onset atrial fibrillation and composite cardiovascular end‐point consisting of all individual outcomes above. Result Mean age was 58 years. The unadjusted rates were higher in DM patients compared to non‐diabetics for the composite cardiovascular end‐point (73.2% vs. 40.6% p < .0001), acute myocarditis (36.6% vs. 15.5% p = .004), acute heart failure (25.3% vs. 5.6% p = .001), acute myocardial infarction (9.9% vs. 1.4% p = .03) and new‐onset atrial fibrillation (12.7% vs. 1.4% p = .009). After controlling for relevant confounding variables, diabetic patients had higher odds of composite cardiovascular end‐point, acute heart failure and new‐onset atrial fibrillation.

Prevalence and Impact of Atrial Fibrillation in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Of the 783 studies identified from the literature search (216 on Pubmed and 567 on EMBASE), 31 studies were selected according to the inclusion and exclusion criteria and included in the analysis [ 3 , 10 , 11 , 12 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] ( Figure S1 in Supplementary Materials ), with a total of 187,716 COVID-19 patients. Baseline characteristics of the studies included are reported in Table 1 .…”

“…Thirteen studies were held in Europe [ 10 , 11 , 25 , 29 , 31 , 33 , 37 , 39 , 42 , 43 , 44 , 47 , 50 ], nine in North America [ 3 , 28 , 30 , 32 , 41 , 45 , 46 , 49 , 51 ], four in Asia [ 26 , 34 , 35 , 48 ], and five in other geographical locations, including one multinational study [ 12 , 27 , 36 , 38 , 40 ]. Twenty-five studies were observational retrospective [ 3 , 10 , 12 , 26 , 28 , 30 , 31 , 32 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], four were based on prospective observational analysis of single center cohorts [ 11 , …”

“…The evaluation of bias for the two outcomes investigated is reported in Supplementary Materials (Tables S2 and S3, respectively) . Among studies reporting the prevalence of AF, 13 studies were categorized as being at high risk of bias [ 11 , 32 , 33 , 34 , 36 , 37 , 39 , 42 , 44 , 46 , 47 , 48 , 51 ]; incomplete reporting of baseline characteristics was the most common concern. Among the studies reporting all-cause mortality according to AF, two studies were at high risk of bias [ 42 , 50 ].…”

Neuropilin-1: A feasible link between liver pathologies and COVID-19

“…After the chaotic initial months of the pandemic, an increasing number of studies have shown that the severity of SARS-CoV-2 is directly related to the health status of the infected individuals[ 2 ] and also with gender[ 3 ]. Severe complications and an increased risk of mortality have been linked with various pathologies[ 2 , 4 ] including obesity, diabetes, lung disease, and hypertension[ 2 , 4 - 7 ]. SARS-CoV-2 invades the mucosal cells of the host, mainly through the nose and mouth.…”

Sudden Cardiac Death Caused by a Fatal Association of Hypertrophic Cardiomyopathy (MYH7, p.Arg719Trp), Heterozygous Familial Hypercholesterolemia (LDLR, p.Gly343Lys) and SARS-CoV-2 B.1.1.7 Infection

“…Furthermore, patients with established cardiovascular disease have an increased risk for severity and mortality with SARS-CoV-2 infection, mainly due to ACE2 receptors abundance in the cardiovascular system, which represents the gateway for the virus entry in the heart [ 7 ]. Although still debated, acute SARS-CoV-2 induced myocarditis represents one of the most common cardiovascular SARS-CoV-2 complicacy along with other pathogens with cardiac tropism [ 8 , 9 ]. Therefore, acute myocarditis presents across a variable range of clinical severity and is a significant diagnostic challenge in the SARS-CoV-2 infection era, considering that diffuse myocardial injury was also detected in the early convalescent stage of SARS-CoV-2 infected and recovered patients who had no active cardiac symptoms [ 10 ].…”