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.

Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis

“…This systematic review and its meta-analyses confirm several correlations between demographic factors and comorbidities and severe illness and death among COVID-19 patients that have been reported in other reviews [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. COVID-19 patients who were smokers, males, with ages ≥60 or 65 years, and those who had hypertension, diabetes, cardiovascular disease, cancer, chronic respiratory disease, chronic kidney disease, chronic liver disease, and cerebrovascular diseases were found to be more susceptible to death.…”

“…The disease outcomes from SARS-CoV-2 infection may vary, which is due to a range of health and demographic factors [ 2 , 3 , 4 ]. Indeed, several meta-analyses studies have correlated hypertension, cardiovascular disease, an older age, and the male sex with severe illness and mortality in COVID-19 patients [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. However, the associations with other comorbidities have been less clear, such as with cancer, chronic liver disease, diabetes, and kidney disease.…”

Low‐density lipoprotein apheresis is associated with removal of SARS‐CoV‐2 antibodies

“…Cerebrovascular and cardiovascular disease are associated with increased severity and mortality in COVID‐19. ( 4 , 5 ) Indication of chronic lipoprotein apheresis requires manifest and progressive cardiovascular disease. ( 6 ) Thus, patients undergoing lipoprotein apheresis mandatorily constitute a high‐risk group for an adverse course of the disease.…”

Efficacy and safety of direct-acting oral anticoagulants compared to vitamin K antagonists in COVID-19 outpatients with cardiometabolic diseases

“…In particular, diabetes is frequent in these patients [ 33 , 34 ], and associated with an increased risk of complications, likely due to clustering with other conditions [ 29 ]. Simultaneously, several cardiovascular diseases, including hypertension, cerebrovascular disease and coronary artery disease, are prevalent in COVID-19 patients, and are associated with a higher risk of adverse outcomes [ 35 ]. Given that the presence of cardiometabolic disease is not uncommon in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, this might have major implications for prognosis in this condition.…”