Relation of Cardiovascular Risk Factors to Mortality and Cardiovascular Events in Hospitalized Patients With Coronavirus Disease 2019 (from the Yale COVID-19 Cardiovascular Registry)

Pareek, Manan; Singh, Avinainder; Vadlamani, Lina; Eder, Maxwell; Pacor, Justin; Park, Jakob; Ghazizadeh, Zaniar; Heard, Alex; Cruz-Solbes, A.S.; Nikooie, Roozbeh; Gier, Chad; Ahmed, Zain; Freeman, James V.; Meadows, Judith; Smolderen, Kim G.; Lampert, Rachel; Velázquez, Eric J.; Ahmad, Tariq; Desai, Nihar R.

doi:10.1016/j.amjcard.2021.01.029

Cited by 33 publications

(51 citation statements)

References 31 publications

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“…This retrospective cohort study used the “Yale COVID-19 Cardiovascular Registry”, which included consecutive patients with COVID-19 hospitalized between March 1st and May 31st 2020. The design of this registry has been previously described [ 5 ]. Body mass index (BMI) was operationalized as patients without obesity (BMI < 30.0 kg/m 2 ), patients with class I obesity (BMI 30.0 kg/m 2 –34.9 kg/m 2 ), patients with class II obesity (BMI 35.0 kg/m 2 –39.9 kg/m 2 ), and patients with class III obesity (BMI ≥ 40.0 kg/m 2 ).…”

Section: Methodsmentioning

confidence: 99%

Association of obesity with venous thromboembolism and myocardial injury in COVID-19

Wang

Singh

Eder

et al. 2021

Obesity Research & Clinical Practice

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Introduction Although both obesity and coronavirus disease 2019 (COVID-19) independently induce inflammation and thrombosis, the association between obesity class and risk of thrombosis in patients with COVID-19 remains unclear. Methods This retrospective cohort study included consecutive patients hospitalized with COVID-19 at a single institution. Patients were categorized based on obesity class. The main outcomes were venous thromboembolism (VTE) and myocardial injury, a marker of microvascular thrombosis in COVID-19. Adjustments were made for sociodemographic variables, cardiovascular disease risk factors and comorbidities. Results 609 patients with COVID-19 were included. 351 (58%) patients were without obesity, 110 (18%) were patients with class I obesity, 76 (12%) were patients with class II obesity, and 72 (12%) were patients with class III obesity. Patients with class I and III obesity had significantly higher risk-adjusted odds of VTE compared to patients without obesity (OR = 2.54, 95% CI: 1.05–6.14 for class I obesity; and OR = 3.95, 95% CI: 1.40–11.14 for class III obesity). Patients with class III obesity had significantly higher risk-adjusted odds of myocardial injury compared to patients without obesity (OR = 2.15, 95% CI: 1.12–4.12). Both VTE and myocardial injury were significantly associated with greater risk-adjusted odds of mortality. Conclusion This study demonstrates that both macrovascular and microvascular thromboses may contribute to the elevated morbidity and mortality in patients with obesity and COVID-19.

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Section: Methodsmentioning

confidence: 99%

Association of obesity with venous thromboembolism and myocardial injury in COVID-19

Wang

Singh

Eder

et al. 2021

Obesity Research & Clinical Practice

Self Cite

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“…It should be pointed out that no demonstration of improved hard outcomes, including mortality, is available, and that evidence does not include sufficient rigorous randomized controlled studies [164,165]. Improvement of hyperglycemia may however potentially improve outcomes in COVID-19 patients [32,129,130]. We therefore suggest that DSF may be considered for enteral nutrition in persons with obesity and hyperglycemia, particularly when blood glucose control is poor (e.g.…”

Section: Hospitalized Persons With Obesity With Covid-19 Withmentioning

confidence: 98%

“…Measurement of blood pressure, blood glucose and plasma lipid profile is commonly part of routine work-up for all hospitalized patients. For hospitalized COVID-19 patients with and without malnutrition, screening for these parameters is of additional value since they represent additional risk factors for worse COVID-19 outcomes [31e33, 129,130]. Also in the hospital setting for COVID-19 infection, due to higher risk of metabolic syndrome and type 2 diabetes, it is important that persons with obesity as well as overweight undergo both nutritional screening for malnutrition and evaluation of MS-associated cardiometabolic risk factors, including waist circumference.…”

Section: Hospitalized Persons With Obesity With Covid-19 Withmentioning

confidence: 99%

“…Also in the hospital setting for COVID-19 infection, due to higher risk of metabolic syndrome and type 2 diabetes, it is important that persons with obesity as well as overweight undergo both nutritional screening for malnutrition and evaluation of MS-associated cardiometabolic risk factors, including waist circumference. Control and ideally optimization of metabolic syndrome components may contribute to minimize risk of poor COVID-19 outcomes and complications [31e33, 129,130], and it should therefore be pursued through pharmacological and nutritional approaches as described for Statement 6.…”

Section: Hospitalized Persons With Obesity With Covid-19 Withmentioning

confidence: 99%

“…Use of disease-specific formula -Nutritional support can cause or exacerbate hyperglycemia, especially in persons with obesity that are at higher risk of insulin resistance or T2DM. Since hyperglycemia is associated with severe COVID-19 and poor outcomes also in non-critically ill COVID-19 patients [32,129,130], monitoring blood glucose and limiting its elevations and fluctuations is an important target in the context of nutritional care. In the medical nutrition setting, nutritional enteral formula for people with diabetes (Diabetes-Specific Formula: DSF) are available, aiming at limiting glycemic peaks and variability.…”

Section: Hospitalized Persons With Obesity With Covid-19 Withmentioning

confidence: 99%

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Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance

et al. 2022

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The COVID-19 pandemics has created unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Among other important risk factors for severe COVID-19 outcomes, obesity has emerged along with undernutrition-malnutrition as a strong predictor of disease risk and severity. Obesity-related excessive body fat may lead to respiratory, metabolic and immune derangements potentially favoring the onset of COVID-19 complications. In addition, patients with obesity may be at risk for loss of skeletal muscle mass, reflecting a state of hidden malnutrition with a strong negative health impact in all clinical settings. Also importantly, obesity is commonly associated with micronutrient deficiencies that directly influence immune function and infection risk. Finally, the pandemic-related lockdown, deleterious lifestyle changes and other numerous psychosocial consequences may worsen eating behaviors, sedentarity, body weight regulation, ultimately leading to further increments of obesity-associated metabolic complications with loss of skeletal muscle mass and higher non-communicable disease risk. Therefore, prevention, diagnosis and treatment of malnutrition and micronutrient deficiencies should be routinely included in the management of COVID-19 patients in the presence of obesity; lockdown-induced health risks should also be specifically monitored and prevented in this population. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing clinical practice guidance for nutritional management of COVID-19 patients with obesity in various clinical settings.

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Heart failure in COVID‐19: the multicentre, multinational PCHF‐COVICAV registry

et al. 2021

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Aims We assessed the outcome of hospitalized coronavirus disease 2019 (COVID‐19) patients with heart failure (HF) compared with patients with other cardiovascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia). We further wanted to determine the incidence of HF events and its consequences in these patient populations. Methods and results International retrospective Postgraduate Course in Heart Failure registry for patients hospitalized with COVID‐19 and CArdioVascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia) was performed in 28 centres from 15 countries (PCHF‐COVICAV). The primary endpoint was in‐hospital mortality. Of 1974 patients hospitalized with COVID‐19, 1282 had cardiovascular disease and/or risk factors (median age: 72 [interquartile range: 62–81] years, 58% male), with HF being present in 256 [20%] patients. Overall in‐hospital mortality was 25% ( n = 323/1282 deaths). In‐hospital mortality was higher in patients with a history of HF (36%, n = 92) compared with non‐HF patients (23%, n = 231, odds ratio [OR] 1.93 [95% confidence interval: 1.44–2.59], P < 0.001). After adjusting, HF remained associated with in‐hospital mortality (OR 1.45 [95% confidence interval: 1.01–2.06], P = 0.041). Importantly, 186 of 1282 [15%] patients had an acute HF event during hospitalization (76 [40%] with de novo HF), which was associated with higher in‐hospital mortality (89 [48%] vs. 220 [23%]) than in patients without HF event (OR 3.10 [2.24–4.29], P < 0.001). Conclusions Hospitalized COVID‐19 patients with HF are at increased risk for in‐hospital death. In‐hospital worsening of HF or acute HF de novo are common and associated with a further increase in in‐hospital mortality.

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Relation of Cardiovascular Risk Factors to Mortality and Cardiovascular Events in Hospitalized Patients With Coronavirus Disease 2019 (from the Yale COVID-19 Cardiovascular Registry)

Cited by 33 publications

References 31 publications

Association of obesity with venous thromboembolism and myocardial injury in COVID-19

Association of obesity with venous thromboembolism and myocardial injury in COVID-19

Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance

Heart failure in COVID‐19: the multicentre, multinational PCHF‐COVICAV registry

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