Severe COVID-19 outcomes by cardiovascular risk profile in England in 2020: a population-based cohort study

Warren‐Gash, Charlotte; Davidson, Jennifer; Strongman, Helen; Herrett, Emily; Smeeth, Liam; Breuer, Judith; Banerjee, Amitava

doi:10.1016/j.lanepe.2023.100604

Cited by 15 publications

(8 citation statements)

References 27 publications

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“…Reassuringly, although AIIRD patients are known to be at increased risk of infections [ 41 , 42 , 43 ] and specifically of HZ reactivation [ 5 , 44 ], we did not find an increase in the risk of HZ reactivation following mRNA vaccination in SpA patients relative to the general population. This finding is particularly noteworthy given that the AIIRD patient population has been aggressively immunized against COVID-19 due to the concern of potentially more severe outcomes of this infection in immunosuppressed individuals and particularly in those with CVD-related comorbidities, as found in PsA patients [ 32 , 45 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

The Risk of Herpes Zoster Events in Patients with Spondyloarthritis and the Effect of BNT162b2 mRNA COVID-19 Vaccine

Gazitt,

Hayat,

Stein

et al. 2024

Vaccines

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The data on the risk of herpes zoster (HZ) in spondyloarthropathy (SpA) patients are sparse, especially regarding its association with the novel mRNA COVID-19 vaccines and immunosuppressants. We aimed to evaluate whether SpA diagnosis and/or immunosuppressant use affect HZ risk and the influence of mRNA COVID-19 vaccination. We assessed the association between SpA (psoriatic arthritis (PsA) and ankylosing spondylitis (AS)) diagnoses and HZ in a large population database with patients matched by age and sex to controls. We also assessed the association between the COVID-19 vaccine and new-onset HZ using two nested case–control studies, identifying all new HZ cases diagnosed from 1 January–31 December 2021 within the SpA and general population cohorts, matched randomly by sex, age and HZ index date to controls without HZ. Exposure to mRNA COVID-19 vaccination was ascertained in the 6 weeks prior to the index date both in cases and controls. In our results, the incidence rate of HZ was higher in PsA patients vs. the general population, at 1.03 vs. 0.64 per 100 person-years, respectively (adjusted HR = 1.55; 95%CI, 1.19–2.02). Within the SpA group, Jak-I treatment was associated with a higher risk of developing new-onset HZ (adjusted OR = 3.79; 1.15–12.5). Multivariable conditional logistic regression models we used showed no association between COVID-19 vaccination and new-onset HZ among the SpA patients (OR = 1.46; 0.68–3.14).

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Section: Discussionmentioning

confidence: 99%

The Risk of Herpes Zoster Events in Patients with Spondyloarthritis and the Effect of BNT162b2 mRNA COVID-19 Vaccine

Gazitt,

Hayat,

Stein

et al. 2024

Vaccines

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“…It is worth noting that COVID-19 positive stroke patients often have more severe strokes, as indicated by higher baseline NIHSS scores, which may have contributed to worse functional outcomes in this pooled patient population ( 35 , 36 ). Lastly, cardiovascular risk factors commonly observed in patients with ischemic stroke have been shown to be associated with a higher risk of severe COVID-19 ( 37 ). This association may further diminish the chances of favorable outcomes in patients with ischemic stroke and COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Intravenous thrombolysis and endovascular therapy for acute ischemic stroke in COVID-19: a systematic review and meta-analysis

et al. 2023

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BackgroundThe impact of COVID-19 on clinical outcomes in acute ischemic stroke patients receiving reperfusion therapy remains unclear. We therefore aimed to synthesize the available evidence to investigate the safety and short-term efficacy of reperfusion therapy in this patient population.MethodsWe searched the electronic databases MEDLINE, Embase and Cochrane Library Reviews for randomized controlled trials and observational studies that investigated the use of intravenous thrombolysis, endovascular therapy, or a combination of both in acute ischemic stroke patients with laboratory-confirmed COVID-19, compared to controls. Our primary safety outcomes included any intracerebral hemorrhage (ICH), symptomatic ICH and all-cause in-hospital mortality. Short-term favorable functional outcomes were assessed at discharge and at 3 months. We calculated pooled risk ratios (RR) and 95% confidence intervals (CI) using DerSimonian and Laird random-effects model. Heterogeneity was evaluated using Cochran’s Q test and I2 statistics.ResultsWe included 11 studies with a total of 477 COVID-19 positive and 8,092 COVID-19 negative ischemic stroke patients who underwent reperfusion therapy. COVID-19 positive patients exhibited a significantly higher risk of experiencing any ICH (RR 1.54, 95% CI 1.16–2.05, p < 0.001), while the nominally increased risk of symptomatic ICH in these patients did not reach statistical significance (RR 2.04, 95% CI 0.97–4.31; p = 0.06). COVID-19 positive stroke patients also had a significantly higher in-hospital mortality compared to COVID-19 negative stroke patients (RR 2.78, 95% CI 2.15–3.59, p < 0.001). Moreover, COVID-19 positive stroke patients were less likely to achieve a favorable functional outcome at discharge (RR 0.66, 95% CI 0.51–0.86, p < 0.001) compared to COVID-19 negative patients, but this difference was not observed at 3-month follow-up (RR 0.64, 95% CI 0.14–2.91, p = 0.56).ConclusionCOVID-19 appears to have an adverse impact on acute ischemic stroke patients who undergo reperfusion therapy, leading to an elevated risk of any ICH, higher mortality and lower likelihood of favorable functional outcome.Systematic review registrationhttps://clinicaltrials.gov/, identifier CRD42022309785.

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“…Adverse events related to COVID-19, such as death or hospitalization, are known to increase not only in individuals with pre-existing atherosclerotic cardiovascular disease (ASCVD), 23 29 but also in individuals with CV risk factors. 30 31 Renal disease, diabetes, hypertension, smoking history, and current smoking status were identified as risk factors for higher mortality and severe COVID-19 in the study by Harrison et al 30 Given that many of the risk factors associated with adverse COVID-19 outcomes are potentially modifiable, the researchers suggested that primary and secondary prevention strategies targeting cardiovascular risk factors could improve outcomes for individuals following a COVID-19 infection. A recent population-based cohort study in England showed that individuals without pre-existing CVD but with elevated CV risk were more likely to experience severe COVID-19 outcomes, including deaths, intensive care unit admissions, or hospitalizations.…”

Section: Special Considerations: Covid-19 Vaccination In Atherosclero...mentioning

confidence: 99%

The Role of COVID-19 Vaccination for Patients With Atherosclerotic Cardiovascular Disease in the Upcoming Endemic Era

Kim

2024

J Lipid Atheroscler

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COVID-19 vaccination has played a pivotal role in coping with the COVID-19 pandemic by providing a powerful tool to curb the spread of the virus, reduce severe illness and hospitalizations, and ultimately save lives and facilitate a return to normal daily routines. As COVID-19 vaccination has become more widespread and more individuals have recovered from the infection, COVID-19 has entered an endemic disease phase. This phase is characterized by a less severe and more stable pattern of infection within certain regions, similar to the predictability of seasonal influenza. In this endemic era, COVID-19 vaccines may appear to be less important, and many people are reluctant to receive COVID-19 vaccination for various reasons, including the fear of adverse events. However, COVID-19 remains a major public health problem, in that the incidence rate of new COVID-19 infections is still high and the morbidity and mortality in high-risk populations are substantial. Therefore, the role of COVID-19 vaccines in protecting high-risk individuals is crucial, and ongoing research and surveillance are imperative to refine vaccination recommendations in the ever-changing landscape of the COVID-19 endemic era. This review explores the role of COVID-19 vaccination in the upcoming COVID-19 endemic era.

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Severe COVID-19 outcomes by cardiovascular risk profile in England in 2020: a population-based cohort study

Cited by 15 publications

References 27 publications

The Risk of Herpes Zoster Events in Patients with Spondyloarthritis and the Effect of BNT162b2 mRNA COVID-19 Vaccine

The Risk of Herpes Zoster Events in Patients with Spondyloarthritis and the Effect of BNT162b2 mRNA COVID-19 Vaccine

Intravenous thrombolysis and endovascular therapy for acute ischemic stroke in COVID-19: a systematic review and meta-analysis

The Role of COVID-19 Vaccination for Patients With Atherosclerotic Cardiovascular Disease in the Upcoming Endemic Era

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