Association of hypertension, diabetes, stroke, cancer, kidney disease, and high-cholesterol with COVID-19 disease severity and fatality: A systematic review

Diabetes Metab Syndr. Sep-Oct 2020;14(5):1133-1142. doi: 10.1016/j.dsx.2020.07.005. Epub 2020 Jul 8.


Background and aims: To undertake a review and critical appraisal of published/preprint reports that offer methods of determining the effects of hypertension, diabetes, stroke, cancer, kidney issues, and high-cholesterol on COVID-19 disease severity.

Methods: A search was conducted by two authors independently on the freely available COVID-19 Open Research Dataset (CORD-19). We developed an automated search engine to screen a total of 59,000 articles in a few seconds. Filtering of the articles was then undertaken using keywords and questions, e.g. "Effects of diabetes on COVID/normal coronavirus/SARS-CoV-2/nCoV/COVID-19 disease severity, mortality?". The search terms were repeated for all the comorbidities considered in this paper. Additional articles were retrieved by searching via Google Scholar and PubMed.

Findings: A total of 54 articles were considered for a full review. It was observed that diabetes, hypertension, and cholesterol levels possess an apparent relation to COVID-19 severity. Other comorbidities, such as cancer, kidney disease, and stroke, must be further evaluated to determine a strong relationship to the virus.

Conclusion: Reports associating cancer, kidney disease, and stroke with COVID-19 should be carefully interpreted, not only because of the size of the samples, but also because patients could be old, have a history of smoking, or have any other clinical condition suggesting that these factors might be associated with the poor COVID-19 outcomes rather than the comorbidity itself. Further research regarding this relationship and its clinical management is warranted.

Keywords: COVID-19; Cancer; Coronavirus; Diabetes; High blood pressure; High cholesterol; Hypertension; Kidney; SARS-CoV-2; Stroke.

Publication types

  • Systematic Review

MeSH terms

  • Betacoronavirus / isolation & purification*
  • COVID-19
  • Cholesterol / metabolism*
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / mortality*
  • Coronavirus Infections / virology
  • Diabetes Mellitus / physiopathology*
  • Diabetes Mellitus / virology
  • Humans
  • Hypertension / physiopathology*
  • Hypertension / virology
  • Kidney Diseases / physiopathology*
  • Kidney Diseases / virology
  • Pandemics
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / mortality*
  • Pneumonia, Viral / virology
  • Prognosis
  • SARS-CoV-2
  • Severity of Illness Index*
  • Stroke / physiopathology*
  • Stroke / virology
  • Survival Rate


  • Cholesterol