The Relationship of COVID-19 Severity with Cardiovascular Disease and Its Traditional Risk Factors: A Systematic Review and Meta-Analysis

Kunihiro Matsushita; Ning Ding; Minghao Kou; Xiao Hu; Mengkun Chen; Yumin Gao; Yasuyuki Honda; Di Zhao; David Dowdy; Yejin Mok; Junichi Ishigami; Lawrence J Appel

doi:10.5334/gh.814

The Relationship of COVID-19 Severity with Cardiovascular Disease and Its Traditional Risk Factors: A Systematic Review and Meta-Analysis

Glob Heart. 2020 Sep 22;15(1):64. doi: 10.5334/gh.814.

Authors

Kunihiro Matsushita^{1

2}, Ning Ding^{1

2}, Minghao Kou^{1

2}, Xiao Hu^{1

2}, Mengkun Chen^{1

2}, Yumin Gao^{1

2}, Yasuyuki Honda^{1

2}, Di Zhao^{1

2}, David Dowdy¹, Yejin Mok^{1

2}, Junichi Ishigami^{1

2}, Lawrence J Appel^{1

2}

Affiliations

¹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, US.
² Welch Center for Prevention, Epidemiology, and Clinical Research, US.

PMID: 33150129
PMCID: PMC7546112
DOI: 10.5334/gh.814

Abstract

Background: Whether cardiovascular disease (CVD) and its traditional risk factors predict severe coronavirus disease 2019 (COVID-19) is uncertain, in part, because of potential confounding by age and sex.

Methods: We performed a systematic review of studies that explored pre-existing CVD and its traditional risk factors as risk factors of severe COVID-19 (defined as death, acute respiratory distress syndrome, mechanical ventilation, or intensive care unit admission). We searched PubMed and Embase for papers in English with original data (≥10 cases of severe COVID-19). Using random-effects models, we pooled relative risk (RR) estimates and conducted meta-regression analyses.

Results: Of the 661 publications identified in our search, 25 papers met our inclusion criteria, with 76,638 COVID-19 patients including 11,766 severe cases. Older age was consistently associated with severe COVID-19 in all eight eligible studies, with RR >~5 in >60-65 versus <50 years. Three studies showed no change in the RR of age after adjusting for covariate(s). In univariate analyses, factors robustly associated with severe COVID-19 were male sex (10 studies; pooled RR = 1.73, [95% CI 1.50-2.01]), hypertension (8 studies; 2.87 [2.09-3.93]), diabetes (9 studies; 3.20 [2.26-4.53]), and CVD (10 studies; 4.97 [3.76-6.58]). RR for male sex was likely to be independent of age. For the other three factors, meta-regression analyses suggested confounding by age. Only four studies reported multivariable analysis, but most of them showed adjusted RR ~2 for hypertension, diabetes, and CVD. No study explored renin-angiotensin system inhibitors as a risk factor for severe COVID-19.

Conclusions: Despite the potential for confounding, these results suggest that hypertension, diabetes, and CVD are independently associated with severe COVID-19 and, together with age and male sex, can be informative for predicting the risk of severe COVID-19.

Keywords: COVID-19; cardiovascular disease; meta-analysis; risk factors.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Age Factors
Aged
COVID-19 / diagnosis*
COVID-19 / therapy
Cardiovascular Diseases / diagnosis*
Cardiovascular Diseases / therapy
Comorbidity
Correlation of Data
Diabetes Mellitus / diagnosis
Diabetes Mellitus / therapy
Female
Humans
Hypertension / diagnosis
Hypertension / therapy
Male
Middle Aged
Risk Factors
Severity of Illness Index*
Sex Factors

Grants and funding

This project is supported by Resolve to Save Lives, which is funded by Bloomberg Philanthropies, the Bill and Melinda Gates Foundation, and Gates Philanthropy.