The Relationship of COVID-19 Severity with Cardiovascular Disease and Its Traditional Risk Factors: A Systematic Review and Meta-Analysis. Issue 1 (22nd September 2020)

• Record Type: Journal Article
• Authors: Matsushita, Kunihiro; Ding, Ning; Kou, Minghao; Hu, Xiao; Chen, Mengkun; Gao, Yumin; Honda, Yasuyuki; Zhao, Di; Dowdy, David; Mok, Yejin; Ishigami, Junichi; Appel, Lawrence J.
• Is Part Of: Global heart. Volume 15:Issue 1(2020)
• Publication Date: 2020-09-22
• Subjects: COVID-19 -- cardiovascular disease -- risk factors -- meta-analysis; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Prevention -- Periodicals; Cardiovascular system -- Diseases -- Treatment -- Periodicals; Cardiovascular system -- Diseases -- Prevention; Cardiovascular Diseases -- prevention & control -- Periodicals; Cardiovascular Diseases -- Periodicals; Developing Countries -- Periodicals; Electronic journals; Electronic journals; Periodicals; 616.1005
• DOI: 10.5334/gh.814
• Languages: English
• ISSNs: 2211-8160

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.