key: cord-0874838-wcxgsfpb
authors: Krittanawong, Chayakrit; Virk, Hafeez Ul Hassan; Narasimhan, Bharat; Wang, Zhen; Narasimhan, Harish; Zhang, Hong Ju; Sun, Tao; Messerli, Franz H.
title: Coronavirus disease 2019 (COVID-19) and cardiovascular risk: A meta-analysis
date: 2020-05-07
journal: Prog Cardiovasc Dis
DOI: 10.1016/j.pcad.2020.05.001
sha: e2f9e211176a1b8ba43a425ca7db6f12af3a8164
doc_id: 874838
cord_uid: wcxgsfpb

nan

The association between the disease severity of COVID-19 and preexisting cardiovascular disease (CVD) risk remains unknown. The aim of this meta-analysis is to determine the association of preexisting CVD risk and the disease severity of COVID-19.

We systematically searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Scopus, and Web of Science as well as preprint servers from December 2019 through April 10, 2020, for observational studies that reported the association between preexisting CVD risk and COVID-19. There were no limitations on language or date of publication. Data were independently reviewed by two investigators. Conflicts were resolved through consensus. The strategies included MeSH and Embase terms as well as keywords including coronavirus, COVID-19, 2019nCoV, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, CVD, CVD events, diabetes (DM), hypertension (HTN), smoking, myocardial injury, cardiac injury, coronary artery disease (CAD), acute myocardial infarct, acute coronary syndrome, or heart failure (HF). Inclusion criteria are as follows: (1) patients were confirmed to have been infected by SARS-CoV-2; and (2) numbers of the preexisting CVD risk, numbers of severe cases and non-severe cases were reported. Reviews, editorials, non-human studies, duplicate publications, only children cases, letters without sufficient data, studies without preexisting CVD risk were excluded. We classified severe disease as patients with confirmed COVID-19 who admitted to the intensive care unit, developed acute respiratory distress syndrome, elevated troponin, the J o u r n a l P r e -p r o o f progression of the disease, required mechanical ventilation, or death. Quality assessment was performed by two independent reviewers using the Newcastle-Ottawa quality assessment scale, a validated scale for non-randomized studies in meta-analyses. Conflicts were resolved through consensus. We assigned scores of 0-3, 3.5-6, and 6.5-9 for low, moderate, and high quality of studies, respectively. Random-effects meta-analyses were used. Subgroup analyses were performed to explore the potential sources of heterogeneity. We defined substantial heterogeneity between the studies if I 2 >50%. All statistical analyses were performed with Stata version 11 (Stata Corp), and all tests were two-sided with a significance level of 0.05.

We identified 13 observational studies. A total of 49,076 confirmed COVID-19 cases There are two main findings from the present study. First, although smoking has been demonstrated to be a CVD risk factor and has known adverse effects on heart and lung function 1 , surprisingly, we could not find the association of the COVID-19 severity and smoking. This may be confounded by the frequency of smoking, duration of smoking, or lung function. Second, we found that DM, HTN, CAD, HF, overall CVD events were associated with severe COVID-19

cases, compared to non-severe COVID-19 cases. Previous studies showed that age, high body mass index, and low CD4 T cell count were independently associated with severe COVID-19 disease. 2, 3 There are certain limitations to this study. First, as discussed earlier, the frequency and duration of smoking are not captured in the included studies. Second, we could not differentiate between medication non-compliance or severity of CVD risk. For instance, poorly controlled DM or HTN is probably associated with more severe COVID-19 disease. Last, our results may be confounded by poor sleep hygiene, nutritional status, or depression. 4, 5 In conclusion, patients with preexisting CVD risk, such as DM and HTN risk, as well as patients with established CVD, are associated with a higher risk of developing severe COVID-19 disease. Smoking was not associated with the severity of the COVID-19 case. Only one study reported ACEI/ARB use and a higher proportion in severe COVID-19 disease, compared to nonsevere COVID-19 disease.

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