key: cord-1043202-x1emnrip
authors: Abe, Temidayo; Egbuche, Obiora; Igwe, Joseph; Jegede, Opeyemi; Wagle, Bivek; Olanipekun, Titilope; Onwuanyi, Anekwe
title: Cardiovascular complications in COVID‐19 patients with or without diabetes mellitus
date: 2020-12-25
journal: Endocrinol Diabetes Metab
DOI: 10.1002/edm2.218
sha: 647c1e8c021ef1dfe9f2cb13d5dc9572a56e05fd
doc_id: 1043202
cord_uid: x1emnrip

INTRODUCTION: Coronavirus disease 2019 (COVID‐19) has become a major global crisis. Preliminary reports have, in general, indicated worse outcomes in diabetes mellitus (DM) patients, but the magnitude of cardiovascular (CV) complications in this subgroup has not been elucidated. METHODS: We included 142 patients admitted with laboratory‐confirmed COVID‐19 from April 1st to May 30th 2020; 71 (50%) had DM. We compared baseline demographics and study outcomes between those with or without DM using descriptive statistics. Multivariate logistic regression was used to estimate the adjusted odds ratio for the study outcomes in DM patients, compared to those without DM, stratified by age, sex and glycaemic control. CV outcomes of interest include acute myocarditis, acute heart failure, acute myocardial infarction, new‐onset atrial fibrillation and composite cardiovascular end‐point consisting of all individual outcomes above. RESULT: Mean age was 58 years. The unadjusted rates were higher in DM patients compared to non‐diabetics for the composite cardiovascular end‐point (73.2% vs. 40.6% p < .0001), acute myocarditis (36.6% vs. 15.5% p = .004), acute heart failure (25.3% vs. 5.6% p = .001), acute myocardial infarction (9.9% vs. 1.4% p = .03) and new‐onset atrial fibrillation (12.7% vs. 1.4% p = .009). After controlling for relevant confounding variables, diabetic patients had higher odds of composite cardiovascular end‐point, acute heart failure and new‐onset atrial fibrillation.

States and is associated with severe illness in patients with COVID-19. 3 While preliminary reports have, in general, indicated worse outcomes in diabetics, the magnitude of CVD complications in this subgroup has not been fully elucidated.

This study was conducted at Grady Memorial Hospital, the largest academic centre in Georgia, United States. This study was approved by our institutional review board with a health insurance portability and accountability act (HIPAA) waiver due to minimal risk to the privacy of individuals. We queried the hospital's electronic medical records from April 1st to May 30th 2020, to identify patients with laboratory-confirmed COVID-19 ( Figure 1 In the stratified analysis, a nonsignificant higher odds for composite cardiovascular end-point was found among older patients, male patients and those with uncontrolled DM (Tables 2 and 3 ).

In this study, DM was associated with worse cardiovascular outcomes, including composite cardiovascular end-point, acute heart failure and new-onset atrial fibrillation. Cardiovascular complications in COVID-19 is thought to be related to direct myocardial injury, microvascular damage, cellular hypoxia and cytokine release. 5 The role of innate im- demonstrated to exhibit severe immune response when infected with COVID-19. 6 We speculate that the inflammatory response associated with DM could explain the worse cardiovascular outcomes, among other possible explanations such as increased comorbidities and decreased utilization of life-saving medications, as demonstrated in this study (Table 1) . Further research is needed to understand the disease process's pathophysiologic mechanisms in diabetics and to devise treatment strategies to mitigate complications. The study must be interpreted with caution as over 80% of our study population were African Americans, limiting our study results' generalizability. Also, the study population consisted predominantly of patients with uncontrolled DM, which might impact the study results.

Author and co-authors have no conflict of interest.

Abe Temidayo and Obiora Egbuche were involved in study conception, data acquisition, interpretation of results, and manuscript writing. Joseph Igwe, Opeyemi Jegede, Bivek Wagle were involved in data acquisition and statistical analysis. Titilope Olanipekun and Anekwe Onwuanyi were engaged in the critical review.

The data that support this study's findings are available on request from the corresponding author [T.A]. The data are not publicly available due to them containing sensitive information that could compromise participant privacy.

Temidayo Abe https://orcid.org/0000-0001-8371-2000

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