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Cardiovascular comorbidities increase COVID-19 mortality risk

Cardiology – July 2020 digest

Systematic review and meta-analysis finds greater risk of in-hospital mortality in COVID-19 patients with cardiovascular disease and cardiac injury.

Li X, Guan B, Su T et al (2020) Impact of cardiovascular disease and cardiac injury on in-hospital mortality in patients with COVID-19: a systematic review and meta-analysis. Heart 27 May [epub ahead of print]

  • COVID-19 results in significant morbidity and mortality. Underlying cardiovascular disease is associated with a greater risk of severe symptoms and admission to intensive care.
  • COVID-19 attacks the respiratory system, targeting angiotensin-converting enzyme II, and can result in elevated cardiac troponin levels in hospitalised patients. As this enzyme is expressed in the cardiovascular system, COVID-19 may cause incident cardiac injury. The authors wanted to examine the association between underlying cardiovascular disease and incident cardiac injury with mortality risk.
  • A systematic review was performed of publications on PubMed, Embase and Web of Science reporting the relationship of underlying hypertension, cardiovascular disease and myocardial injury with death in patients hospitalised with COVID-19.
  • Odds ratios from meta-analysis of 10 studies – seven for hypertension, eight for cardiovascular disease and eight for acute cardiac injury – were extracted and pooled.
  • Unadjusted odds ratios (ORs) showed that all three comorbidities increased the risk of in-hospital mortality: acute cardiac injury (unadjusted OR 21.15), hypertension (unadjusted OR 3.67) and cardiovascular disease (unadjusted OR 4.85).
  • Underlying cardiovascular comorbidities may increase the risk of death in patients with COVID-19 and acute cardiac injury may act as a marker of mortality risk. The authors propose that early recognition of patients with established cardiovascular disease and acute myocardial injury is warranted and elevated troponin be considered an important predictor of mortality risk.

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