Risk factors for cardiovascular disease such as obesity, smoking and diabetes, rather than preexisting heart disease, are the main contributors to death and poor outcomes among critically ill COVID-19 patients, according to a study.
Patients with cardiovascular disease were found to have close to a 30 per cent higher mortality rate than critically ill COVID patients without the preexisting condition. However, when adjusted for risk factors -- including age, sex, race, smoking and others -- that relationship was no longer statistically significant.
"The fact that the association between cardiovascular disease and death was so heavily diminished when accounting for comorbidities suggests that cardiovascular risk factors rather than preexisting heart disease are the main contributors to in-hospital death in patients with severe COVID-19," said senior author Salim Hayek.
The team, led by researchers at the University of Michigan in the US, analysed outcomes for more than 5,100 patients admitted to intensive care units at 68 centers across the US with severe COVID between March and June of 2020.
Of those patients, 1,174 had either preexisting coronary artery disease, congestive heart failure or atrial fibrillation.
A total of 34.6 per cent of patients died within 28 days and nearly 18 per cent suffered a cardiovascular event, such as cardiac arrest or myocarditis.
Researchers say the association between such events and death did not differ between patients with and without preexisting heart disease.
The study, published in the journal Circulation: Cardiovascular Quality and Outcomes, found that the presence of myocardial injury was associated with cardiovascular events and death, regardless of whether a patient had preexisting heart disease.
Myocardial injury was common among patients in the ICU, occurring in nearly half of patients who had heightened levels of troponin, a protein released when the heart muscle is damaged.
Patients with the highest troponin measurements were nearly three times more likely to die than those without myocardial injury, the researchers said in a statement. "While patients with severe COVID commonly had signs of cardiac injury, our findings reinforce COVID-19 as a pulmonary disease with multi-organ injury related to systemic inflammation," Hayek said.
"The evidence of heart damage that we frequently see in patients with severe COVID-19 is more likely a reflection of the severity of the illness and the stress it imparts on all organs, rather than the development of new complications or the exacerbation of preexisting heart disease," he said.
The findings should not minimise the fact that patients with cardiovascular disease are still at risk for death due to COVID-19, as they have a high burden of risk factors for the disease, such as diabetes, hypertension and smoking, says co-first author Alexi Vasbinder.
We are currently working on studies to further define groups of patients with COVID-19 at highest risk for severe outcomes, such as those with advanced heart failure or coronary artery disease, Vasbinder said.
Cardiovascular disease is a common condition among patients who suffer severe COVID illness, given its prevalence among older adults and associated chronic inflammation.
In the study, age, obesity and diabetes were much stronger predictors of death due to COVID, the researchers added.
