Cardiovascular risk factors such as hypertension, smoking, obesity, heart disease and diabetes are associated with worse outcomes in patients with Covid-19 but are potentially modifiable, according to new research.

The study study published in European Heart Journal – Quality of Care and Clinical Outcomes, found that strategies which improve cardiovascular health may also improve outcomes for people following Covid-19.

Emerging evidence has suggested that Covid-19 patients with heart disease may be more likely to need hospitalisation or ventilation or die from Covid-19 compared to those without heart disease. Studies have also examined whether risk factors for cardiovascular disease such as high blood pressure and smoking may be linked with poor outcomes from Covid-19.

Further reading

Many reviews have been conducted to consolidate the research linking cardiovascular disease and Covid-19. The aim of this study, commissioned by Public Health England, was to discover what is the association between cardiovascular risk factors and outcomes for patients with Covid-19 and what is the impact of Covid-19 on cardiovascular health? 

The authors identified the highest quality reviews – a total of 32 reviews including studies of up to ~45,000 patients with Covid-19. For each risk factor and heart problem the researchers selected the best quality, most recent, and largest analysis.

Promoting heart health may be another way to improve outcomes for Covid-19 patients

The factors associated with a higher likelihood of worse outcomes from Covid-19 were high blood pressure, current or past smoking, obesity, diabetes, previous stroke or pre-existing cardiovascular disease, liver disease, and kidney disease. To take some examples, obesity, diabetes, high blood pressure and heart disease were associated with more than doubled odds of dying from Covid-19. Heart disease was linked with a nearly four-fold odds of severe Covid-19, while the odds were more than doubled for hypertension and diabetes, and 80% higher in smokers compared to non-smokers.

Study author Dr Stephanie Harrison of the University of Liverpool, UK, said: “One possible explanation may be that cardiovascular disease, or its risk factors, may cause changes to pathways which impact the body’s ability to effectively respond to the virus.”

She noted that the research was based on observational studies, meaning that it suggests relationships but cannot confirm causality. In addition, there was limited or no evidence to determine connections between alcohol consumption, cholesterol levels, irregular heart rhythms, diet, physical activity or dementia and Covid-19 outcomes.

The reviews also found that in patients hospitalised with Covid-19, the following cardiovascular complications occurred: venous thromboembolism (25% of patients), pulmonary embolism (19%), arrhythmias (18%), myocardial injury (10%), angina (10%), deep vein thrombosis (7%), myocardial infarction (4%) and acute heart failure (2%).

Dr Harrison added: “Early in the pandemic, concerns were raised about the potential for Covid-19 to cause cardiovascular complications or exacerbate existing heart disease because of prior knowledge from influenza epidemics and outbreaks of other respiratory viruses. These findings suggest that these initial concerns were correct.

Our study indicates that Covid-19 patients with heart disease or its risk factors are at greater risk of hospitalisation, ventilation or death due to Covid-19 and might need more intense treatment and monitoring. Promoting heart health may be another way to improve outcomes for Covid-19 patients. More research is needed on the long-term impact of Covid-19 on the heart.”

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