Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China
Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China [published online ahead of print, 2020 Mar 11]. Clin Res Cardiol. 2020;1–8. doi:10.1007/s00392-020-01626-9
Review written by:
Tara Lucian, edited by Elizabeth Harty
To compile this meta-analysis, the researchers included studies from China between December 2019 and February 2020 that included more than 10 people each and looked at the prevalence or impact of cardiovascular and metabolic disease on COVID-19. Additionally, researchers compared ICU cases to non-ICU cases. In studies where cases were designated as severe or non-severe, those were equated with ICU and non-ICU, respectively.
Using data from three Chinese studies and 1278 patients, the researchers analyzed the prevalence of hypertension, diabetes, and cardiac-cerebrovascular disease among COVID-19 cases. The authors also describe the incidence of these comorbidities in ICU and non-ICU hospitalized patients. The prevalence of hypertension among COVID-19 patients in China is 17.1%, compared to 23.2% of the general population. The prevalence of diabetes in COVID-19 patients and general population were 9.7% and 10.9%, respectively. This suggests that hypertension and diabetes do not increase the risk of contracting COVID-19. The prevalence of cardiac-cerebrovascular disease among COVID-19 patients (16.4%) was higher than in the general population (number not reported), suggesting that it does increase the risk of COVID-19. All three conditions increase the risk of having a more severe case of COVID-19 by twofold, twofold and threefold, respectively.
Analysis of the impact of COVID-19 on cardiac injury was more limited due to less available data. The researchers analyzed two studies with a combined sample of 179 patients. The incidence of cardiac injury among this sample, determined by elevated levels of Troponin I/T, was 8%. The risk of cardiac injury for ICU/severe patients was 13 times the risk of cardiac injury for non-ICU/severe patients, but this estimate has a very wide confidence interval due to the low incidence and smaller sample size (RR: 13.48, 95% CI: 3.6, 50.47). If the definition of cardiac injury is expanded to include cases with elevated levels of creatine kinase (but without confirmation of cardiac injury), the incidence of cardiac injury increases to 11.5%, from a sample size of 1377 patients.
Final conclusions about cardiac injury are based on two of the six studies, with a sample size of 178 patients compared to the 1278 patients included in the other analyses. The authors note that the small sample size, limited time, and the lack of data on comorbidities hinder the ability to analyze the potential for association between cardiovascular metabolic disease and COVID-19 induced deaths. Furthermore, unexplained discrepant use of odds ratios and risk ratios reported in this paper raise questions about the exact magnitudes of the reported relationships, though not the direction of those relationships.