Relationship between COVID-19 infection and Cardiovascular diseases (CVD) is complex and multifactorial in nature. In the early phase of pandemic, it was observed that individuals having comorbid conditions such as obesity, diabetes, hypertension and dyslipidemia are more susceptible to COVID-19 infection and are at a greater risk of developing severe consequences of the diseases. 1 On the other hand, presence of these comorbid conditions already indicates that they are already predisposed to heart diseases as these are well established risk factors of CVD and can complicate any other illness management including COVID-19. 2,3 Albeit there is a causality dilemma associated with CVD risk and COVID-19 infection outcome as numerous evidences now reports cardiovascular complications as sequelae of COVID-19. 4 This could be partly explained by the fact that physiological response of COVID-19 involves inflammation, endothelial dysfunction, and thrombosis all increasing risk of cardiac event. 5
Current cross-sectional study aims to present 10-years risk of CVD event in individuals having history of severe or non-severe COVID-19 infection. To the best of our knowledge till date no study has compared CVD risk profile of patients as per COVID severity in Indian population. From the community setting, 943 participants having history of RT-PCR confirmed COVID-19 infection were enrolled for the study after obtaining written consent. Participants who were above the age of 25 and not having any known CVD were included from two districts of Gujarat State, India. Out of 943, 824 (85.6%) had mild-moderate form of COVID infection and were recovered through medication with home isolation. However, 119 (14.4%) participants had severe infection and reported history of hospitalization for the management of the disease. The time between complete recovery from COVID-19 and enrollment for current study was 6-14 (median 10.2) months. Details of demographic, anthropometric, risk factors, COVID infection and management history, life style factors and blood sugar (HbA1C) and lipids levels, inflammation (Hs-CRP) marker and NT-proBNP levels were assessed in the participants at the time of enrollment for the study. These variables were compared (table 1) between patients recovered through home isolation (group 1; N=824; 85.6%) and patients who required hospitalization (group 2; N=119; 14.4%). QRISK3 algorithm was used to estimate 10-year risk of CVD in all the participants and above 20% QRISK score was used to define high risk CVD.
Demographic characteristics (age and gender) of the population was comparable between the groups. History of diabetes, hypertension, chronic kidney disease and premature CVD was present in 18.7%, 35.7%, 2.6% and 4.2% of the population respectively. After COVID-19, 16.5% new cases of hypertension were reported in group 1, which was slightly lower than the cases found in group 2 (18.5%). Significantly (p<0.05) higher systolic and diastolic blood pressure was noted in patients having history of hospitalization. However, in case of diabetes only few new patients were reported (2.3% vs 1.2% in group 1 and 2 respectively). Blood sugar level and various lipids were significantly (p<0.05) higher in group 1 as compared to group 2. Marker of inflammation (hs-CRP) and heart failure (NT-pro BNP), suggestive of potential cardiac damage were higher in hospitalized patients. Collectively this is reflected in 10-years CVD risk score of both the groups with 14% of the hospitalized patients having higher QRISK score (more than 20%; a threshold for pharmacological intervention) in contrast to only 5.9% in the home isolation group. The study clearly indicates that patients who recovered from severe COVID-19 infection have greater risk of CVD due to presence of variety of risk factors as compared to their counterparts having milder disease. This emphasizes the need of better risk management strategy and clinical attention towards the vulnerable population. However, the study could not resolve the causality dilemma associated with COVID-19 and CVD risk due to cross-sectional nature and suggest further research in the area.
Table 1: Comparison of anthropometric parameters, biochemical markers and 10-years CVD risk (QRISK score) in patients having history of COVID recovery through home isolation with hospitalized patients
|
Study participant groups
|
Mean
|
Std. Deviation
|
|
Systolic Blood Pressure (mm/Hg)*
|
Group 1
|
128.5
|
16.8
|
|
Group 2
|
132.7
|
20.2
|
|
Diastolic Blood Pressure (mm/Hg)
|
Group 1
|
82.3
|
10.5
|
|
Group 2
|
82.9
|
12.6
|
|
Height (cm)
|
Group 1
|
165.0
|
9.9
|
|
Group 2
|
164.5
|
8.7
|
|
Weight (kg)*
|
Group 1
|
72.3
|
13.9
|
|
Group 2
|
75.9
|
12.8
|
|
Mid Upper Arm Circumference (cm)*
|
Group 1
|
29.6
|
3.5
|
|
Group 2
|
30.7
|
3.3
|
|
Waist circumference (cm)*
|
Group 1
|
93.9
|
11.2
|
|
Group 2
|
99.0
|
11.7
|
|
Hip circumference (cm)*
|
Group 1
|
101.5
|
9.3
|
|
Group 2
|
104.7
|
10.1
|
|
Body Mass Index kg/m²*
|
Group 1
|
26.6
|
4.5
|
|
Group 2
|
28.1
|
4.7
|
|
Waist-to-Hip Ratio (cm)*
|
Group 1
|
0.9
|
0.1
|
|
Group 2
|
0.9
|
0.1
|
|
Waist-to-Height Ratio (cm)*
|
Group 1
|
0.6
|
0.1
|
|
Group 2
|
0.6
|
0.1
|
|
Random Blood Sugar (mg/dl)*
|
Group 1
|
105.0
|
22.5
|
|
Group 2
|
113.7
|
12.1
|
|
HbA1C (%)*
|
Group 1
|
6.1
|
1.3
|
|
Group 2
|
6.4
|
1.0
|
|
hs-CRP (mg/L)*
|
Group 1
|
0.2
|
0.2
|
|
Group 2
|
0.3
|
0.2
|
|
Total Cholesterol (mg/dL)*
|
Group 1
|
186.2
|
40.9
|
|
Group 2
|
194.8
|
45.2
|
|
Triglycerides (mg/dL)*
|
Group 1
|
171.2
|
101.1
|
|
Group 2
|
172.1
|
72.0
|
|
High Density Lipoprotein Cholesterol – HDL (mg/dL)*
|
Group 1
|
44.1
|
10.7
|
|
Group 2
|
42.8
|
9.5
|
|
Low Density Lipoprotein Cholesterol – LDL (mg/dL)*
|
Group 1
|
113.4
|
36.8
|
|
Group 2
|
128.1
|
42.0
|
|
Very Low Density Lipoprotein Cholesterol – VLDL (mg/dL)
|
Group 1
|
32.8
|
16.7
|
|
Group 2
|
35.3
|
14.6
|
|
Total Cholesterol/HDL ratio*
|
Group 1
|
4.4
|
1.2
|
|
Group 2
|
4.7
|
1.1
|
|
LDL/HDL Ratio*
|
Group 1
|
2.6
|
1.1
|
|
Group 2
|
3.1
|
1.1
|
|
Total lipid (mg/dL)*
|
Group 1
|
540.8
|
144.3
|
|
Group 2
|
573.0
|
141.6
|
|
Non-HDL Cholesterol (mg/dL)*
|
Group 1
|
141.3
|
40.6
|
|
Group 2
|
152.0
|
41.2
|
|
Nt-Pro BNP (pg/mL)*
|
Group 1
|
96.0
|
13.2
|
|
Group 2
|
129.0
|
23.1
|
|
QRISK3 Score*
|
Group 1
|
6.2
|
2.6
|
|
Group 2
|
12.1
|
5.9
|
*Statistically significant at the level of p<0.05. Group 1 – Home isolated COVID patients; Group 2 – Hospital admitted COVID patients
The work is supported through Grant-in-aid scheme of Department of Health Research, New Delhi, India. The authors herewith confirm that ethical approval of the study was obtained from Institutional Ethics Committee of Indian Institute of Public Health Gandhinagar.