The initial nationwide cohort study aimed to assess the risk of cardiovascular outcomes in East Asian populations by comparing COVID-19 and non-COVID-19 pneumonia. Leveraging the Korean National Health Insurance Service (NHIS) database, the research explored whether COVID-19 hospitalization correlated with incident cardiovascular outcomes compared to non-COVID-19 pneumonia hospitalization. Surprisingly, patients hospitalized with COVID-19 did not exhibit an increased risk of cardiovascular outcomes in contrast to those with non-COVID-19 pneumonia.
Previous investigations of the risk of cardiovascular outcomes in the post-acute stage of COVID-19 in hospitalized patients were limited by inadequate risk adjustment for preexisting cardiovascular disease. The investigation searched for the risk of cardiovascular outcomes among those who survived acute COVID-19 hospitalization. A cohort of hospitalized patients with non-COVID-19 pneumonia was used as a historical comparison group. COVID-19 has claimed numerous lives, and researchers are conducting studies to prevent further loss.
Upon statistical weighting, the study included 125,810 COVID-19 patients (mean [SD] age, 47.2 [17.6] years; men, 49.3%) and 28,492 non-COVID-19 pneumonia patients (mean [SD] age, 48.6 [18.4] years; men, 47.2%). COVID-19 hospitalization did not show an increased risk of Major Adverse Cardiovascular Events (MACE) (Hazard Ratio [HR], 0.84; 95% Confidence Interval [CI] 0.69–1.03). However, patients aged 18–39 with COVID-19 displayed significantly elevated risks of MACE (HR, 7.30; 95% CI 3.29–16.21), dysrhythmia (HR, 1.88; 95% CI 1.04–3.42), acute myocarditis (HR, 11.33; 95% CI 2.97–43.20), myocardial infarction (HR, 6.78; 95% CI 3.03–15.15), congestive heart failure (HR, 1.95; 95% CI 1.37–2.77), and thrombotic disease (HR, 8.26; 95% CI 4.06–16.83).
A press release held for the study emphasized that “younger COVID-19 patients, especially those without cardiovascular risk factors, showed elevated risks of cardiovascular complications, implying that COVID-19 may be an independent risk factor in this subgroup.”1
3 Key Takeaways
The study, leveraging the Korean National Health Insurance Service (NHIS) database, reveals that patients hospitalized with COVID-19 did not exhibit an increased risk of cardiovascular outcomes compared to those with non-COVID-19 pneumonia.
Despite the overall lack of increased cardiovascular risk, a notable exception was observed in younger COVID-19 patients aged 18–39. This subgroup displayed significantly elevated risks of Major Adverse Cardiovascular Events (MACE), dysrhythmia, acute myocarditis, myocardial infarction, congestive heart failure, and thrombotic disease.
Dr. Kim and the researchers suggest that vaccination, especially for patients with preexisting cardiovascular disease, may help in reducing the risks associated with COVID-19.
COVID-19 patients admitted to hospitals are more likely to be younger, male, possess fewer comorbidities, have higher income, and be admitted to higher volume hospitals. The risk of acute myocarditis was notably higher in COVID-19 patients without cardiovascular risk factors, those with fewer comorbidities, less organ dysfunction, and those experiencing mild to moderate illness. Interestingly, male patients had a higher Hazard Ratio (HR) for acute myocarditis than female patients. Regarding thrombotic disease, the risk was notably higher in female COVID-19 patients without cardiovascular risk factors, fewer comorbidities, less organ dysfunction, and mild to moderate illness.
“Previous studies that assessed the risk of cardiovascular outcomes after COVID-19 selected general hospital admission as controls, neglecting the potential cardiovascular risks following non-COVID-19 pneumonia hospitalization. Won-Young Kim, PhD, MS, BSc, stated, “In addition, the demographic composition of previous studies (based on mostly White and older male populations) may limit the generalizability of the results.”2
The study design incorporated a weighted control group of patients hospitalized with non-COVID-19 pneumonia, considering proinflammatory changes linked to pneumonia that might contribute to cardiovascular risk. This challenges prior research that compared outcomes after COVID-19 and general hospital admission without accounting for the severity of pneumonia.
However, the study acknowledges several limitations, including its retrospective observational design, potential unmeasured confounders, limitations in the accuracy of ICD-10 codes, and the exclusion of vital signs and laboratory data. Additionally, the increased risk of acute myocarditis in COVID-19 patients may be influenced by increased medical care after SARS-CoV-2 infection, and the study did not assess the impact of different SARS-CoV-2 variants on cardiovascular outcomes.
"Our results suggest that COVID-19 vaccination may prevent cardiovascular outcomes.” Kim emphasizes, “This supports vaccination, especially for patients with preexisting cardiovascular disease.” 2
Kim and the researchers in this study underscore the importance of vaccination efforts in protecting vulnerable populations. Furthermore, additional research is warranted to determine whether the elevated risk of cardiovascular outcomes is specific to younger patients, addressing current gaps in knowledge.
References
Lee, MT., Baek, M.S., Kim, T.W. et al. Cardiovascular outcomes between COVID-19 and non-COVID-19 pneumonia: a nationwide cohort study. BMC. Med 21, 394 (2023).
Lee MT, Baek MS, Kim TW, Jung SY, Kim WY. Chung-Ang University Study Looks at Cardiovascular Risks in COVID-19 Survivors. Published December 27, 2023. Accessed January 15, 2024. https://neweng.cau.ac.kr/cms/FR_CON/BoardView.do?MENU_ID=920&CONTENTS_NO=&SITE_NO=3&BOARD_SEQ=14&BOARD_CATEGORY_NO=&BBS_SEQ=117#;
