Cardiovascular disease and mortality sequelae of COVID-19 in the UK Biobank
Cardiovascular disease and mortality sequelae of COVID-19 in the UK Biobank
Objective To examine association of COVID-19 with incident cardiovascular events in 17 871 UK Biobank cases between March 2020 and 2021. Methods COVID-19 cases were defined using health record linkage. Each case was propensity score-matched to two uninfected controls on age, sex, deprivation, body mass index, ethnicity, diabetes, prevalent ischaemic heart disease (IHD), smoking, hypertension and high cholesterol. We included the following incident outcomes: Myocardial infarction, stroke, heart failure, atrial fibrillation, venous thromboembolism (VTE), pericarditis, all-cause death, cardiovascular death, IHD death. Cox proportional hazards regression was used to estimate associations of COVID-19 with each outcome over an average of 141 days (range 32-395) of prospective follow-up. Results Non-hospitalised cases (n=14 304) had increased risk of incident VTE (HR 2.74 (95% CI 1.38 to 5.45), p=0.004) and death (HR 10.23 (95% CI 7.63 to 13.70), p<0.0001). Individuals with primary COVID-19 hospitalisation (n=2701) had increased risk of all outcomes considered. The largest effect sizes were with VTE (HR 27.6 (95% CI 14.5 to 52.3); p<0.0001), heart failure (HR 21.6 (95% CI 10.9 to 42.9); p<0.0001) and stroke (HR 17.5 (95% CI 5.26 to 57.9); p<0.0001). Those hospitalised with COVID-19 as a secondary diagnosis (n=866) had similarly increased cardiovascular risk. The associated risks were greatest in the first 30 days after infection but remained higher than controls even after this period. Conclusions Individuals hospitalised with COVID-19 have increased risk of incident cardiovascular events across a range of disease and mortality outcomes. The risk of most events is highest in the early postinfection period. Individuals not requiring hospitalisation have increased risk of VTE, but not of other cardiovascular-specific outcomes.
COVID-19, epidemiology
119-126
Raisi-Estabragh, Zahra
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Cooper, Jackie
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Salih, Ahmed
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Raman, Betty
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Lee, Aaron Mark
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Neubauer, Stefan
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Harvey, Nicholas C
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Petersen, Steffen E
04f2ce88-790d-48dc-baac-cbe0946dd928
24 October 2022
Raisi-Estabragh, Zahra
43c85c5e-4574-476b-80d6-8fb1cdb3df0a
Cooper, Jackie
f78de577-4cac-496f-ad11-5f59dd305046
Salih, Ahmed
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Raman, Betty
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Lee, Aaron Mark
58a0fb9e-1bbe-4a73-bbcd-9103d4fa4fc6
Neubauer, Stefan
c8a34156-a4ed-4dfe-97cb-4f47627d927d
Harvey, Nicholas C
ce487fb4-d360-4aac-9d17-9466d6cba145
Petersen, Steffen E
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Raisi-Estabragh, Zahra, Cooper, Jackie, Salih, Ahmed, Raman, Betty, Lee, Aaron Mark, Neubauer, Stefan, Harvey, Nicholas C and Petersen, Steffen E
(2022)
Cardiovascular disease and mortality sequelae of COVID-19 in the UK Biobank.
Heart, 109 (2), , [321492].
(doi:10.1136/heartjnl-2022-321492).
Abstract
Objective To examine association of COVID-19 with incident cardiovascular events in 17 871 UK Biobank cases between March 2020 and 2021. Methods COVID-19 cases were defined using health record linkage. Each case was propensity score-matched to two uninfected controls on age, sex, deprivation, body mass index, ethnicity, diabetes, prevalent ischaemic heart disease (IHD), smoking, hypertension and high cholesterol. We included the following incident outcomes: Myocardial infarction, stroke, heart failure, atrial fibrillation, venous thromboembolism (VTE), pericarditis, all-cause death, cardiovascular death, IHD death. Cox proportional hazards regression was used to estimate associations of COVID-19 with each outcome over an average of 141 days (range 32-395) of prospective follow-up. Results Non-hospitalised cases (n=14 304) had increased risk of incident VTE (HR 2.74 (95% CI 1.38 to 5.45), p=0.004) and death (HR 10.23 (95% CI 7.63 to 13.70), p<0.0001). Individuals with primary COVID-19 hospitalisation (n=2701) had increased risk of all outcomes considered. The largest effect sizes were with VTE (HR 27.6 (95% CI 14.5 to 52.3); p<0.0001), heart failure (HR 21.6 (95% CI 10.9 to 42.9); p<0.0001) and stroke (HR 17.5 (95% CI 5.26 to 57.9); p<0.0001). Those hospitalised with COVID-19 as a secondary diagnosis (n=866) had similarly increased cardiovascular risk. The associated risks were greatest in the first 30 days after infection but remained higher than controls even after this period. Conclusions Individuals hospitalised with COVID-19 have increased risk of incident cardiovascular events across a range of disease and mortality outcomes. The risk of most events is highest in the early postinfection period. Individuals not requiring hospitalisation have increased risk of VTE, but not of other cardiovascular-specific outcomes.
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heartjnl-2022-321492.full
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Accepted/In Press date: 8 August 2022
e-pub ahead of print date: 24 October 2022
Published date: 24 October 2022
Additional Information:
Funding Information:
ZR-E recognises the National Institute for Health Research (NIHR) Integrated Academic Training programme which supports her Academic Clinical Lectureship post and was also supported by British Heart Foundation Clinical Research Training Fellowship No. FS/17/81/33318. AS was supported by a British Heart Foundation project grant (PG/21/10619). BR is funded by BHF Oxford CRE (RE/18/3/34214). Barts Charity (G-002346) contributed to fees required to access UK Biobank data (access application #2964). SEP acknowledges support from the NIHR Biomedical Research Centre at Barts. SEP has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no 825903 (euCanSHare project). SEP acknowledges support from the “SmartHeart” EPSRC programme grant (www.nihr.ac.uk; EP/P001009/1). SN is supported by the Oxford NIHR Biomedical Research Centre (IS-BRC-1215-20008) and the Oxford BHF Centre of Research Excellence. This project was enabled through access to the Medical Research Council (MRC) eMedLab Medical Bioinformatics infrastructure (www.mrc.ac.uk; MR/L016311/1). NCH acknowledges support from MRC (MC_PC_21003; MC_PC_21001) and NIHR Southampton Biomedical Research Centre. This work was supported by Health Data Research UK, an initiative funded by UK Research and Innovation, Department of Health and Social Care (England) and the devolved administrations, and leading medical research charities. The funders provided support in the form of salaries for authors as detailed above.
Publisher Copyright:
© 2023 Author(s). Published by BMJ.
Keywords:
COVID-19, epidemiology
Identifiers
Local EPrints ID: 471775
URI: http://eprints.soton.ac.uk/id/eprint/471775
ISSN: 1355-6037
PURE UUID: 17d8153f-ab0d-46fe-b60f-50b96c192985
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Date deposited: 18 Nov 2022 17:30
Last modified: 17 Mar 2024 02:59
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Contributors
Author:
Zahra Raisi-Estabragh
Author:
Jackie Cooper
Author:
Ahmed Salih
Author:
Betty Raman
Author:
Aaron Mark Lee
Author:
Stefan Neubauer
Author:
Steffen E Petersen
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