William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
Heart. 2022 Dec 22;109(2):119-126. doi: 10.1136/heartjnl-2022-321492.
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.
目的:在 2020 年 3 月至 2021 年期间,在英国生物库的 17871 例病例中,研究 COVID-19 与心血管事件的关联。
方法:通过健康记录关联来定义 COVID-19 病例。每个病例均与未感染的对照病例按年龄、性别、贫困程度、体重指数、种族、糖尿病、缺血性心脏病(IHD)、吸烟、高血压和高胆固醇进行倾向评分匹配。我们纳入了以下事件结局:心肌梗死、中风、心力衰竭、心房颤动、静脉血栓栓塞症(VTE)、心包炎、全因死亡、心血管死亡、IHD 死亡。使用 Cox 比例风险回归来估计 COVID-19 与平均 141 天(范围 32-395)前瞻性随访期间每个结局的关联。
结果:非住院病例(n=14304)的新发 VTE(HR 2.74(95%CI 1.38 至 5.45),p=0.004)和死亡(HR 10.23(95%CI 7.63 至 13.70),p<0.0001)风险增加。因 COVID-19 住院的患者(n=2701)有所有考虑结局的风险增加。最大的效应大小与 VTE(HR 27.6(95%CI 14.5 至 52.3);p<0.0001)、心力衰竭(HR 21.6(95%CI 10.9 至 42.9);p<0.0001)和中风(HR 17.5(95%CI 5.26 至 57.9);p<0.0001)有关。那些因 COVID-19 作为次要诊断住院的患者(n=866)也有类似的心血管风险增加。感染后 30 天内的风险最高,但即使在此期间,风险仍高于对照组。
结论:因 COVID-19 住院的患者有一系列疾病和死亡率结局的心血管事件风险增加。大多数事件的风险在感染后的早期最高。不需要住院的患者 VTE 风险增加,但其他心血管特定结局的风险没有增加。
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