Objective Previous studies that evaluated cardiovascular risk factors considered age as a potential confounder. We aimed to investigate the impact of cardiovascular disease (CVD) and its risk factors on fatal outcomes according to age in patients with COVID-19.
Methods A systematic literature review and meta-analysis was performed on data collected from PubMed and Embase databases up to 11 June 2020. All observational studies (case series or cohort studies) that assessed in-hospital patients were included, except those involving the paediatric population. Prevalence rates of comorbid diseases and clinical outcomes were stratified by mean patient age in each study (ranges: <50 years, 50–60 years and ≥60 years). The primary outcome measure was a composite fatal outcome of severe COVID-19 or death.
Results We included 51 studies with a total of 48 317 patients with confirmed COVID-19 infection. Overall, the relative risk of developing severe COVID-19 or death was significantly higher in patients with risk factors for CVD (hypertension: OR 2.50, 95% CI 2.15 to 2.90; diabetes: 2.25, 95% CI 1.89 to 2.69) and CVD (3.11, 95% 2.55 to 3.79). Younger patients had a lower prevalence of hypertension, diabetes and CVD compared with older patients; however, the relative risk of fatal outcomes was higher among the former.
Conclusions The results of the meta-analysis suggest that CVD and its risk factors (hypertension and diabetes) were closely related to fatal outcomes in COVID-19 for patients across all ages. Although young patients had lower prevalence rates of cardiovascular comorbidities than elderly patients, relative risk of fatal outcome in young patients with hypertension, diabetes and CVD was higher than in elderly patients.
Prospero registration number CRD42020198152.
- cardiac risk factors and prevention
- quality and outcomes of care
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Contributors SAB, SRK, M-NK and S-MP conceived the idea of the study. SAB and S-MP screened the studies and performed data extraction. SAB performed the statistical analysis, and S-MP supervised the analysis. SAB, S-MP, SRK, M-NK and WJS interpreted the findings. SAB drafted the manuscript; S-MP critically reviewed the manuscript, and SAB revised the manuscript for final submission. All authors have approved the final draft of the manuscript. S-MP and SAB are guarantors. S-MP accepts full responsibility for the work and conduct of the study, has access to the data and controls the decision to publish. The corresponding author attests that all listed authors meet the authorship criteria and that no others meeting the criteria have been omitted.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Additional data are available from the corresponding author on reasonable request.
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