The relationship of COVID-19 severity with cardiovascular disease and its traditional risk factors: A systematic review and meta-analysis

Kunihiro Matsushita; Ning Ding; Minghao Kou; Xiao Hu; Mengkun Chen; Yumin Gao; Yasuyuki Honda; David Dowdy; Yejin Mok; Junichi Ishigami; Lawrence J Appel

To our knowledge, this is the first systematic review and meta-analysis focusing on the relationship of severe COVID-19 with CVD and its risk factors. We confirmed a robust association of age and male sex with severe COVID-19. Their contributions are likely to be independent of each other. A few studies demonstrated positive associations of current smoking with severe COVID-19. Several studies reported that pre-existing CVD, hypertension, and diabetes were also associated with severe COVID-19. However, only two studies that reported estimates for these comorbidities adjusted for age and/or sex. One study found that the association between coronary heart disease and severe COVID-19 was no longer statistically significant after age adjustment, 25 whereas the other showed independent associations of hypertension and diabetes with severe COVID-19 in analyses that adjusted for age and a few other comorbidities. 17 Although the primary estimate was not statistically significant, our metaregression analyses indicated some degree of confounding by age, but not necessarily by sex, for the associations of hypertension, diabetes, and prior CVD with severe COVID-19.