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Risk of cardiovascular events following COVID-19 in people with and without pre-existing chronic respiratory disease

Hannah Whittaker, Constantinos Kallis, Thomas Bolton, Angela Wood Orcid Logo, Samantha Walker, Aziz Sheikh, Alex Brownrigg, Ashley Akbari Orcid Logo, Kamil Sterniczuk, Jennifer K Quint, (CVD-COVID-UK/COVID-IMPACT Consortium)

International Journal of Epidemiology, Volume: 53, Issue: 3

Swansea University Author: Ashley Akbari Orcid Logo

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DOI (Published version): 10.1093/ije/dyae068

Abstract

BackgroundCOVID-19 is associated with cardiovascular outcomes in the general population, but it is unknown whether people with chronic respiratory disease (CRD) have a higher risk of cardiovascular events post-COVID-19 compared with the general population and, if so, what respiratory-related factors...

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Published in: International Journal of Epidemiology
ISSN: 0300-5771 1464-3685
Published: Oxford University Press (OUP) 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa71178
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Adjusted Cox proportional hazard regression was used to quantify the association between CRD, asthma-related factors, chronic obstructive pulmonary disease (COPD)-related factors, and risk of cardiovascular events. Asthma-specific factors included baseline asthma control, exacerbations, and inhaled corticosteroid (ICS) dose. COPD-specific risk factors included baseline ICS and exacerbations. Secondary objectives quantified the impact of COVID-19 hospitalisation and vaccine dose on cardiovascular outcomes.ResultsOf 3&#x200A;670&#x200A;455 people, those with CRD had a higher risk of cardiovascular events [adjusted hazard ratio (HRadj), 1.08; 95% confidence interval (CI) 1.06&#x2013;1.11], heart failure (HRadj, 1.17; 95% CI, 1.12&#x2013;1.22), angina (HRadj, 1.13; 95% CI, 1.06&#x2013;1.20) and pulmonary emboli (HRadj, 1.24; 95% CI, 1.15&#x2013;1.33) compared with people without CRD. In people with asthma or COPD, baseline exacerbations were associated with a higher risk of cardiovascular outcomes (HRadj, 1.36; 95% CI, 1.27&#x2013;1.00 and HRadj, 1.35; 95% CI, 1.24&#x2013;1.46, respectively). Regardless of CRD, the risk of cardiovascular events was lower with increasing COVID-19 vaccine dose.ConclusionsHigher risk of cardiovascular events post-COVID-19 might be explained by the underlying severity of the CRD, and COVID-19 vaccines were beneficial to both people with and those without CRD with regards to cardiovascualr events.</abstract><type>Journal Article</type><journal>International Journal of Epidemiology</journal><volume>53</volume><journalNumber>3</journalNumber><paginationStart/><paginationEnd/><publisher>Oxford University Press (OUP)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0300-5771</issnPrint><issnElectronic>1464-3685</issnElectronic><keywords/><publishedDay>7</publishedDay><publishedMonth>6</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-06-07</publishedDate><doi>10.1093/ije/dyae068</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>The British Heart Foundation Data Science Centre (grant No SP/19/3/34678), awarded to Health Data Research (HDR) UK funded co-development (with NHS England) of the Secure Data Environment service for England, provision of linked data sources, data access, user software licences, computational usage, data management and wrangling support, with additional contributions from the HDR UK Data and Connectivity component of the UK Government Chief Scientific Adviser&#x2019;s National Core Studies programme to coordinate national COVID-19 priority research. Consortium partner organizations funded the time of contributing data analysts, biostatisticians, epidemiologists and clinicians. This research is part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant ref: MC_PC_20058).</funders><projectreference/><lastEdited>2026-01-16T16:39:11.1590509</lastEdited><Created>2025-12-29T15:43:55.4752423</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Hannah</firstname><surname>Whittaker</surname><order>1</order></author><author><firstname>Constantinos</firstname><surname>Kallis</surname><order>2</order></author><author><firstname>Thomas</firstname><surname>Bolton</surname><order>3</order></author><author><firstname>Angela</firstname><surname>Wood</surname><orcid>0000-0002-7937-304x</orcid><order>4</order></author><author><firstname>Samantha</firstname><surname>Walker</surname><order>5</order></author><author><firstname>Aziz</firstname><surname>Sheikh</surname><order>6</order></author><author><firstname>Alex</firstname><surname>Brownrigg</surname><order>7</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>8</order></author><author><firstname>Kamil</firstname><surname>Sterniczuk</surname><order>9</order></author><author><firstname>Jennifer K</firstname><surname>Quint</surname><order>10</order></author><author><firstname>(CVD-COVID-UK/COVID-IMPACT</firstname><surname>Consortium)</surname><order>11</order></author></authors><documents><document><filename>71178__36027__75d78a817256435c969c8a3dded2d163.pdf</filename><originalFilename>71178.VoR.pdf</originalFilename><uploaded>2026-01-16T16:36:01.5406155</uploaded><type>Output</type><contentLength>1572709</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>Copyright: The Author(s) 2024. 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spelling 2026-01-16T16:39:11.1590509 v2 71178 2025-12-29 Risk of cardiovascular events following COVID-19 in people with and without pre-existing chronic respiratory disease aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 2025-12-29 MEDS BackgroundCOVID-19 is associated with cardiovascular outcomes in the general population, but it is unknown whether people with chronic respiratory disease (CRD) have a higher risk of cardiovascular events post-COVID-19 compared with the general population and, if so, what respiratory-related factors may modify this risk in these people.MethodsPrimary and secondary care data from the National Health Service England were used to define a population of adults in England with COVID-19 (index date) between 1 January 2020 and 30 November 2021. Adjusted Cox proportional hazard regression was used to quantify the association between CRD, asthma-related factors, chronic obstructive pulmonary disease (COPD)-related factors, and risk of cardiovascular events. Asthma-specific factors included baseline asthma control, exacerbations, and inhaled corticosteroid (ICS) dose. COPD-specific risk factors included baseline ICS and exacerbations. Secondary objectives quantified the impact of COVID-19 hospitalisation and vaccine dose on cardiovascular outcomes.ResultsOf 3 670 455 people, those with CRD had a higher risk of cardiovascular events [adjusted hazard ratio (HRadj), 1.08; 95% confidence interval (CI) 1.06–1.11], heart failure (HRadj, 1.17; 95% CI, 1.12–1.22), angina (HRadj, 1.13; 95% CI, 1.06–1.20) and pulmonary emboli (HRadj, 1.24; 95% CI, 1.15–1.33) compared with people without CRD. In people with asthma or COPD, baseline exacerbations were associated with a higher risk of cardiovascular outcomes (HRadj, 1.36; 95% CI, 1.27–1.00 and HRadj, 1.35; 95% CI, 1.24–1.46, respectively). Regardless of CRD, the risk of cardiovascular events was lower with increasing COVID-19 vaccine dose.ConclusionsHigher risk of cardiovascular events post-COVID-19 might be explained by the underlying severity of the CRD, and COVID-19 vaccines were beneficial to both people with and those without CRD with regards to cardiovascualr events. Journal Article International Journal of Epidemiology 53 3 Oxford University Press (OUP) 0300-5771 1464-3685 7 6 2024 2024-06-07 10.1093/ije/dyae068 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee The British Heart Foundation Data Science Centre (grant No SP/19/3/34678), awarded to Health Data Research (HDR) UK funded co-development (with NHS England) of the Secure Data Environment service for England, provision of linked data sources, data access, user software licences, computational usage, data management and wrangling support, with additional contributions from the HDR UK Data and Connectivity component of the UK Government Chief Scientific Adviser’s National Core Studies programme to coordinate national COVID-19 priority research. Consortium partner organizations funded the time of contributing data analysts, biostatisticians, epidemiologists and clinicians. This research is part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant ref: MC_PC_20058). 2026-01-16T16:39:11.1590509 2025-12-29T15:43:55.4752423 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Hannah Whittaker 1 Constantinos Kallis 2 Thomas Bolton 3 Angela Wood 0000-0002-7937-304x 4 Samantha Walker 5 Aziz Sheikh 6 Alex Brownrigg 7 Ashley Akbari 0000-0003-0814-0801 8 Kamil Sterniczuk 9 Jennifer K Quint 10 (CVD-COVID-UK/COVID-IMPACT Consortium) 11 71178__36027__75d78a817256435c969c8a3dded2d163.pdf 71178.VoR.pdf 2026-01-16T16:36:01.5406155 Output 1572709 application/pdf Version of Record true Copyright: The Author(s) 2024. This is an Open Access article distributed under the terms of the Creative Commons Attribution License. true eng https://creativecommons.org/licenses/by/4.0/)
title Risk of cardiovascular events following COVID-19 in people with and without pre-existing chronic respiratory disease
spellingShingle Risk of cardiovascular events following COVID-19 in people with and without pre-existing chronic respiratory disease
Ashley Akbari
title_short Risk of cardiovascular events following COVID-19 in people with and without pre-existing chronic respiratory disease
title_full Risk of cardiovascular events following COVID-19 in people with and without pre-existing chronic respiratory disease
title_fullStr Risk of cardiovascular events following COVID-19 in people with and without pre-existing chronic respiratory disease
title_full_unstemmed Risk of cardiovascular events following COVID-19 in people with and without pre-existing chronic respiratory disease
title_sort Risk of cardiovascular events following COVID-19 in people with and without pre-existing chronic respiratory disease
author_id_str_mv aa1b025ec0243f708bb5eb0a93d6fb52
author_id_fullname_str_mv aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
author Ashley Akbari
author2 Hannah Whittaker
Constantinos Kallis
Thomas Bolton
Angela Wood
Samantha Walker
Aziz Sheikh
Alex Brownrigg
Ashley Akbari
Kamil Sterniczuk
Jennifer K Quint
(CVD-COVID-UK/COVID-IMPACT Consortium)
format Journal article
container_title International Journal of Epidemiology
container_volume 53
container_issue 3
publishDate 2024
institution Swansea University
issn 0300-5771
1464-3685
doi_str_mv 10.1093/ije/dyae068
publisher Oxford University Press (OUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description BackgroundCOVID-19 is associated with cardiovascular outcomes in the general population, but it is unknown whether people with chronic respiratory disease (CRD) have a higher risk of cardiovascular events post-COVID-19 compared with the general population and, if so, what respiratory-related factors may modify this risk in these people.MethodsPrimary and secondary care data from the National Health Service England were used to define a population of adults in England with COVID-19 (index date) between 1 January 2020 and 30 November 2021. Adjusted Cox proportional hazard regression was used to quantify the association between CRD, asthma-related factors, chronic obstructive pulmonary disease (COPD)-related factors, and risk of cardiovascular events. Asthma-specific factors included baseline asthma control, exacerbations, and inhaled corticosteroid (ICS) dose. COPD-specific risk factors included baseline ICS and exacerbations. Secondary objectives quantified the impact of COVID-19 hospitalisation and vaccine dose on cardiovascular outcomes.ResultsOf 3 670 455 people, those with CRD had a higher risk of cardiovascular events [adjusted hazard ratio (HRadj), 1.08; 95% confidence interval (CI) 1.06–1.11], heart failure (HRadj, 1.17; 95% CI, 1.12–1.22), angina (HRadj, 1.13; 95% CI, 1.06–1.20) and pulmonary emboli (HRadj, 1.24; 95% CI, 1.15–1.33) compared with people without CRD. In people with asthma or COPD, baseline exacerbations were associated with a higher risk of cardiovascular outcomes (HRadj, 1.36; 95% CI, 1.27–1.00 and HRadj, 1.35; 95% CI, 1.24–1.46, respectively). Regardless of CRD, the risk of cardiovascular events was lower with increasing COVID-19 vaccine dose.ConclusionsHigher risk of cardiovascular events post-COVID-19 might be explained by the underlying severity of the CRD, and COVID-19 vaccines were beneficial to both people with and those without CRD with regards to cardiovascualr events.
published_date 2024-06-07T05:32:18Z
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score 11.098786

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