New CVD, Diabetes Diagnoses Spike, Then Diverge after COVID-19

The study covered in this summary was published on medRxiv.org as a preprint and has not yet been peer reviewed.

Key Takeaways

• New diabetes mellitus (DM) diagnoses increased in the first 4 weeks after COVID-19 diagnosis and remained elevated for up to 1 year following COVID. 

• New cardiovascular disease (CVD) diagnoses jumped in the first 4 weeks after COVID-19 diagnosis but returned to baseline levels by 1 year.

Why This Matters 

• Diabetes and CVD are associated with more severe illness from COVID-19.

• COVID-19 may lead to reduced physical activity and deconditioning, while reduced contacts with medical care may decrease opportunities to detect undiagnosed CVD and diabetes.

Study Design 

• This study was conducted using electronic records for 1473 family practices in the UK’s national Clinical Practice Research Datalink database.

• Multivariable Poisson models were used to estimate the incidence of DM and CVD during four periods: the 52 weeks before COVID-19 diagnosis and within 4 weeks of (acute), 5-12 weeks after (post-acute), and 13-52 weeks after (long COVID-19) diagnosis.

• A total of 372,816 matched pairs of COVID-19 cases and controls with no COVID-19 infection were included, with follow-up to October 2021.

Key Results 

• Patients were at slightly greater risk of CVD (11.44 vs 6.72 per 100,000 patient-weeks) and diabetes (13.73 vs 10.10 per 100,000 patient-weeks) than controls, even before the COVID-19 diagnosis.

• After adjustment, new DM diagnoses increased 1.7-fold (rate ratio [RR], 1.71) during acute COVID-19 and remained elevated during both post-acute (RR, 1.17) and long COVID-19 (RR, 1.20).

• New CVD events increased sixfold during acute COVID-19 (RR, 6.02) before declining during post-acute COVID-19 (RR, 1.68) and returning to baseline levels during long COVID-19 (RR, 0.95).

• The increase in CVD events was driven by pulmonary embolism (RR, 14.5), atrial arrhythmias (6.58), and venous thromboses (5.44), but myocardial infarction (3.53), heart failure (3.52), and stroke (2.16) were also increased.

Limitations

• This study drew on clinical records with several limitations, and important covariates were not always completely recorded.

• Both confirmed and suspected COVID-19 cases were included, although a sensitivity analysis restricted to polymerase chain reaction-confirmed (PCR) infections did not alter conclusions.

• PCR testing was associated with patient characteristics, and reliance on PCRconfirmation for participant selection might lead to bias.

• Analyses did not include measures of COVID-19 illness severity.

• Analyses did not include a measure of deprivation, which is associated with both diabetes and CVD, but cases and controls were matched for family practice.

• Data were lacking for secondary care prescribing, thus exposure to glucocorticoids might be underestimated.

• The observational nature of this study limits causal inferences.

Disclosures

• This study was supported by the UK National Institute for Health Research (NIHR).

• The authors acknowledge support by the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London (IS-BRC-1215-20006).

• The authors have declared no competing interests.

This is a summary of a preprint research study, “Differential impact of Covid-19 on incidence of diabetes mellitus and cardiovascular diseases in acute, post-acute and long Covid-19: population-based cohort study in the United Kingdom,” written by Emma Rezel-Potts from Kings College provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on medRxiv.org

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Cite this: New CVD, Diabetes Diagnoses Spike, Then Diverge After COVID-19 – Medscape – Dec 28, 2021.