In a recent study published on the Research Square* preprint server, researchers examined the contribution of lifestyle and genetic factors to the risk of cardiovascular and thromboembolic events (CVEs) after coronavirus disease 2019 (COVID-19). .
Study: Contribution of genetics and lifestyle to the risk of major cardiovascular and thromboembolic complications after COVID-19. Image Credit: cool attention / Shutterstock
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Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and cardiovascular morbidity and mortality have recently increased due to the COVID-19 pandemic. Prevention of CVE is crucial during the treatment of COVID-19. However, it is challenging to identify people at risk for intensive surveillance and targeted prophylaxis.
Although prophylactic anticoagulation is recommended for hospitalized patients with COVID-19, there is conflicting evidence for its use in more critically ill patients and outpatients with mild COVID-19. General risk factors can help inform clinical practice, but they are not specific to CVD risk. Alternatively, the sum of the genetic risk for a given trait, the polygenic risk score (PRS), has been proposed for cardiovascular risk stratification.
About the study
In the present study, the researchers evaluated the association between lifestyle risk factors, PRS, and the risk of CVE within 90 days of COVID-19. They enrolled participants with COVID-19 between March 2020 and September 2021 from the United Kingdom (UK) Biobank. Participants lacking baseline data on age, gender, body mass index, socioeconomic status, genotyping, and lifestyle factors were excluded.
The team used standard PRS for coronary artery disease (CAD), ischemic stroke (ISS), venous thromboembolic disease (VTE), and atrial fibrillation (AF) in the primary analysis. A composite healthy lifestyle index was defined by aggregating data on smoking, physical activity, alcohol consumption, duration of sleep and television viewing, and intake of fruit/vegetables, oily fish, red meat, and processed meat.
The team used the Cox proportional hazards model to examine the association between the PRS and the corresponding CVE outcomes (AF, CAD, VTE, and ISS). Hazard ratios and associated 95% confidence intervals were derived after adjusting for sex, age, educational level, multiple deprivation index (MDI), genotyping batch, and the first ten principal components of genetic ancestry.
A multivariable Cox regression model was used for the overall cohort for lifestyle factors and across all PRS categories. The combined effect of lifestyle and genetics was estimated on CVE results statistically associated with lifestyle and genetic factors. Finally, several sensitivity analyzes were also performed.
recommendations
The researchers identified 25,335 people with COVID-19 from the UK Biobank eligible for inclusion. The mean age of the participants was 65.9; the majority were white (84.6%) and female (52.7%). Overall, 8.6% of the COVID-19 cohort had an unhealthy lifestyle according to the Composite Lifestyle Index, with prevalence ranging from 10.8% for smoking to 48.5%. for the low intake of oily fish.
Post-COVID-19, 422 AF (1.67%), 135 VTE (0.53%), 244 CAD (0.96%), and 29 ISS (0.12%) events were recorded in a period of 90 days. The incidence rate was estimated to be 6.12, 28, 48.5, and 86.9 per 1000 person-years for ISS, VTE, CAD, and FA, respectively. A higher PRS for FA, VTE, or CAD was associated with an elevated risk of CVE post-COVID-19.
There was a dramatic increase in CVE results in the first 15 to 30 days after COVID-19. Participants with the highest genetic risk showed a significantly higher incidence of CVE after COVID-19 than those with low genetic risk. People who followed a healthy lifestyle had a significantly lower risk of CAD, AF, and ISS in the 90 days after COVID-19 than those with an unhealthy lifestyle; this association was absent for post-COVID-19 VTE.
About 5.86% of ISS, 2.95% of CAD, and 2.46% of AF could have been avoided if COVID-19 patients with unhealthy lifestyles had switched to healthy lifestyles. In particular, no significant interactions between lifestyle and genetic factors were found for any CVE outcome. Nonetheless, the team noted the additive effect of high genetic risk and unhealthy lifestyles on the increased risk of CAD and AF after COVID-19. In general, sensitivity analyzes yielded results consistent with the primary analysis.
conclusions
The researchers observed that a higher PRS-based genetic risk for CVE outcomes was associated with a higher incidence of CVE post-COVID-19. A healthy lifestyle among COVID-19 patients substantially reduces the risk of arterial events. Of note, around 11.4% of CVE results could have been prevented if participants with unhealthy lifestyles followed a healthier lifestyle.
Taken together, the study found that genetic predisposition to CVE was associated with short-term risk of post-COVID-19 AF, CAD, and VTE, but not ISS, and that healthier lifestyles may reduce cardio load.
*Important news
Research Square publishes preliminary scientific reports that are not peer-reviewed and therefore should not be considered conclusive, guide clinical practice or health-related behavior, or treated as established information.
Source: news.google.com