Cardiovascular diseases are known to be the leading cause of death worldwide. Recently, cardiovascular morbidity and mortality have further increased due to the direct and indirect impact of the coronavirus disease 2019 (COVID-19) pandemic. The repercussions and long-term consequences of COVID-19 could lead to a further increase in cardiovascular load to abnormal levels.
Study: Contribution of genetics and lifestyle to the risk of major cardiovascular and thromboembolic complications after COVID-19. Image credit: peterschreiber.media/Shutterstock
Background
Prevention of life-threatening cardiovascular and thromboembolic events (CVEs) is important in treating COVID-19 patients on an individual level. However, accurately identifying individuals at sufficient risk that they might require high surveillance or specific pharmacological interventions is challenging.
General risk factors, such as age, obesity, and gender, have been reported to be important predictors of COVID-19 severity, hospitalization, and need for mechanical ventilation. However, they are not very effective in determining CVD risk. Polygenic risk scores (PRS), a sum of genetic risk for a specific trait, have been identified as an important tool for precision medicine and early categorization of cardiovascular risk. However, it is unknown whether genetic susceptibility to CVD will affect the occurrence of CVD associated with COVID-19 during periods of post-acute or acute illness.
Furthermore, effective public health interventions are required immediately to reduce the cardiovascular burden of the population, especially given the increase in COVID-19 infections following the removal of early restrictions. In 2022, the US Preventive Service Task Force updated its recommendations to promote healthy behavior counseling for all adults to prevent cardiovascular complications. However, all clinical and public health guidelines cannot determine the impact of healthy lifestyle modifications in reducing cardiovascular complications of COVID-19, mainly due to insufficient evidence.
A new study published on the medRxiv* preprint server aimed to analyze the association between lifestyle risk factors, PRS, and their interactions along with CVD risk within 90 days of COVID-19 diagnosis. .
About the study
The study involved UK Biobank participants who tested positive in a PCR test for COVID-19 between March 1, 2020 and September 30, 2021. The UK Biobank developed and validated two sets of PRS, standard and enhanced. PRS for ischemic stroke (ISS), coronary artery disease (CAD), venous thromboembolic disease (VTE), and atrial fibrillation (AF) was used in the primary analysis, while enhanced PRS was used in one of the analyses. In addition, continuous PRS was categorized into high risk, low risk, and intermediate risk.
A composite healthy lifestyle index was defined through a combination of nine lifestyle component data including alcohol consumption, smoking, time spent watching television, physical activity, oily fish consumption , the consumption of processed meat, the consumption of red meat, the consumption of fruits and vegetables. and the duration of sleep. Each lifestyle factor was assigned 0 points if it was healthy and 1 point if it was not. Subsequently, a sum of all the lifestyle factors was made, the scores ranging from 0 to 4 were categorized as healthy lifestyle, and those ranging from 5 to 9 were categorized as unhealthy lifestyle.
Finally, the date of the first COVID-19 infection was defined as the index date and the participants were followed for 90 days. An analysis of four main CVDs (VTE, CAD, AF and ISS) reported as cardiovascular complications related to COVID-19 was carried out. International Classification of Diseases, 10th Revision (ICD-10) codes similar to those used in the development of PRS were used to determine clinical outcomes.
Study Findings
The results indicated that the average age of the COVID-19 participants was 65.99 years, of which the majority were of white ethnicity and were women. The prevalence of the nine unhealthy lifestyle factors was found to range from 10.8% for smoking to 48.5% for low consumption of oily fish. Overall, a total of 8.6% of infected people were reported to be leading an unhealthy lifestyle.
Post-infection, 135 VTE, 29 ISS, 244 CAD, and 422 AF events were reported to have occurred during the follow-up period, accounting for 0.53%, 0.12%, 0.96% and 1.67% of the COVID-19 cohort, respectively. . The incidence rate was reported to be 6.12 per 1000 person-years for ISS, 86.9 for AF, 48.5 for CAD, and 28.0 for VTE.
Furthermore, a higher PRS for VTE, AF, or CVD was reported to be associated with an increased risk of CVE post-COVID-19. However, no association was observed between ISS-PRS and post-COVID-19 ISS. The overall association between VTE, CAD, and AF with each PRS was found to be similar despite differences in baseline risks. In addition, participants with higher genetic risk were reported to show a higher incidence of post-COVID-19 CVD.
People with healthier habits were found to have a lower risk of CAD, AF, and ISS, while no association with VTE was observed. The prevented fraction of CVD outcomes by changing to a healthy lifestyle was reported to be 5.86% for ISS, 2.95% for CAD, and 2.46% for AF. No interaction between lifestyle and genetic factors was observed for any CVD outcomes.
In addition, the results of the sensitivity analysis were found to be similar to those of the primary analysis. The scope of the PRS association was reduced for the sensitivity analysis of events related to hospital admission and incident events compared to estimates of events diagnosed after infection.
Therefore, the current study demonstrated that genetic risk of cardiovascular disease might be associated with short-term risk of VTE, AF, and VAD complications after COVID-19 infection. However, the risk was lower for people who adhered to a healthy lifestyle, regardless of their genetic risk. This suggests that healthy lifestyle interventions can reduce the cardiovascular burden of the population during the ongoing pandemic, regardless of its genetic background.
Limitations
The study has certain limitations. First, the PRS score may not be able to indicate the maximum genetic contribution to cardiovascular complications of COVID-19. Second, the study could record overdiagnosis for COVID-19 patients. Third, PRS may not be able to provide additional predictive information. Fourth, data on lifestyle behavior collected ten years ago could be subject to misclassification and bias. Finally, the UK Biobank participants represent a healthier population than the general population and are of European descent, which could limit the generalisability of the results.
*Important news
medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore should not be considered conclusive, guide clinical practice or health-related behavior, or be treated as established information.
Source: news.google.com