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

Abstract Background COVID-19 is associated with a higher risk of cardiovascular outcomes in the general population, but it is unknown whether people with pre-existing 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 risk factors may modify this risk in these people. Methods Primary and secondary care data from the National Health Service and COVID-19-specific linked data were used to define a population of adults in England with COVID-19 (index date) between 01/01/2020-30/11/2021. Adjusted Cox Proportional Hazard regression was used to quantify the association between CRD, asthma-related factors, COPD-related factors, and risk of cardiovascular events. CRD included asthma, COPD, bronchiectasis, cystic fibrosis, or pulmonary fibrosis prior to COVID-19 diagnosis. Asthma-specific factors included baseline asthma control, exacerbations, and inhaled corticosteroid (ICS) dose. COPD-specific risk factors included baseline ICS prescriptions and exacerbations. Secondary objectives quantified the impact of COVID-19 hospitalisation and vaccine dose on cardiovascular outcomes. Results Of 3,670,455 people, those with CRD had a modest higher risk of cardiovascular events (HR adj 1.11, 95%CI 1.07-1.14), heart failure (HR adj 1.15, 1.09-1.21), and pulmonary emboli (HR adj 1.20, 1.11-1.30) compared with people without CRD. In people with asthma, baseline exacerbations and high-dose ICS were associated with a higher risk of cardiovascular outcomes (HR adj 1.24, 1.15-1.34 and 1.12, 1.01-1.24, respectively). In people with COPD, exacerbations were associated with a higher risk of cardiovascular outcomes (HR adj 1.40, 1.28-1.52). Regardless of CRD, the risk of cardiovascular events was lower with increasing COVID-19 vaccine dose. Conclusions Higher risk of cardiovascular events following COVID-19 might be explained at least in part by the underlying CRD and severity of that condition. In addition, COVID-19 vaccines were beneficial to both people with and without CRD with regards to CV events. Key Messages Pre-existing chronic respiratory disease, asthma and COPD severity were associated with a higher risk of various types of cardiovascular outcomes following COVID-19. Regardless of having pre-existing chronic respiratory disease, COVID-19 vaccination reduced the risk of cardiovascular events following COVID-19.