Cardiometabolic outcomes up to 12 months after COVID-19 infection. A matched cohort study in the UK

Abstract

Background Acute Coronavirus Disease 2019 (COVID-19) has been associated with new-onset cardiovascular disease (CVD) and diabetes mellitus (DM), but it is not known whether COVID-19 has long-term impacts on cardiometabolic outcomes. This study aimed to determine whether the incidence of new DM and CVDs are increased over 12 months after COVID-19 compared with matched controls. Methods and findings We conducted a cohort study from 2020 to 2021 analysing electronic records for 1,356 United Kingdom family practices with a population of 13.4 million. Participants were 428,650 COVID-19 patients without DM or CVD who were individually matched with 428,650 control patients on age, sex, and family practice and followed up to January 2022. Outcomes were incidence of DM and CVD. A difference-in-difference analysis estimated the net effect of COVID-19 allowing for baseline differences, age, ethnicity, smoking, body mass index (BMI), systolic blood pressure, Charlson score, index month, and matched set. Follow-up time was divided into 4 weeks from index date (“acute COVID-19”), 5 to 12 weeks from index date (“post-acute COVID-19”), and 13 to 52 weeks from index date (“long COVID-19”). Net incidence of DM increased in the first 4 weeks after COVID-19 (adjusted rate ratio, RR 1.81, 95% confidence interval (CI) 1.51 to 2.19) and remained elevated from 5 to 12 weeks (RR 1.27, 1.11 to 1.46) but not from 13 to 52 weeks overall (1.07, 0.99 to 1.16). Acute COVID-19 was associated with net increased CVD incidence (5.82, 4.82 to 7.03) including pulmonary embolism (RR 11.51, 7.07 to 18.73), atrial arrythmias (6.44, 4.17 to 9.96), and venous thromboses (5.43, 3.27 to 9.01). CVD incidence declined from 5 to 12 weeks (RR 1.49, 1.28 to 1.73) and showed a net decrease from 13 to 52 weeks (0.80, 0.73 to 0.88). The analyses were based on health records data and participants’ exposure and outcome status might have been misclassified. Conclusions In this study, we found that CVD was increased early after COVID-19 mainly from pulmonary embolism, atrial arrhythmias, and venous thromboses. DM incidence remained elevated for at least 12 weeks following COVID-19 before declining. People without preexisting CVD or DM who suffer from COVID-19 do not appear to have a long-term increase in incidence of these conditions. Emma Rezel-Potts and colleagues investigate whether the incidence of new diabetes mellitus and cardiovascular diseases are increased over 12 months after Covid-19 compared with matched controls. Author summary Why was this study done? ➢ Acute Coronavirus Disease 2019 (COVID-19) may be associated with cardiovascular complications and disorders of blood glucose. ➢ It is not known whether patients recovering from COVID-19 remain at increased risk of cardiovascular disease (CVD) or diabetes mellitus (DM). ➢ This study aimed to find out whether new diagnoses of DM and CVDs are increased over 12 months after COVID-19 compared with matched control patients who did not have COVID-19. What did the researchers do and find? ➢ We analysed electronic records for 428,650 COVID-19 patients who were matched with 428,650 control patients and followed up to January 2022. We evaluated new diagnoses of DM and CVD up to 12 months after COVID-19 infection. We compared COVID-19 patients with controls and adjusted for baseline differences in risk. ➢ DM diagnoses were increased by 81% in acute COVID-19 and remained elevated by 27% from 4 to 12 weeks after the infection. ➢ Acute COVID-19 was associated with a 6-fold increase in cardiovascular diagnoses overall, including an 11-fold increase in pulmonary embolism, a 6-fold increase in atrial arrythmias, and a 5-fold increase in venous thromboses. CVD diagnoses declined from 4 to 12 weeks after COVID-19 and returned to baseline levels or below from 12 weeks to 1 year after the infection. What do these findings mean? ➢ Acute COVID-19 is associated with increased risk of cardiovascular disorders, but risk generally returns to background levels soon after the infection. ➢ The risk of new DM remains increased for at least 12 weeks following COVID-19 before declining. ➢ Patients recovering from COVID-19 should be advised to consider measures to reduce diabetes risk including healthy diet and taking exercise. ➢ People without preexisting CVD or DM who suffer from COVID-19 do not appear to have a long-term increase in incidence of these conditions.