In a recent study published in PLOS, researchers determined whether the incidence of new diabetes mellitus (DM) and cardiovascular disease (CVD) increases in one year among those recovering from coronavirus disease 2019 (COVID-19).
Study: Cardiometabolic outcomes up to 12 months after COVID-19 infection. A study of paired cohorts in the UK. Image credit: Kateryna Novikova / Shutterstock
Fund
Some of the first COVID-19-induced cardiac manifestations detected in the first four weeks of infection include heart failure, acute myocardial infarction, and ischemic stroke. In addition, patients with COVID-19 have reported new cases of hyperglycemia and DM, with diabetic ketoacidosis and hyperosmolarity.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is likely to cause direct pancreatic damage. In addition, it triggers a proinflammatory “cytokine storm” in critically ill patients characterized by increased levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFα) that impair insulin secretion and resistance. . Simply put, COVID-19 increases the risk of blood glucose disorders and cardiovascular complications. However, studies have barely investigated and characterized new diagnoses of DM and CVD for 12 months after COVID-19.
Social constraints during the pandemic led to profound changes in the diet and exercise routines of people who could have caused CVD and DM in the general population without COVID-19. Therefore, controlled studies are needed to carefully evaluate the long-term impacts of SARS-CoV-2 infection and its cardiometabolic outcomes that take into account pre-existing health conditions in cases and controls and their variations over time in the control cohort.
In addition, cohort studies should clarify the distinction between adverse cardiometabolic outcomes that occur during the acute (first four weeks of infection), postacute (five to 12 weeks after first infection), or long-term phases. duration of COVID with symptoms persisting for more than 12 weeks. after infection.
About the study
In the present study, the researchers analyzed the electronic health records (EHR) of 428,650 patients with COVID-19 without ECV or DM between 2020 and 2021 in the United Kingdom (UK). The index date was the date of the first code for COVID-19 at the February 2021 release of Clinical Practice Research Datalink (CPRD) Aurum. The database includes the EHRs of 1,356 family clinics in the UK with about 13.4 million registered patients, according to its March 2022 launch.
The study population comprised an equal number of matching test and control patients 1: 1 according to age, sex, and family practice. Other covariates in the study included body mass index (BMI), Charlson score, systolic blood pressure, and month index. The team tracked the study population until January 2022; they divided the one-year study into three tranches from the index date, as follows: i) the first four weeks, ii) five to 12 weeks, iii) 13 to 52 weeks.
The primary results of the study were the first diagnostic record of MCV and DM. The researchers classified the diagnosis of CVD into multiple categories, as follows: i) atrial arrhythmias, including atrial fibrillation and supraventricular tachycardia, ii) heart attack, iii) myocardial infarction and ischemic heart disease, iv) pulmonary embolism, v) venous thrombosis, vi) cardiomyopathy and myocarditis, and vii) stroke.
Likewise, diagnoses of DM had two broad categories: individuals with type 1 and 2 DM and those receiving oral hypoglycemic drugs and insulin. The team considered the second hemoglobin A1c (HbA1c) record greater than or equal to 48 mmol / mol diagnosis of diabetes. They assessed mortality from the date of death of the CPRD.
Study results
Net diagnoses of DM increased by 81% during the first four weeks after COVID-19, with an adjusted rate-to-increase (RR) ratio of 1.81, and remained high between five and 12 weeks (RR = 1.27). However, the overall increase in DM diagnoses could not be maintained between 13 and 52 weeks (R = 1.07). In addition, the authors observed a six-fold increase in diagnoses of CVD with acute COVID-19 (RR = 5.82). In addition, they observed an 11-fold increase in pulmonary embolism, a six-fold increase in atrial arrhythmias, and a five-fold increase in venous thrombosis, with RRs of 11.51, 6.44, and 5 , 43, respectively. In particular, the incidence of CVD decreased between five and 12 weeks of initial SARS-CoV-2 infection (RR = 1.49) and reached initial or lower levels between 12 weeks and 12 months, with RR = 0.80.
Conclusions
The results of the current study showed that while CVDs increased soon after COVID-19, diagnoses of DM remained elevated for a minimum of 12 weeks after COVID-19 before decreasing again. . The authors observed that the initial increase in ECV diagnoses was mainly due to pulmonary embolism, atrial arrhythmias, and venous thrombosis. People without pre-existing CVD or DM who contracted COVID-19 did not show increased susceptibility to the incidence of these two conditions. The authors highlighted a healthy diet and exercise for people recovering from COVID-19.