We truly appreciate the comments from C.E. Leiva Sisnieguez and colleagues, who have performed a further analysis on the potential association between cardiovascular comorbidities and the clinical outcomes of coronavirus disease 2019 (COVID-19), particularly the mortality). We also applaud the suggestion to thoroughly adjust for potential confounding factors when interpreting the association between specific categories of cardiovascular comorbidities (e.g. hypertension) and the clinical outcomes of COVID-19. To this end, we have attempted to incorporate the cardiovascular diseases (including coronary heart disease) into the multivariate regression model [1]. Findings of the model indicated a prominent collinearity between hypertension and coronary heart disease, and we have therefore elected to retain hypertension in the regression model for further analyses.
Short abstract
Comorbid hypertension correlates with poorer outcomes in patients with COVID-19 https://bit.ly/2zoT9f0
From the authors:
We truly appreciate the comments from C.E. Leiva Sisnieguez and colleagues, who have performed a further analysis on the potential association between cardiovascular comorbidities and the clinical outcomes of coronavirus disease 2019 (COVID-19), particularly the mortality). We also applaud the suggestion to thoroughly adjust for potential confounding factors when interpreting the association between specific categories of cardiovascular comorbidities (e.g. hypertension) and the clinical outcomes of COVID-19. To this end, we have attempted to incorporate the cardiovascular diseases (including coronary heart disease) into the multivariate regression model [1]. Findings of the model indicated a prominent collinearity between hypertension and coronary heart disease, and we have therefore elected to retain hypertension in the regression model for further analyses.
Like other comorbidities, such as COPD, information about cardiovascular comorbidities was derived from patient self-report, which does not preclude under-reporting. Therefore, the percentage of patients with cardiovascular diseases might have been underestimated given the urgency of data collection (history taking) within the wards during the outbreak. Our findings could also have been attributed to the relatively low proportion of patients with coexisting hypertension and coronary heart disease in our study. Nonetheless, the overall proportion of patients with comorbidities in our study [1] was in keeping with previous publications [2–6]. Our findings were likely to be generalisable to other populations worldwide.
The cause of the association between cardiovascular diseases and the poor clinical outcome of COVID-19 may be multifaceted, including, but not limited to, age and cardiac dysfunction caused by viral infections. As ours was a cross-sectional case study, causality could not be inferred from the study design. Dynamic monitoring of cardiovascular symptoms, cardiac function and laboratory markers might help unravel the underlying pathways linking cardiovascular diseases to the poor clinical outcomes of COVID-19.
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Author contributions: Wei-jie Guan and Wen-hua Liang drafted the manuscript; all authors provided critical review of the manuscript and approved the final draft for publication.
Conflict of interest: Wei-jie Guan has nothing to disclose.
Conflict of interest: Wen-hua Liang has nothing to disclose.
Conflict of interest: Jian-xing He has nothing to disclose.
Conflict of interest: Nan-shan Zhong reports grants from National Health Commission and Dept of Science and Technology of Guangdong Province, during the conduct of the study.
Support statement: Supported by National Health Commission, Dept of Science and Technology of Guangdong Province. The funder had no role in the conduct of the study. Funding information for this article has been deposited with the Crossref Funder Registry.
References
- 1.Guan W-j, Liang W-h, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020; 55: 2000547. doi: 10.1183/13993003.00547-2020 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Placzek HED, Madoff LC. Association of age and comorbidity on 2009 influenza A pandemic H1N1-related intensive care unit stay in Massachusetts. Am J Public Health 2014; 104: e118–e125. doi: 10.2105/AJPH.2014.302197 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Booth CM, Matukas LM, Tomlinson GA, et al. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA 2003; 289: 2801–2809. doi: 10.1001/jama.289.21.JOC30885 [DOI] [PubMed] [Google Scholar]
- 4.Alqahtani FY, Aleanizy FS, Ali Hadi Mohammed R, et al. Prevalence of comorbidities in cases of Middle East respiratory syndrome coronavirus: a retrospective study. Epidemiol Infect 2018; 5: 1–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Badawi A, Ryoo SG. Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV). Int J Infect Dis 2016; 49: 129–133. doi: 10.1016/j.ijid.2016.06.015 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Alanazi KH, Abedi GR, Midgley CM, et al. Diabetes mellitus, hypertension, and death among 32 patients with MERS-CoV infection, Saudi Arabia. Emerging Infect Dis 2020; 26: 166–168. doi: 10.3201/eid2601.190952 [DOI] [PMC free article] [PubMed] [Google Scholar]
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