CONTROL OF ATHEROSCLEROTIC RISK FACTORS BEFORE AND DURING THE COVID-19 PANDEMIC

Background

Public health measures critical to limiting transmission of COVID-19 not only led to widespread social and economic changes but also affected the delivery of health care. We evaluated pandemic-related changes in cardiovascular risk factors and 10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD) among adults within an integrated health care system in the United States.

Methods

We included adults between the ages of 40 and 79 with lipid panel and blood pressure measurements before the pandemic (March 19, 2019-March 18, 2020) and another set of measurements after COVID-19 vaccines became available, more than 9 months into the pandemic (December 14, 2020-June 30, 2021). An individual's estimated 10-year ASCVD risk during each study period was calculated using the pooled cohort equation. Logistic regression was used to assess the association between baseline characteristics and a >10% increase in ASCVD risk during the pandemic.

Results

Of 184,764 adults with lipid and blood pressure information before and during the pandemic, median age was 59 years (IQR 51,66), 58.5% were women, 33.5% White, 8.9% Black, 15.1% Asian, and 37.2% Hispanic. During the pandemic, a higher proportion of individuals had uncontrolled hypertension ≥ 140 mmHg (17.6% vs. 13.4%) and elevated cholesterol ≥ 240 mg/dL (11.0% vs. 9.9%). At a population level, median estimated 10-year ASCVD risk increased from 6.2% (IQR 2.5%, 13.4%) pre-pandemic to 6.5% (IQR 2.6%, 14.0%) during the pandemic, and a higher proportion of individuals were categorized as having high (≥ 20%) ASCVD risk (14.6% vs. 13.5%). Factors associated with increased odds of having >10% increase in ASCVD risk included older age (OR 3.4, 95% CI 3.3-3.6, for each decade increase), male sex (OR 1.8, 95% 1.7-1.9), black race (OR 2.2, 95% CI 2.0-2.5) and low income (OR 1.3, 95% 1.1-1.4).

Conclusion

The COVID-19 pandemic was associated with a higher proportion of individuals with uncontrolled blood pressure and cholesterol as compared to prior to the pandemic. This resulted in an increase in their estimated 10-year ASCVD risk. Individuals who were older, black, or with low income were disproportionately affected.