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CVD and diabetes rates spike post-COVID: Study

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The UK study, published in PLOS Medicine, also shows acute COVID-19 is associated with an overall six times increase in cardiovascular disease (CVD) in the first four weeks after infection, mainly from pulmonary embolus (PE), atrial arrhythmias and venous thromboses.

Meanwhile, risk of diabetes mellitus (DM) after COVID-19 increases by 81% in the first four weeks and remained elevated by 27% until 12 weeks. However, the study did not identify any long-term increase in the incidence of CVD and DM after recovering from COVID.

To produce its findings, the King’s College London team examined almost a million patient records for one year after COVID-19 diagnosis, comparing those with documented COVID-19 infection to controls, and assessed their rates of new CVD or DM.

‘Use of a large, national database of electronic health records from primary care has enabled us to characterise the risk of cardiovascular disease and diabetes mellitus during the acute and longer-term phases following COVID-19 infection,’ lead author Dr Emma Rezel-Potts said.

More specifically, PE was associated with an 11 times increase, atrial arrhythmias a six times increase and venous thromboses a five times increase.

CVD rates declined after four weeks and returned to baseline from 12 weeks. DM risk returned to baseline after 23 weeks.

Dr Gary Deed, Chair of RACGP Specific Interests Diabetes, told newsGP the study adds to existing evidence regarding the ongoing impact of COVID in the adult community and the need for GPs to be vigilant of the possible onset of diabetes post infection.

‘COVID infection now is being observed to be associated with a rise in post-COVID diabetes rates through as yet unexplained mechanisms – potentially inflammatory triggers to hormonal and metabolic dysregulation of glycaemia – with people with the more serious forms of COVID being more at risk,’ he said.

‘But also noting people who are also at higher risk from COVID are those that cluster with the same metabolic risks that elevate diabetes risks, such as hypertension, obesity and cardiovascular disease.’

The study authors noted patients with COVID-19 were generally less healthy than controls and this might, in part, account for differences in DM and CVD outcomes.

In the paper, DM was defined to include type 1 and type 2 diabetes mellitus, as well as initiation of oral hypoglycaemics and insulin. CVD included PE, venous thromboses, atrial arrhythmias, acute myocardial infarction, ischaemic heart disease, heart failure, cardiomyopathy, stroke and myocarditis.

The study participants were followed until January 2022 and vaccination status was not tracked. The authors note as the study was based on health records, the date and participants’ exposure and outcome status might have been misclassified.

Nonetheless, for GPs, COVID-19 infection provides another opportunity to discuss diet, lifestyle and exercise with patients in order to reduce their risks of CVD and DM.

‘The information provided by this very large population-based study on the longer-term effects of COVID-19 on development of cardiovascular conditions and diabetes will be extremely valuable to doctors managing the millions of people who have had COVID-19 by now,’ co-author Professor Ajay Shah said.

‘It is clear that particular vigilance is required for at least the first three months after COVID-19.’

Dr Deed recommends the RACGP handbook as good support for GPs trying to determine which symptoms and diagnostic tests may be required. He also says the research shows GPs require more resources to help manage the increasingly growing burden posed by COVID-19.

‘It is a real call on regulators and government to help support primary care management of diabetes,’ he said.

‘GPs play a vital role in not just supporting patients affected or at risk of COVID, but also people post-COVID.’

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cardiovascular disease COVID-19 CVD diabetes

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