Pre-existing Cardiovascular Disease in United States Population at High Risk for Severe COVID-19 Infection

Abstract

Background and Purpose—There is increasing recognition of a relatively high burden of pre-existing
cardiovascular disease in Corona Virus Disease 2019 (COVID-19)-infected patients. We determined the
burden of pre-existing cardiovascular disease in persons residing in United States (US) who are at risk for
severe COVID-19 infection.
Methods—Age (≥60 years), presence of chronic obstructive pulmonary disease, diabetes mellitus, hyper‐
tension, and/or malignancy were used to identify persons at risk for admission to intensive care unit, or
invasive ventilation, or death with COVID-19 infection. Persons were classified as low risk (no risk fac‐
tors), moderate risk (1 risk factor), and high risk (two or more risk factors present) using nationally repre‐
sentative sample of US adults from National Health and Nutrition Examination Survey 2017–2018 survey.
Results—Among a total of 5856 participants, 2386 (40.7%) were considered low risk, 1325 (22.6%)
moderate risk, and 2145 persons (36.6%) as high risk for severe COVID-19 infection. The proportion of
patients who had pre-existing stroke increased from 0.6% to 10.5% in low risk patients to high risk patients
[odds ratio19.9, 95% confidence interval (CI) 11.6–34.3). The proportion of who had pre-existing myocar‐
dial infection increased from 0.4% to 10.4% in low risk patients to high risk patients (OR 30.6, 95% CI
15.7–59.8).
Conclusions—A large proportion of persons in US who are at risk for developing severe COVID-19
infection are expected to have pre-existing cardiovascular disease. Further studies need to identify whether
targeted strategies toward cardiovascular diseases can reduce the mortality in COVID-19 infected patients.