Risks of major arterial and venous thrombotic diseases after hospitalisation for influenza, pneumonia, and COVID-19: A population-wide cohort in 2.6 million people in Wales
Spencer Keene, Hoda Abbasizanjani, Fatemeh Torabi, Rochelle Knight, Venexia Walker, Elena Raffetti, Genevieve Cezard, Samantha Ip, Alexia Sampri, Thomas Bolton, Rachel Denholm, Kamlesh Khunti, Ashley Akbari, Jennifer Quint, Spiros Denaxas, Cathie Sudlow, Emanuele Di Angelantonio, Jonathan A.C. Sterne, Angela Wood, William N. Whiteley, on behalf of the CVD-COVID-UK/COVID-IMPACT Consortium and the Longitudinal Health and Wellbeing COVID-19 National Core Study
COVID-19 is primarily a respiratory disease. However, it is also a systemic illness with the widespread expression of angiotensin-converting enzyme-2 in infected individuals leading to prothrombotic and hyperinflammation. Thus, this severe viral infection may increase the risk of serious cardiovascular diseases.
Any elevated risk of cardiovascular disease after SARS-CoV-2 infection needs to be put into the context of risk after other acute viral infections, such as influenza or pneumonia, to allow a better understanding of the COVID-19 specific mechanisms that lead to complications such as stroke, myocardial infarction, pulmonary embolism, and deep vein thrombosis, and to understand the relative burden of cardiovascular disease (CVD) after COVID-19. This work will be an important contribution to our understanding of the clinical relevance of any endothelial or systemic inflammation associated with infection and have implications for new effective prevention strategies including therapeutic targets.
The inflammatory responses to COVID-19 may make underlying cardiovascular disease more likely to manifest. The comparison between COVID-19 and other respiratory infections will allow us to assess whether COVID-19 is associated with an elevated risk of adverse CVD outcomes above and beyond that of other respiratory infections and to show whether the high-risk periods are different between COVID-19 and viral influenza or pneumonia (non-COVID+) infections to better define when precautions are most effective.
Our aims are:
- To quantify if the risk of cardiovascular diseases after COVID-19 infection is higher than non-COVID+ infection in general or in particular populations;
- Define whether the increased risk persists longer with COVID-19 than non-COVID+ infection;
- To understand whether subsequent risk varies according to whether patients infected with COVID-19 or non-COVID+ are hospitalised or not hospitalised.
Keene S, Abbasizanjani H, Torabi F, et al. Risks of major arterial and venous thrombotic diseases after hospitalisation for influenza, pneumonia, and COVID-19: A population-wide cohort in 2.6 million people in Wales. Thromb Res. Published online November 19, 2024. doi:https://doi.org/10.1016/j.thromres.2024.109213
- View the analysis code used in the SAIL Databank
- View the phenotyping algorithms and codelists used in the SAIL Databank
This is a sub-project of project CCU002 approved by the CVD-COVID-UK / COVID-IMPACT Approvals & Oversight Board (sub-project: CCU002_04).
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