Nature published a comprehensive study this week on cardiovascular risk including a total of over 11 million patients that has made a few headlines. The aim was to identify the cause of increased cardiac pathology. It should have been a very simple study comparing four groups:
Not infected and never vaccinated
Not infected and vaccinated
Infected but not vaccinated
Infected and vaccinated
It is hard to believe the authors did not look at these groups, but whatever was found when comparing them remains a mystery.
Instead, the following groups were compared:
Not infected and never vaccinated data from 2017
Not infected, including vaccinated and not vaccinated
Infected but not vaccinated
Infected with vaccinated people included but using modelled adjustments
When studies with huge datasets use modelling and fail to share data prior to their adjustments alarm bells should start ringing. Therefore, I took a deeper dive to see what else was questionable.
The cardiovascular complications of acute coronavirus disease 2019 (COVID-19) are well described, but the post-acute cardiovascular manifestations of COVID-19 have not yet been comprehensively characterized. Here we used national healthcare databases from the US Department of Veterans Affairs to build a cohort of 153,760 individuals with COVID-19, as well as two sets of control cohorts with 5,637,647 (contemporary controls) and 5,859,411 (historical controls) individuals, to estimate risks and 1-year burdens of a set of pre-specified incident cardiovascular outcomes. We show that, beyond the first 30 d after infection, individuals with COVID-19 are at increased risk of incident cardiovascular disease spanning several categories, including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease. These risks and burdens were evident even among individuals who were not hospitalized during the acute phase of the infection and increased in a graded fashion according to the care setting during the acute phase (non-hospitalized, hospitalized and admitted to intensive care). Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial. Care pathways of those surviving the acute episode of COVID-19 should include attention to cardiovascular health and disease.
Vitamin D deficiency is strongly associated with increased risk for coronavirus disease 2019 (COVID-19).
The odds ratio for COVID-19 increases with vitamin deficiency in black individuals.
Diabetes, obesity, and periodontal disease are associated with an increased risk for both COVID-19 and vitamin D deficiency.
Patients with vitamin D deficiency were 4.6 times more likely to be positive for COVID-19 (indicated by the ICD-10 diagnostic code COVID19) than patients with no deficiency (P < 0.001). The association decreased slightly after adjusting for sex (odds ratio [OR] = 4.58; P < 0.001) and malabsorption (OR = 4.46; P < 0.001), respectively. The association decreased significantly but remained robust (P < 0.001) after adjusting for race (OR = 3.76; P < 0.001), periodontal disease status (OR = 3.64; P < 0.001), diabetes (OR = 3.28; P < 0.001), and obesity (OR = 2.27; P < 0.001), respectively. In addition, patients with vitamin D deficiency were 5 times more likely to be infected with COVID-19 than patients with no deficiency after adjusting for age groups (OR = 5.155; P < 0.001).
We have had plenty of anecdotes about people failing to be diagnosed with serious diseases during lockdown. This is thanks to either to hospitals cancelling appointments, GP surgeries stopping face-to-face meetings or people picking up the message that they should protect the NHS by trying not to use it.
Our study shows that the COVID-19 pandemic has resulted in a large number of potentially missed or delayed diagnoses of health conditions, which carry high risk if not promptly diagnosed and effectively treated. Primary and secondary care services must proactively prepare to address the large backlog of patients that is likely to follow. Should a public health emergency on the scale of the COVID-19 pandemic occur in the future, or if subsequent surges in COVID-19 cases arise, national communication strategies must be carefully considered to ensure that large numbers of patients with urgent health needs do not disengage with health services.