Associations of COVID-19 Status with Risk for Death and Hospitalization Among Prevalent and Incident Cardiovascular Medication Users

Abstract

The relationship between cardiovascular disease/injury and COVID-19 has been well described, but the use of cardiovascular medication as a proxy for cardiovascular disease and injury has not been explored. Our study used electronic health record (EHR) data in a large prospective cohort of 17,003 patients from University of Washington, Seattle, WA, to assess the risk of hospitalization and death by COVID-19 status for individuals taking cardiovascular medications. Use of cardiovascular medication was separated into prevalent and incident use based on COVID-19 diagnosis date. Information on demographics and comorbidities including age, race, gender, primary language spoken, chronic respiratory illnesses, diabetes, hypertension, heart disease, stroke/transient ischemic attach, chronic kidney disease, liver disease, cancer, vascular disease, and auto-immune disorders were extracted from EHR and used as covariates in the analysis. We analyzed data using Cox Proportional Hazard models to ascertain Hazard Ratios, 95% Confidence Intervals and p-values. We found that individuals who were using cardiovascular medications prior to a COVID-19 diagnosis (prevalent use) were at a higher risk of death but not hospitalization after becoming COVID-19 positive (HR: 1.88, 95% CI: 1.48-2.38) in fully adjusted models. This relationship remained when stratifying patients by type of medication used, either antihyperlipidemics, antihypertensives, or beta blockers. There were no associations between COVID-19 and increased risk of hospitalization or death in patients that were prescribed new CVD medications after becoming COVID-19 positive (incident use). However, non-significant hazard ratios below 1.00 (reduced risk) of death were found. Those with prevalent use of cardiovascular medication should take preventative measures to avoid COVID-19 infection and clinicians should be aware of increased risk of death in these patients. Use of cardiovascular medications when indicated for new COVID-19 diagnoses should be further explored.