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Most COVID-19 hospitalizations in the United States are attributable to four pre-existing cardiometabolic diseases, a new study suggests.
The authors estimate that among the total of 906,849 hospitalizations for COVID-19 that occurred among adults in the United States in November 2020, 30% were attributable to obesity; 26% for hypertension; 21% for diabetes; and 12% for heart failure.
From the data, the researchers estimate that almost two thirds (63.5%) of hospitalizations were attributed to these cardiometabolic conditions and that these hospitalizations would have been avoided had these conditions not been present.
They estimate that a 10% reduction in these four cardiometabolic conditions would have potentially prevented 11.1% of hospitalizations for COVID-19.
The authors believe that more needs to be done to promote healthy lifestyle measures to improve overall cardiometabolic health and potentially minimize the risk of severe COVID-19.
Dr. Dariush Mozaffarian
“It is a sad fact that this disease has existed for an entire year with millions of deaths and tens of millions hospitalized worldwide, and we have not addressed one of the main ways to prevent such serious results,” senior author Dariush Mozaffarian, MD, said. Medscape Medical News.
“We are closing deals and preventing people from seeing their loved ones, but we are not telling them to lose weight and get some exercise. We should focus public health messages on reducing diabetes and obesity as a means of reducing COVID disease. serious”. he said.
Mozaffarian, who is a cardiologist and dean of the School of Nutrition Science and Policy Gerald J. and Dorothy R. Friedman at Tufts University, Boston, Massachusetts, added: “If individuals exercised a little more and ate a little more healthily, see improvements in diabetes and hypertension in just a few weeks. We should shout it from the top, along with the messages to wash your hands, distance yourself socially and wear masks. “
The study was published online on February 25 in Journal of the American Heart Association.
For the study, the researchers used a mathematical simulation to estimate the number and proportion of national hospitalizations for COVID-19 that could have been avoided if the Americans had not suffered from the four main cardiometabolic conditions.
The researchers used data on the association between hospitalizations for COVID-19 and each of the four conditions in a study of factors associated with hospital admission among 5,279 patients with COVID-19 at a major health center in New York City.
Data from the COVID-NET system of the Center for Disease Control and Prevention and the COVID Tracking Project were used to estimate hospitalizations for COVID-19 by population subgroup. Data on the national distribution of the four conditions came from the most recent National Health and Nutrition Examination Survey.
The model indicated that age and race / ethnicity were associated with disparities in hospitalizations for COVID-19 as a result of these four conditions. For example, about 8% of hospitalizations for COVID-19 among adults under 50 were estimated to be due to diabetes, compared with about 29% of hospitalizations for COVID-19 among those 65 and over. Obesity had an equally damaging impact on hospitalizations for COVID-19 in all age groups.
At any age, hospitalizations for COVID-19 attributable to all four conditions were higher in black than in white individuals and were generally higher for diabetes and obesity among Hispanics than among whites.
For example, for people aged 65 and over, diabetes has been estimated to cause about 25% of hospitalizations for COVID-19 among whites, about 32% among blacks and about 34% among Hispanics.
When the four conditions were considered together, the proportion of attributable hospitalizations was highest for black adults of all ages, followed by Hispanics. For example, among adults 18 to 49 years old, it has been estimated that the four conditions together cause about 39% of hospitalizations for COVID-19 among whites and 50% among blacks.
“National data shows that blacks and Hispanic Americans are suffering the worst results of COVID-19. Our findings support the need to prioritize the distribution of vaccines, good nutrition and other preventive measures for people with cardiometabolic conditions, particularly among the most affected groups. for health disparities, “said Mozaffarian.
“Policies designed to reduce the prevalence of these four cardiometabolic conditions among blacks and Hispanic Americans should be part of any state or national policy discussion aimed at reducing the health disparities in COVID-19,” he said.
Mozaffarian pointed out that the study used an established analytical modeling approach, but that the results are estimates and do not prove cause and effect.
“Association does not equate causality, and our modeling approach does not prove that improvements in cardiometabolic health will reduce the risk of hospitalization for COVID-19. However, the magnitude of our simulated results supports the need for interventional studies to test this possibility,” researchers claim.
Still, Mozaffarian believes that the results reflect cause and effect.
“These conditions are strongly related to severe COVID infection. We adjusted for age, sex and other medical conditions and we still found that these four cardiometabolic conditions are independently associated with hospitalization for COVID, ”he noted. “This is not just a respiratory virus. It causes widespread vascular inflammation, which is consistent with these cardiometabolic conditions. If these conditions did not exist, COVID would be less severe,” he commented.
“But even if our estimate of 64% is below half – which I don’t believe – that would still be a third of the serious cases caused by four preventable cardiometabolic diseases. Those are huge numbers.”
COVID-19 is a rapid pandemic on top of the slow obesity and diabetes pandemic.
Mozaffarian highlighted the need for the public to understand the importance of good nutrition. “This is the basis for health. Malnutrition is the biggest contributor to disease worldwide and is also contributing to the COVID situation,” he said. “COVID-19 is a rapid pandemic on top of the slow obesity and diabetes pandemic.”
Commenting on the study for Medscape Medical NewsGeorge L. Bakris, MD, professor of medicine and director of the Comprehensive Hypertension Center at the American Heart Association at the University of Chicago Medicine in Chicago, Illinois, said the data was consistent with observations that older people, especially those with diabetes, have heart disease, and lung disease, are at increased risk for more severe disease manifestations than COVID-19.
But he noted that, based on many epidemiological under-studies, hypertension alone, in the absence of heart disease, lung disease or diabetes, was not implicated as a factor in the severity of COVID.
“The government had already run campaigns to encourage exercise and weight loss, and all the programs available to help facilitate that did not help. The concept of cognitive dissonance is applicable. Although people are aware of the risks, they have great difficulty in change behavior “. Bakris added
Recognizing the difficulty in persuading people to change their habits, Mozaffarian points out that the COVID pandemic is an exceptional event and has caused the vast majority of people to change their behavior.
“People would also change their diet and exercise habits if they received a clear message that doing so could reduce the risk of a serious COVID result,” he said.
He urges key stakeholders – governments, cardiovascular societies and companies – to get that message across.
“Every day, we should listen to advice to eat more vegetables and less chips, soft drinks and processed foods and walk a little more,” he said. “This could have a huge effect on the results of COVID disease and public health in general.”
The research was supported by the National Institutes of Health and the National Heart, Lung and Blood Institute. Mozaffarian received research funding from the Gates Foundation and the Rockefeller Foundation; personal fees from the Global Organization for EPA & DHA omega-3 (GOED), Barilla, Bunge, Indigo Agriculture, Motif FoodWorks, Amarin, the Cleveland Clinic Foundation and America’s Test Kitchen (modest) and Acasti Pharma and Danone (significant). He participated in scientific advisory boards of startups focused on health innovations, including Brightseed, Calibrate, DayTwo, Elysium Health, Filtricine, Foodome, HumanCo and Tiny Organics (significant) and received chapter royalties from UpToDate (modest), all out of the submitted work.
J Am Heart Assoc. Published online February 25, 2021. Full text
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