In a study conducted by Whittaker and colleagues, published in the International Journal of Epidemiology in June 2024, two prominent findings were made on the relationship between the presence or absence of chronic respiratory disease (CRD) post-Covid-19 infection and the risk of developing an adverse cardiovascular event.

The results of the UK-based study concluded that post-Covid-19 infection, patients who had preexisting CRD were at higher risk of experiencing a cardiovascular event compared to those who did not have preexisting CRD.

The second significant finding was that the severity of Covid-19 infection modified the risk of developing a cardiovascular event in individuals with preexisting CRD.

The SARS-CoV-2 virus elicits an increase in proinflammatory cytokines in the body, which manifests into other adverse health outcomes such as chronic and acute cardiovascular events.

Having CRD also increases the risk of cardiovascular events. Therefore, it is reasonable to assume that patients with preexisting CRD would be more negatively impacted after Covid-19 infection compared to those without preexisting CRD.

However, until recently, empirical evidence quantifying this difference was lacking in the literature.

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One common cardiovascular event is heart failure, which is associated with high hospitalisation rates, healthcare costs, and high mortality and morbidity.

Heart failure impacts the lives of many people globally.

In the UK, leading data and analytics company GlobalData epidemiologists forecast that there will be just over 789,000 diagnosed prevalent cases of heart failure in men and women of all ages by the end of 2024.

GlobalData epidemiologists also forecast this number to increase to 873,000 cases by the end of 2027.

Whittaker and colleagues accessed the electronic health records of 56 million people living in England through the National Health Service (NHS).

They identified 3,670,460 people aged 18 and older who had a laboratory-confirmed diagnosis of Covid-19 from 2020 to 2021.

From this group, 81.7% of patients were categorised as adults without preexisting CRD and 18.3% were categorised as adults with preexisting CRD.

This cohort was further split into the chronic obstructive pulmonary disease (COPD) group and the asthma group, making up 12.5% and 90.6% of the preexisting CRD cohort, respectively.

The CRD cohort was 1.08 times more likely to experience composite cardiovascular outcomes and 1.17 times more likely to experience pulmonary embolism compared to the non-CRD cohort, after Covid-19 infection.

Looking more specifically at the subgrouping of CRD, those with preexisting asthma were 1.05 times more likely to experience composite cardiovascular events, 1.08 times more likely to experience heart failure, 1.11 times more likely to experience angina, and 1.16 times more likely to experience pulmonary emboli compared to people without preexisting asthma.

Among those with preexisting asthma, those with one or two exacerbations at baseline were 1.36 times more likely to experience composite cardiovascular outcomes and arterial-related outcomes, and 1.39 times more likely for other cardiovascular-related outcomes compared to people with asthma who did not exacerbate at baseline.

People with preexisting COPD were 1.11 times more likely to experience cardiovascular outcomes, 1.25 times more likely to experience heart failure, 1.14 times more likely to experience angina, and 1.36 times more likely to experience pulmonary emboli compared to those without preexisting COPD.

This research is important because it helps show how Covid-19 infection may change what was previously understood about the level of risk associated with adverse health outcomes for those with preexisting chronic respiratory conditions.

In turn, this educates physicians and public health officials about updating their guidelines and clinical practices.