Publication date: Jul 14, 2023

COVID-19 complications have been linked to worse outcomes among patients with established atherosclerotic cardiovascular disease (ASCVD). Less is known about the cumulative consequences of multiple ASCVD risk factors on COVID-19 outcomes. We evaluated the dose-response associations between 10-year ASCVD risk scores and COVID-19 complications. The National COVID-19 Cohort Collaborative collects electronic health record data from over 70 US health systems. Our analysis was limited to patients with positive COVID-19 tests without documented ASCVD events at the time of the first positive test. We evaluated the dose-response associations between 10-year ASCVD risk scores, categorized into categorized as low (20. 0%), and COVID-19 complications, including hospitalizations and mortality. We reported the outcomes using multivariable-adjusted hazard ratios and 95% confidence intervals (CIs). Our cohort included 120,335 patients with documented positive COVID-19 test results who were free of ASCVD events. The mean age was 51. 9 +/- 16. 1 years, 59. 4% were women, 15. 3% were Black, and 13. 7% were Hispanic/Latino. Overall, 15,363 patients (12. 8%) were hospitalized and 2,058 (1. 7%) died. Patients at intermediate risk of developing ASCVD were had a 1. 49 (95% CI 1. 41 to 1. 56) increased risk of hospitalization and 1. 77 (95% CI 1. 76 to 1. 79) increased risk of mortality compared with patients at low risk. Patients at high risk had a 2. 23 (95% CI 2. 10 to 2. 38) increased risk of hospitalization and a 5. 98 (95% CI 5. 93 to 6. 03) increased risk of mortality. In conclusion, patients in this nationwide cohort at high risk of developing ASCVD are at substantially greater risk of COVID-19 complications. COVID-19 mitigation efforts should focus on these patient populations.

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