Cardiovascular comorbidity and its impact on patients with COVID-19.

From the authors:

We truly appreciate the comments from C.E. Leiva Sisnieguez and colleagues, who have performed a further analysis on the potential association between cardiovascular comorbidities and the clinical outcomes of coronavirus disease 2019 (COVID-19), particularly the mortality). We also applaud the suggestion to thoroughly adjust for potential confounding factors when interpreting the association between specific categories of cardiovascular comorbidities (e.g. hypertension) and the clinical outcomes of COVID-19. To this end, we have attempted to incorporate the cardiovascular diseases (including coronary heart disease) into the multivariate regression model [1]. Findings of the model indicated a prominent collinearity between hypertension and coronary heart disease, and we have therefore elected to retain hypertension in the regression model for further analyses.

Like other comorbidities, such as COPD, information about cardiovascular comorbidities was derived from patient self-report, which does not preclude under-reporting. Therefore, the percentage of patients with cardiovascular diseases might have been underestimated given the urgency of data collection (history taking) within the wards during the outbreak. Our findings could also have been attributed to the relatively low proportion of patients with coexisting hypertension and coronary heart disease in our study. Nonetheless, the overall proportion of patients with comorbidities in our study [1] was in keeping with previous publications [2-6]. Our findings were likely to be generalisable to other populations worldwide.

The cause of the association between cardiovascular diseases and the poor clinical outcome of COVID-19 may be multifaceted, including, but not limited to, age and cardiac dysfunction caused by viral infections. As ours was a cross-sectional case study, causality could not be inferred from the study design. Dynamic monitoring of cardiovascular symptoms, cardiac function and laboratory markers might help unravel the underlying pathways linking cardiovascular diseases to the poor clinical outcomes of COVID-19.

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