COVID-19 Is a Coronary Artery Disease Risk Equivalent and Exhibits a Genetic Interaction With ABO Blood Type | Arteriosclerosis, Thrombosis, and Vascular Biology
BACKGROUND: COVID-19 is associated with acute risk of major adverse cardiac events (MACE), including
myocardial infarction, stroke, and mortality (all-cause). However, the duration and
underlying determinants of heightened risk of cardiovascular disease and MACE post–COVID-19
are not known. METHODS: Data from the UK Biobank was used to identify COVID-19 cases (n=10 005) who were positive
for polymerase chain reaction (PCR+)-based tests for SARS-CoV-2 infection (n=8062) or received hospital-based International Classification of Diseases version-10 (ICD-10) codes for COVID-19 (n=1943) between February 1, 2020 and December 31, 2020. Population
controls (n=217 730) and propensity score—matched controls (n=38 860) were also drawn
from the UK Biobank during the same period. Proportional hazard models were used to
evaluate COVID-19 for association with long-term (>1000 days) risk of MACE and as
a coronary artery disease risk equivalent. Additional analyses examined whether COVID-19
interacted with genetic determinants to affect the risk of MACE and its components. RESULTS: The risk of MACE was elevated in COVID-19 cases at all levels of severity (HR, 2.09
[95% CI, 1.94–2.25]; P<0.0005) and to a greater extent in cases hospitalized for COVID-19 (HR, 3.85 [95%
CI, 3.51–4.24]; P<0.0005). Hospitalization for COVID-19 represented a coronary artery disease risk
equivalent since incident MACE risk among cases without history of cardiovascular
disease was even higher than that observed in patients with cardiovascular disease
without COVID-19 (HR, 1.21 [95% CI, 1.08–1.37]; P<0.005). A significant genetic interaction was observed between the ABO locus and hospitalization for COVID-19 (Pinteraction=0.01), with risk of thrombotic events being increased in subjects with non-O blood
types (HR, 1.65 [95% CI, 1.29–2.09]; P=4.8×10−5) to a greater extent than subjects with blood type O (HR, 0.96 [95% CI, 0.66–1.39];
P=0.82). CONCLUSIONS: Hospitalization for COVID-19 represents a coronary artery disease risk equivalent,
with post–acute myocardial infarction and stroke risk particularly heightened in non-O
blood types. These results may have important clinical implications and represent,
to our knowledge, one of the first examples of a gene-pathogen exposure interaction
for thrombotic events. Graphical Abstract