4 conditions linked to COVID-19 hospitalizations

Almost two-thirds of COVID-19-related hospitalizations in the US are due to at least one of four underlying cardiometabolic conditions: obesity, hypertension, diabetes, or heart failure (HF), according to a modelling study.

“While newly authorized COVID-19 vaccines will eventually reduce infections, we have a long way to go to get to that point,” said principal investigator Dr Dariush Mozaffarian of Friedman School of Nutrition Science and Policy at Tufts University, Boston, Massachusetts, US. “Our findings call for interventions to determine whether improving cardiometabolic health will reduce hospitalizations, morbidity, and healthcare strains from COVID-19.”

Analysing a total of 906,849 COVID-19 hospitalizations that had occurred up to mid-November 2020 in the US, the researchers found that a huge proportion of hospitalizations could have been prevented if the patients had not have at least one of the four major cardiometabolic conditions above. [J Am Heart Assoc 2021;doi:10.1161/JAHA.120.019259]

In order of descending contribution, 30.2 percent of the hospitalizations were attributable to obesity (BMI ≥30 kg/m²), 26.2 percent were due to hypertension, 20.5 percent were attributable to diabetes mellitus, and 11.7 percent could have been prevented if not for pre-existing HF in the patients.

In other words, although these patients might still have been infected, their illness might not have been severe enough to require hospitalizations in the absence of any of the four conditions.

When all four conditions were considered jointly, 63.5 percent of the COVID-19 hospitalizations could have been prevented if these cardiometabolic conditions had not been present. Further, reducing the prevalence of each condition by 10 percent nationwide would prevent approximately 11 percent of all COVID-19 hospitalizations.  

“We know that changes in diet quality alone, even without weight loss, rapidly improve metabolic health within just six to eight weeks. It’s crucial to test such lifestyle approaches for reducing severe COVID-19 infections, both for this pandemic and future pandemics likely to come,” said Mozaffarian.

One factor that had an influence on the association between these cardiometabolic conditions and COVID-19 hospitalizations is age. For instance, 29 percent of COVID-19 hospitalizations among older adults aged ≥65 years were attributable to diabetes, compared to 8 percent of COVID-19 hospitalizations among younger adults aged <50 years.

Obesity, however, was equally detrimental across age groups, in terms of COVID-19 hospitalizations.

“Medical providers should educate patients who may be at risk for severe COVID-19 and consider promoting preventive lifestyle measures, such as improved dietary quality and physical activity, to improve overall cardiometabolic health,” advised lead author Meghan O'Hearn, also from the Friedman School.

“Public health messaging on effective strategies such as social distancing, face masks, and hand washing should additionally consider highlighting the critical risk for Americans with underlying cardiometabolic conditions,” suggested O’Hearn and co-authors.