Predictive value of ASCVD risk score for mortality and major adverse cardiovascular events in the year following a COVID-19 infection among US Veterans

• Published in: International journal of cardiology 2023-09, Vol.387, p.131120, Article 131120
• Main Authors: Guardino, Eric T., Tarko, Laura, Wilson, Peter W.F., Gaziano, J. Michael, Cho, Kelly, Gagnon, David R., Orkaby, Ariela R.
• Format: Article
• Language: English
• Subjects: ASCVD risk score; Atherosclerosis; Cardiovascular Diseases - diagnosis; COVID-19; Female; Humans; Long COVID; Male; Middle Aged; Retrospective Studies; Risk Assessment; Risk Factors; US Veterans; Veterans
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2023.131120

Morbidity and mortality following COVID-19 infection may be influenced by baseline atherosclerotic cardiovascular disease (ASCVD) risk, yet limited data are available to identify those at highest risk. We examined the association between baseline ASCVD risk with mortality and major adverse cardiovascular events (MACE) in the year following COVID-19 infection. We evaluated a nationwide retrospective cohort of US Veterans free of ASCVD who were tested for COVID-19. The primary outcome was absolute risk of all-cause mortality in the year following a COVID-19 test among those hospitalized vs. not stratified by baseline VA-ASCVD risk scores. Secondarily, risk of MACE was examined. There were 393,683 Veterans tested for COVID-19 and 72,840 tested positive. Mean age was 57 years, 86% were male, and 68% were white. Within 30 days following infection, hospitalized Veterans with VA-ASCVD scores >20% had an absolute risk of death of 24.6% vs. 9.7% (P ≤0.0001) for those who tested positive and negative for COVID-19 respectively. In the year following infection, risk of mortality attenuated with no difference in risk after 60 days. The absolute risk of MACE was similar for Veterans who tested positive or negative for COVID-19. Veterans without clinical ASCVD experienced an increased absolute risk of death within 30 days of a COVID-19 infection compared to Veterans with the same VA-ASCVD risk score who tested negative, but this risk attenuated after 60 days. Whether cardiovascular preventive medications can lower the risk of mortality and MACE in the acute period following COVID-19 infection should be evaluated. •Risk of death attenuates back to baseline 60 days after a COVID-19 infection.•No increased risk of death 1 year after a COVID-19 infection.•Baseline ASCVD risk score predicts short term risk of death after COVID-19 infection.