{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T01:58:09Z","timestamp":1776909489334,"version":"3.51.2"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T00:00:00Z","timestamp":1650931200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>More than 80% of individuals in low and middle-income countries (LMICs) are unvaccinated against coronavirus disease 2019 (COVID-19). In contrast, the greatest burden of cardiovascular disease is seen in LMIC populations. Hypertension (HTN), diabetes mellitus (DM), ischaemic heart disease (IHD) and myocardial injury have been variably associated with adverse COVID-19 outcomes. A systematic comparison of their impact on specific COVID-19 outcomes is lacking. We quantified the impact of DM, HTN, IHD and myocardial injury on six adverse COVID-19 outcomes: death, acute respiratory distress syndrome (ARDS), invasive mechanical ventilation (IMV), admission to intensive care (ITUadm), acute kidney injury (AKI) and severe COVID-19 disease (SCov), in an unvaccinated population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methodology<\/jats:title><jats:p>We included studies published between 1<jats:sup>st<\/jats:sup> December 2019 and 16<jats:sup>th<\/jats:sup> July 2020 with extractable data on patients \u226518 years of age with suspected or confirmed SARS-CoV-2 infection. Odds ratios (OR) for the association between DM, HTN, IHD and myocardial injury with each of six COVID-19 outcomes were measured.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 110 studies comprising 48,809 COVID-19 patients. Myocardial injury had the strongest association for all six adverse COVID-19 outcomes [death: OR 8.85 95% CI (8.08\u20139.68), ARDS: 5.70 (4.48\u20137.24), IMV: 3.42 (2.92\u20134.01), ITUadm: 4.85 (3.94\u20136.05), AKI: 10.49 (6.55\u201316.78), SCov: 5.10 (4.26\u20136.05)]. HTN and DM were also significantly associated with death, ARDS, ITUadm, AKI and SCov. There was substantial heterogeneity in the results, partly explained by differences in age, gender, geographical region and recruitment period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>COVID-19 patients with myocardial injury are at substantially greater risk of death, severe disease and other adverse outcomes. Weaker, yet significant associations are present in patients with HTN, DM and IHD. Quantifying these associations is important for risk stratification, resource allocation and urgency in vaccinating these populations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic Review Registration<\/jats:title><jats:p><jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>, registration no: CRD42020201435 and CRD42020201443.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.871151","type":"journal-article","created":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T18:38:49Z","timestamp":1663958329000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Quantifying the Excess Risk of Adverse COVID-19 Outcomes in Unvaccinated Individuals With Diabetes Mellitus, Hypertension, Ischaemic Heart Disease or Myocardial Injury: A Meta-Analysis"],"prefix":"10.3389","volume":"9","author":[{"given":"Sher May","family":"Ng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiliu","family":"Pan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyriacos","family":"Mouyis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sreenivasa Rao","family":"Kondapally Seshasai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vikas","family":"Kapil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth M.","family":"Rice","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajay K.","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,4,26]]},"reference":[{"key":"B1","unstructured":"RitchieH\n            MathieuE\n            Rod\u00e9s-GuiraoL\n            AppelC\n            GiattinoC\n            Ortiz-OspinaE\n          Our World in DataCoronavirus Pandemic (COVID-19)2020"},{"key":"B2","doi-asserted-by":"publisher","first-page":"600878","DOI":"10.3389\/fpubh.2021.600878","article-title":"Living and dying with COVID-19 in South Asian low- and middle-income countries","volume":"9","author":"Gyawali","year":"2021","journal-title":"Front Public Health"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1885","DOI":"10.1016\/S0140-6736(21)00441-4","article-title":"Patient care and clinical outcomes for patients with COVID-19 infection admitted to African high-care or intensive care units (ACCCOS): a multicentre, prospective, observational cohort study","volume":"397","author":"Biccard","year":"2021","journal-title":"Lancet."},{"key":"B4","doi-asserted-by":"publisher","first-page":"177","DOI":"10.15585\/mmwr.mm7105e1","article-title":"SARS-CoV-2 Infection and Hospitalization Among Adults Aged \u226518 Years, by Vaccination Status, Before and During SARS-CoV-2 B.1.1.529 (Omicron) Variant Predominance \u2014 Los Angeles County, California, November 7, 2021\u2013January 8, 2022","volume":"71","author":"Danza","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"B5","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1111\/acem.13992","article-title":"Comparing rapid scoring systems in mortality prediction of critically ill patients with novel coronavirus disease","volume":"27","author":"Hu","year":"2020","journal-title":"Acad Emerg Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1513\/AnnalsATS.202003-225OC","article-title":"Hospitalization and critical care of 109 decedents with COVID-19 Pneumonia in Wuhan, China","volume":"17","author":"Du","year":"2020","journal-title":"Ann Am Thorac Soc."},{"key":"B7","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1093\/biomet\/asq006","article-title":"On the relative efficiency of using summary statistics versus individual-level data in meta-analysis","volume":"97","author":"Lin","year":"2010","journal-title":"Biometrika."},{"key":"B8","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"B9","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1002\/jrsm.1401","article-title":"Improved inference for fixed-effects meta-analysis of 2 \u00d7 2 tables","volume":"11","author":"Qijun Li","year":"2020","journal-title":"Res Synth Methods."},{"key":"B10","unstructured":"Cochrane Handbook for Systematic Reviews of Interventions. 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