Cardiovascular risk and the COVID-19 pandemic: a retrospective observational study in a population of healthcare professionals
Authors: Solfanelli G , Tropea A , Giaccio D , Bucicovschi V , Gallo G , Tocci G , Musumeci M B , Marcellini L , Barbato E , Volpe M , Battistoni A 
Published: November 2023

Abstract

Background
To contain the spread of COVID-19, many countries imposed several restrictive measures, leading to radical changes in daily life behaviors.
Social isolation, stress, the fear of being infected by SARS-CoV-2 and economic crisis could have generate unhealthy habits such as eating junk food, sedentary lifestyle and increased alcohol and tobacco consumption, that could have a serious impact on individual cardiovascular (CV) risk [1, 2, 3]. Healthcare workers experienced additional stress due to the increased risk of contagion, possibly leading to an increase in unhealthy habits [4]. Currently, there is no data in literature about the potential effect of these lifestyle changes on the CV risk of healthcare workers during the pandemic.

Purpose
In our study, we investigated how the CV risk has changed during the pandemic in a healthy population of healthcare workers, calculating the SCORE-2, a new algorithm to estimate 10-year risk of CV disease in apparently healthy people aged 40-69 years, described in 2021 by European Society of Cardiology (ESC) guidelines [5].

Methods
We included healthy healthcare workers, aged &gt;40 years with at least one complete medical examination with anamnestic and laboratory data in the 12 months preceding the lockdown (T0, from 10/03/2019 to 09/03/2020) and two more annual medical assessments during the pandemic period (T1, from 10/03/2020 to 09/03/2021 and T2, from 10/03/2021 to 09/03/2022). From records, we investigated the presence of main CV risk factors as outlined by ESC guidelines [5], stratifying individuals in low-moderate, high and very high risk for fatal and non-fatal CV disease at 10 years according to the SCORE-2 [5]. An analysis by subgroups was also conducted (sportspeople vs sedentary subjects).

Results
We included 264 consecutive participants, the average age was 47.1 +/- 5.9 years (72% female, 28% men). The main characteristics at T0, T1 and T2 of the population are summarized in Picture 1. We found a significant increase in the average CV risk, according to SCORE-2, during the follow-up in our healthy population, with a shift from a mean low-moderate risk profile (T0: 2.35%; T1: 2.49%) to a mean high-risk profile at T2 (2.80%) (Picture 2 A). In the population of physically active subjects the SCORE-2 ranged from 2.22% at T0 to 2,25% at T1 and 2,45% at T2. Whereas, in sedentary subjects the baseline SCORE-2 was 2.38%, increasing to 2,55% at T1 and reaching 2,88% at T2 (Picture 2 B). Furthermore, in our population a significant increase in total cholesterol, LDL and HDL cholesterol, glycemia, BMI, PAD and smoking habit was observed (Picture 1).

Conclusions
Since 2019, we observed an increase in CV risk profile in a healthy population of healthcare workers, particularly in sedentary subjects, highlighting the need to reassess SCORE-2 every year to promptly treat high-risk subjects, according to the latest Guidelines.