Abstract Body: Background: Severe COVID-19 is a known cause of cardiac injury, while hypertension (HTN) remains a dominant cardiovascular risk factor. However, the cardiac and inflammatory biomarker profiles in community-dwelling adults with asymptomatic SARS-CoV-2 infection, when combined with HTN, remain unclear, limiting evidence-based post-pandemic cardiovascular risk stratification.
Objective: To assess independent associations and multiplicative interactions between prior mild SARS-COV-2 infection and HTN of these biomarkers: high-sensitivity troponin I (Hs-cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP), Galectin-3, and C-reactive protein (CRP) in this cohort.
Methods: We conducted a cross-sectional analysis of the C-FORWARD cohort. SARS-Cov-2 infection was defined by positive nucleocapsid IgG serology. Participants were categorized into four mutually exclusive groups: COVID-19 + HTN, COVID-19 only, HTN only, or neither (reference). Biomarkers were dichotomized using clinical thresholds: Hs-cTnI (≥ 6 ng/L), NT-proBNP (≥ 125 pg/mL), Galectin-3 (≥ 20.8 ng/mL), and CRP (≥ 0.9 mg/L). We ran multivariable logistic regression models for each biomarker, including a multiplicative interaction term between COVID-19 and HTN, adjusting for age, sex, BMI, diabetes, and CVD.
Results: Among 606 participants (mean age 50.6 [16.8]), 28 (4.6%) had COVID-19+HTN, 62 (10.3%) had COVID-19 only, 173 (28.5%) had HTN only, and 343 (56.6%) had neither. Compared to the reference, the HTN-only group had higher odds of elevated Hs-cTnI (OR 4.90, 95% CI 3.76–6.41) and Galectin-3 (OR 2.28, 95% CI 1.72–3.02) but lower odds of elevated CRP (OR 0.66, 95% CI 0.43–0.98) and NT-proBNP (OR 0.67, 95% CI 0.51–0.88). The COVID-19-only group had lower odds of elevated hs-cTnI (OR 0.64, 95% CI 0.52–0.79) and NT-proBNP (OR 0.68, 95% CI 0.58–0.81) with no significant differences in Galectin-3 (OR 0.88, 95% CI 0.71–1.09) and CRP (OR 0.82, 95% CI 0.65–1.04). The COVID-19+HTN group had lower odds of elevated CRP (OR 0.82, 95% CI 0.63–1.08) and NT-proBNP (OR 0.55, 95% CI 0.46–0.65), but higher odds of elevated Galectin-3 (OR 1.89, 95% CI 1.52–2.37) and slightly higher hs-cTnI (OR 1.14, 95% CI 0.92–1.42). Notably negative interaction for hs-cTnI.
Conclusion:
In this cohort, HTN, not prior mild SARS-CoV-2 infection, was the main driver of biomarker elevations. These findings reinforce the importance of targeting traditional cardiovascular risk factors amid mild COVID-19 in the post-pandemic era.