P3.280: The Pressure is On: Pediatric COVID-19 Infections Increase the Risk of Hypertension But Not Dyslipidemia or Type 2 Diabetes

Background: Hypertension, dyslipidemia and type 2 diabetes (T2DM) are adiposopathy (sick-fat)-associated conditions which elevate cardiovascular risk, impair quality of life and strain healthcare systems. Fat dysfunction, traditionally linked to obesity, plays a role in the development of these metabolic conditions. SARS-CoV-2 infection may lead to fat dysfunction through its direct infection and inflammation of fat tissues. There is some evidence, mostly in adults, to suggest COVID-19 increases the risk of adiposopathy-related conditions, but the specific impact on children is unclear. This study investigated the potential direct association between COVID-19 infection and new diagnoses of hypertension, dyslipidemia and T2DM, in children.

Methods: We conducted a retrospective propensity score-matched cohort study using the Military Health System Database in dependent children and youth, ages 2-24 years. COVID-19 infections (07/2020-06/2021) were identified by ICD-10 codes and labs. Propensity score matching (1:2) COVID-19 exposed to non-exposed individuals was completed using approximately 1,800 clinical variables representing diagnoses, hospitalizations, procedures, prescriptions, age, sex, beneficiary type and month (Table 1). Outcomes were identified by ICD-10 codes and to focus on incident cases those with pre-existing diagnoses prior to COVID-19 exposure were excluded. Proportional Hazards regression estimated hazard ratios (HR) for incident hypertension, dyslipidemia and T2DM post-infection, adjusted for overweight/obesity (identified through ICD-10 codes).

Results: After washout to remove prevalent cases, 1,634 (1.31%) of 124,503 participants developed hypertension, 945 (0.74%) of 127,584 dyslipidemia, and 229 (0.17%) of 131,052 T2DM. Median time to incident hypertension was 179 days in COVID-19 exposures versus 192 days in controls, dyslipidemia was 187.5 days in exposures versus 182 in controls, and T2DM was 196 days in exposures versus 173 in controls. COVID-19 infection was associated with increased risk of hypertension (HR 1.33; 95%CI 1.19-1.47), but not dyslipidemia (HR 1.13; 95%CI 0.98-1.30) or T2DM (HR 0.90; 95%CI 0.67-1.21)(Figure 1). Median age at hypertension diagnosis was 17 years (IQR 14-19), dyslipidemia was 17 years (IQR 14-19), and T2DM was 18 years (IQR 15-19), slightly older than those unaffected (median 15 years (IQR 10-18)). Compared to the overall cohort (53% female), there was a modest male predominance in hypertension (49% female), while dyslipidemia (61% female) and T2DM (56% female) showed a modest female predominance. As expected, overweight and obesity were more common in those with incident sick-fat associated diagnoses compared to those without.

Conclusion: This study demonstrates a significant association between COVID-19 infection and increased hypertension risk in pediatric patients. Dyslipidemia and T2DM were not significantly associated with COVID-19 infection. Targeted cardiovascular monitoring in children post-COVID-19 may be beneficial for early identification of hypertension. Demonstrated risks associated with COVID-19 infection in children support ongoing vaccination efforts. These findings inform pediatric healthcare by emphasizing early intervention to mitigate potential long-term cardiovascular risks and improve outcomes in this at-risk group.