The COVID-19 pandemic and temporal change in metabolic risk factors for cardiovascular disease: a natural experiment within the HELIUS study.

ObjectiveWe studied the association between the coronavirus disease 2019 (COVID-19) pandemic, including the restrictive measures, and metabolic risk factors for cardiovascular disease (CVD) in women and men. Next, we analysed whether changes in these metabolic risk factors were mediated by psychological and behavioural mechanisms. DesignIn this natural experiment, we assessed changes from baseline in metabolic CVD risk factors in the exposed group (whose follow-up measurements were taken during the pandemic), and compared these to the changes in the control group (whose follow-up measurements were taken before the pandemic). ParticipantsThis study used data from 6962 participants from six different ethnic groups (Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan) of the HELIUS study, based in Amsterdam, the Netherlands. We included women and men without prior CVD, who participated in both the baseline (2011-2015) and follow-up measurements (2019-2021). Outcome measuresChanges between baseline and follow-up measurements in six metabolic CVD risk factors were calculated for systolic and diastolic blood pressure (SBP, DBP), total cholesterol (TC), fasting plasma glucose (FPG), haemoglobin A1c (HbA1c), and estimated glomerular filtration rate (eGFR). ResultsThe exposed group experienced somewhat less favourable changes over time in SBP, DBP and FPG (the latter only in women) than the control group, while temporal changes in HbA1c and eGFR were more favourable among the control group. For instance, SBP was 1.119 mmHg [0.046, 2.193] higher in exposed than non-exposed women, and 1.380 [0.288, 2471] in men. Changes in SBP and DBP were partially mediated by changes in behavioural factors, most notably BMI and alcohol consumption. ConclusionsThe COVID-19 pandemic, including the restrictive lockdown measures, is associated with a deterioration of several CVD risk factors in women and men. These findings may aid in decision making concerning the management of and the recovery following the pandemic. Strengths and limitations of this studyO_LIThe COVID19 pandemic lockdown measures led to a pause in the data collection for the prospective, population-based HELIUS study, which shaped a natural experiment. C_LIO_LINatural experiments, as quasi-experimental designs, are generally considered stronger than cross-sectional studies. C_LIO_LIThrough inverse-probability weighting, this study aimed to account for baseline differences between the control and exposed group. C_LIO_LIWe could not adjust for differences in follow-up time that occurred as a result of the restrictive measures, which may have affected estimates of variables that change with age. C_LIO_LIThe effects of certain mediators may be underestimated, as the data available for defining these variables were largely based on self-reports. C_LI FundingThe HELIUS study is funded by the Dutch Heart Foundation (grant 2010T084), the Netherlands Organization for Health Research and Development (ZonMw; grant 200500003), the European Union (FP-7; grant 278901), and the European Fund for the Integration of non-EU immigrants (EIF; grant 2013EIF013). This work was additionally supported by ZonMw Gender and Health Program (grant 849200008). Conflict of interestsNone declared