A massive analysis of health records has revealed recovered COVID-19 patients are at a significantly higher risk of cardiovascular complications in the year following an acute infection. The new findings, published in Nature Medicine, showed COVID-19 survivors were 55 percent more likely to experience a serious cardiovascular event after recovering.
“We wanted to build upon our past research on COVID’s long-term effects by taking a closer look at what’s happening in people’s hearts,” explained Ziyad Al-Aly, senior author on the new study from Washington University. “What we’re seeing isn’t good. COVID-19 can lead to serious cardiovascular complications and death. The heart does not regenerate or easily mend after heart damage. These are diseases that will affect people for a lifetime.”
The researchers looked at medical records from the US Department of Veteran Affairs, analyzing around 150,000 positive COVID-19 cases. Cardiovascular outcomes in the 12 months after acute disease were compared to two large control groups of more than five million patients.
In a period starting 30 days after initial infection, and up to a year later, COVID patients were 72 percent more likely to experience coronary artery disease compared to those without SARS-CoV-2 infection. They were also 52 percent more likely to have a stroke and 63 percent more likely to suffer a heart attack.
Overall, the study found COVID-19 patients experienced a 55 percent higher rate of major adverse cardiovascular events in the year following their acute disease. These adverse events included cerebrovascular disorders such as stroke, ischemic and non-ischemic heart disease, pericarditis, myocarditis, and heart failure.
Al-Aly pointed out that risks of cardiovascular events were higher in those with pre-existing heart conditions and those suffering from more severe COVID-19. However, across all cohorts the study still found COVID-19 increased one’s risk of heart problems.
“… most remarkably, people who have never had any heart problems and were considered low risk are also developing heart problems after COVID-19,” said Al-Aly. “Our data showed an increased risk of heart damage for young people and old people; males and females; Blacks, whites and all races; people with obesity and people without; people with diabetes and those without; people with prior heart disease and no prior heart disease; people with mild COVID infections and those with more severe COVID who needed to be hospitalized for it.”
Exactly why SARS-CoV-2 infection is increasing a person’s risk of cardiovascular disease is still unclear. In the new study the researchers hypothesize a number of potential mechanisms, such as lingering damage in cells from the acute viral infection to a persistent hyperactive immune response following the disease.
“These mechanistic pathways might explain the range of post-acute COVID-19 cardiovascular sequelae investigated in this report,” the researchers wrote in the study. “A deeper understanding of the biologic mechanisms will be needed to inform development of prevention and treatment strategies of the cardiovascular manifestations among people with COVID-19.”
These results add to a growing body of data highlighting the long-term effects of COVID-19. Most recently, an Australian study tracked 20,000 COVID-19 cases for up to one year following acute infection. That study found COVID-19 significantly increased a person’s risk of neurological, cardiac and vascular disease events compared to those not infected with SARS-CoV-2.
“Risk of myocarditis and pericarditis is particularly high, estimated between 18- and 21-fold higher following SARS-CoV-2 infection,” the new Australian study noted. “Elevated risk have also been shown for acute myocardial infarction (AMI) between 3- and 6-fold, ischaemic stroke at 3- to 10-fold, and venous thromboembolism at up to 8-fold. Notably, these risk estimates are higher than those imposed by other viral respiratory infections and vaccination.”
It is important to note both of these studies, and most long-term COVID-19 follow-up research, are tracking cases from 2020. These are cohorts that are primarily unvaccinated and experiencing infection from early strains of the virus.
Al-Aly does indicate it is likely vaccination will reduce the long-term cardiovascular risks associated with COVID-19. But, it will take more time to understand exactly how much protection vaccines confer in terms of these long COVID outcomes.
In the short-term, Al-Aly says it is vital governments prepare for increased pressure on health systems over the coming years due to these longer-term effects of COVID-19. He especially notes these findings underscore the importance of vaccine distribution in low-income countries as a way to try to mitigate the future impact of these post-COVID events.
“Governments and health systems around the world should be prepared to deal with the likely significant contribution of the COVID-19 pandemic to a rise in the burden of cardiovascular diseases,” said Al-Aly. “Because of the chronic nature of these conditions, they will likely have long-lasting consequences for patients and health systems, and also have broad implications on economic productivity and life expectancy.”