As we enter the third year of the pandemic, it is becoming increasingly clear that Covid-19 infection impacts our health beyond the acute stage of the illness. More than 40% of Covid-19 survivors globally have experienced longer-term symptoms. Now, a new study demonstrates that infection with Covid-19 appears to impact the risk of cardiovascular events up to 12 months post-infection, even in those who weren’t hospitalized or had mild cases. Risks increased regardless of age, race, sex, obesity, smoking, or other cardiovascular disease risk factors.
The study found the incidence of serious cardiovascular problems was 4.5% higher in the 12 months after people were diagnosed with Covid-19 compared to those who were not infected. This percentage may seem small until you consider that the CDC recently estimated that over 140 million people in the US have been infected with Covid-19, meaning approximately 6.3 million could be facing cardiovascular problems. Our ongoing case counts could create generations of patients with heart problems.
The study published in Nature used data from US Department of Veterans Affairs national health care databases to follow over 153,000 veterans with a history of Covid-19 infection for up to a year after their recovery. The researchers also used a contemporary and a historical control group to estimate risks and 1-year burdens of a set of pre-specified cardiovascular incident outcomes. The contemporary control group compromised of 5,637,647 patients with no evidence of SARS-CoV-2 infection who used VHA services in 2019. The historical control group compromised of 5,859,411 pre-pandemic patients who used VHA services in 2017.
The study population was largely made up of older white male patients. The Covid-19 cohort, which averaged 61 years old, included 89 percent males and about 71 percent white individuals. However because the study population was large, it also included almost 17, 000 female patients; approximately 37, 000 Black patients; and almost 8,000 Latino, Asian, American Indian, Native Hawaiian, and patients of other races with Covid-19.
The researchers found that in the year after recovering from the illness’s acute phase, patients had starkly increased risks of different cardiovascular problems, including abnormal heart rhythms, heart muscle inflammation, blood clots, strokes, myocardial infarction, and heart failure.
At the 12-month mark, for every 1000 people compared to the contemporary control group, Covid-19 infection was associated with:
- 45.29 incidents of any prespecified cardiovascular outcome
- 23.48 incidents of major adverse cardiovascular events including myocardial infarction, stroke, and all-cause mortality
- 19.86 incidents of dysrhythmias, including 10.74 incidents of atrial fibrillation
- 12.72 incidents of other cardiovascular disorders including 11.61 incidents of heart failure and 3.56 incidents of nonischemic cardiomyopathy
- 9.88 incidents of thromboembolic disorders, including 5.47 incidents of pulmonary embolism and 4.18 incidents of deep vein thrombosis
- 7.28 incidents of ischemic heart disease including 5.35 incidents of acute coronary disease, 2.91 incidents of myocardial infarction, and 2.5 incidents of angina
- 5.48 incidents of cerebrovascular disorders, including 4.03 incidents of stroke
- 1.23 incidents of inflammatory disease of the heart or pericardium, including 0.98 incidents of pericarditis and 0.31 incidents of myocarditis
While hospitalization did increase the likelihood of future cardiovascular complications, people who avoided hospitalization were still at higher risk for many conditions. Other subgroup analyses found increased risks regardless of age, race, sex, obesity, smoking, hypertension, diabetes, chronic kidney disease, hyperlipidemia, and preexisting cardiovascular disease.
The study was well designed, not only using extensive control cohorts but also accounting for external factors. Because some Covid-19 vaccines may be associated with very rare cases of myocarditis and pericarditis, the researchers conducted analyses to remove the effect of vaccination. The increased risk of myocarditis and pericarditis remained among people who were not vaccinated and was clear regardless of vaccination status.
Based on the results of this study, I recommend that everyone who has been infected with Covid-19, mild or otherwise get a cardiovascular workup within 12 months of infection. I urge anyone who has unexplained cardiovascular symptoms after a Covid-19 infection to take them seriously and seek medical care immediately. Physicians should also be adjusting their screening questions to include past infection with Covid-19 and assess for all Long Covid symptoms including cardiovascular. Early identification, diagnosis, and treatment of heart disease are essential to lessen the risk of adverse health impacts.
The cardiovascular disease risk associated with Covid-19 infection further highlights how we need a coordinated global response strategy to urgently address the challenges of dealing with the long-term health effects of Covid-19.