Infectious Disease

In survivors of acute COVID-19, CV risk, burden ‘substantial’

February 09, 2022

2 min read

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The authors report no relevant financial disclosures.

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Compared with controls, survivors of acute COVID-19 have elevated CV risks and burdens at 1 year, even if they were not hospitalized for COVID-19, researchers reported in Nature Medicine.

“Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial,” Yan Xie, mph, biostatistician in the Clinical Epidemiology Center at the VA St. Louis Health Care System, and colleagues wrote.

Xie and colleagues used Veterans Affairs databases to create three cohorts: 153,760 veterans who survived the first 30 days of COVID-19, a contemporary control group of 5,637,647 veterans who had no evidence of COVID-19 and a historical control group of 5,859,411 veterans from 2017 who did not have COVID-19.

Participants were followed for approximately 1 year, corresponding to 12,095,836 person-years of follow-up, for incidence of various CV outcomes. The COVID-19 cohort was stratified into three groups representing disease severity: not hospitalized, hospitalized and admitted to the ICU.

Elevated risks and burdens

Xie and colleagues found that compared with contemporary controls, the COVID-19 cohort had elevated risk for and burden of the following CV outcomes at 1 year:

  • cerebrovascular outcomes (HR = 1.53; 95% CI, 1.45-1.61; burden per 10,000 persons = 5.48; 95% CI, 4.65-6.35);
  • arrhythmia outcomes (HR = 1.69; 95% CI, 1.64-1.75; burden per 10,000 persons = 19.86; 95% CI, 18.31-21.46);
  • ischemic heart disease outcomes (HR = 1.66; 95% CI, 1.52-1.8; burden per 10,000 persons = 7.28; 95% CI, 5.8-8.88);
  • other CV disorders such as HF, nonischemic cardiomyopathy, cardiac arrest and cardiogenic shock (HR = 1.72; 95% CI, 1.65-1.79; burden per 10,000 persons = 12.72; 95% CI, 11.54-13.96);
  • thromboembolic disorders (HR = 2.39; 95% CI, 2.27-2.51; burden per 10,000 persons = 9.88; 95% CI, 9.05-10.74);
  • major adverse CV events, defined as MI, stroke or all-cause death (HR = 1.55; 95% CI, 1.5-1.6; burden per 10,000 persons = 23.48; 95% CI, 21.54-25.48); other
  • any CV outcome (HR = 1.63; 95% CI, 1.59-1.68; burden per 10,000 persons = 45.29; 95% CI, 42.22-48.45).

The results were similar when the COVID-19 group was compared with the historical controls, Xie and colleagues wrote.

The results did not vary by age, race, sex, obesity, smoking, diabetes, chronic kidney disease, hyperlipidemia and CVD. An analysis of only participants who had no CVD at baseline was consistent with the main results, the researchers wrote.

Severity of infection

Compared with the contemporary control group, in the COVID-19 group, the risks and 1-year burdens of the CV outcomes increased with increasing severity of infection, but even those who had COVID-19 and were not hospitalized for it had elevated risk for most CV outcomes compared with controls, according to the researchers, who noted there were similar findings for the COVID-19 group compared with the historical controls.

In addition, Xie and colleagues wrote, COVID-19 was associated with elevated risk for myocarditis and pericarditis when participants were censored at the time of first COVID-19 vaccine dose and after adjustment for vaccination as a time-varying covariate.

“Care strategies of people who survived the acute episode of COVID-19 should include attention to cardiovascular health and disease,” Xie and colleagues wrote. “Our study shows that the risk of incident cardiovascular disease extends well beyond the acute phase of COVID-19.”

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