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Long-Term Cardiovascular Outcomes of COVID-19
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- Using data from the US Department of Veterans Affairs, this 12-month longitudinal cohort study estimated the risks and burdens of a set of prespecified cardiovascular outcomes in individuals who survived acute COVID-19. Beyond the first 30 days after acute infection, individuals in the COVID-19 group demonstrated increased risks and burdens for all the prespecified cardiovascular outcomes compared with those in the control group. Furthermore, the risks and burdens for the prespecified cardiovascular outcomes increased in a graded fashion according to the care setting (outpatient, hospitalized, or ICU admission) during the acute phase of the infection.
- The 1-year risks and burdens of post-acute COVID-19 cardiovascular sequelae are substantial and span several diseases. Care strategies for survivors of acute COVID-19 should include attention to cardiovascular health.
abstract
This abstract is available on the publisher's site.
Access this abstract nowThe cardiovascular complications of acute coronavirus disease 2019 (COVID-19) are well described, but the post-acute cardiovascular manifestations of COVID-19 have not yet been comprehensively characterized. Here we used national healthcare databases from the US Department of Veterans Affairs to build a cohort of 153,760 individuals with COVID-19, as well as two sets of control cohorts with 5,637,647 (contemporary controls) and 5,859,411 (historical controls) individuals, to estimate risks and 1-year burdens of a set of pre-specified incident cardiovascular outcomes. We show that, beyond the first 30 d after infection, individuals with COVID-19 are at increased risk of incident cardiovascular disease spanning several categories, including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease. These risks and burdens were evident even among individuals who were not hospitalized during the acute phase of the infection and increased in a graded fashion according to the care setting during the acute phase (non-hospitalized, hospitalized and admitted to intensive care). Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial. Care pathways of those surviving the acute episode of COVID-19 should include attention to cardiovascular health and disease.
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Long-term cardiovascular outcomes of COVID-19
Nat. Med. 2022 Feb 07;[EPub Ahead of Print], Y Xie, E Xu, B Bowe, Z Al-AlyFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Cardiovascular complications post COVID-19 infection
Many times, we have heard experts say that “COVID-19 is just a cold so what’s the big deal?” In fact, many think that the more people get COVID-19, the better because we will reach herd immunity. Unfortunately, this virus can cause some adverse long-term complications. Now I am not talking about long COVID—I am talking about cardiovascular complications. Could COVID-19 increase cardiovascular events after the acute infection is over?
These researchers used the US veterans database and compared 153,760 individuals who had COVID-19 with over 5 million patients who did not have COVID-19 infection. They noticed that the COVID-19–infected group had more cardiovascular outcomes across the board than those who did not have COVID-19. Here are just a few of the common events:
Therefore, having had COVID-19 increased the risk of all these complications by 50% to 70%. However, in the case of pulmonary embolism and myocarditis, the risk increased by 290% and 530%, respectively. Therefore, there are long-term consequences of having had COVID-19.
The authors also looked at the data based on whether the patient was admitted to the ICU, was hospitalized, or was not hospitalized. There was a dose–response. The ICU patients had the highest hazard ratios, whereas the outpatients had the lowest hazard ratios. However, when we say "the lowest hazard ratios" we are still talking about 50% to 70% higher than those of the non-COVID group.
This study tells us that the virus can cause long-term cardiovascular complications. The mechanism through which the virus causes these complications is not fully understood. Is it as a result of the damage caused by the virus during the infection or is it due to damaged caused by an over-responsive immune system even after resolution of the acute infection? We do not know. However, it is clear that it is better not to be infected. For those who say that COVID-19 is just a cold—it is not just a cold and nothing good comes from getting infected with this virus. Getting infected might not even protect us against the next mutant as we saw that patients who were infected with the delta variant could still get infected with the omicron variant.
For individuals who have not had the infection, the advice is simple—don’t get the infection. For individuals who have had it, there is a need to reduce all other cardiovascular risk factors and monitor these patients more closely to prevent future events.
Perhaps the risk calculators such as, Framingham or European SCORE need to add a check box for COVID-19 and another box for hospitalized or admitted to the ICU. This might help us identify the higher-risk individuals. This is the legacy that this virus is leaving with us. COVID-19 is not just a cold.