The cardiovascular disease burden after an acute COVID-19 infection is substantial even among those with mild to moderate disease
The cardiovascular disease burden in patients who survived after an infection with COVID-19 appears to be enormous, affecting both hospitalised and non-hospitalised patients alike. This was the finding of a study by researchers from the Clinical Epidemiology Center, Research and Development Service, Missouri, US.
It has already become clear that among those originally hospitalised because of a COVID-19 infection, there have been higher rates of subsequent cardiovascular disease. In fact, COVID-19 has become a recognised risk factor for acute myocardial infarction and ischaemic stroke. However, many of the studies for which an association between COVID-19 and subsequent adverse cardiovascular outcomes has been made, have related to patients who were originally hospitalised because of their infection. In addition, follow-up periods have been restricted to no longer than six months. Moreover, as hospitalised patients may have had a number of other co-morbidities, this alone could have further contributed to their cardiovascular disease risk burden.
In the absence of a comprehensive assessment of the cardiovascular effects of COVID-19 over a longer time frame and for individuals treated in different care settings, the authors of the current study, set out to address this important knowledge gap.
The team used the US department of Veterans Affairs national healthcare databases to build a cohort of individuals who had survived for at least 30 days after an acute COVID-19 infection and two other groups; one consisting of Veterans Affairs members with no evidence of a COVID-19 infection and a historical cohort (i.e., prior to the current pandemic) from 2017. The researchers followed these three cohorts to estimate the risks of pre-specified incident cardiovascular outcomes and further analysed these outcomes with respect to the existence of prior cardiovascular disease and according to their particular care settings.
Cardiovascular disease burden and COVID-19
The overall sample included 153,760 individuals with a mean age of 61.4 years (89% male) who had COVID-19, 5,637,647 contemporary controls and 5,859,411 historical controls. All three groups were followed for a median of 347.3 days.
Among those with COVID-19, there was a 52% increased risk of stroke (hazard ratio, HR = 1.52, 95% CI 1.43 – 1.62) compared to contemporary controls and a 49% increased risk of a transient ischaemic attack (HR = 1.49). Increased risks were also found for dysrhythmias including atrial fibrillation (HR = 1.71) and sinus tachycardia (HR = 1.84) and thromboembolic disorders such as a pulmonary embolism (HR = 2.93) and deep vein thrombosis (HR = 2.09).
The authors then used the composite endpoint of major adverse cardiovascular events (MACE) which included myocardial infarction, stroke and any of the pre-specified outcomes. Compared to the contemporary control group, the risk of MACE was 55% higher (HR = 1.55) and for any cardiovascular outcome (HR = 1.63).
The cardiovascular disease burden after a COVID-19 infection was also higher than for contemporary controls among those who did not have prior cardiovascular disease. Furthermore, these risks were still elevated, compared to those in the contemporary group, irrespective of the care setting where patients were treated, e.g., non-hospitalised, hospitalised and intensive care.
The authors concluded that their study had demonstrated a substantial cardiovascular disease burden among those who had experienced an acute infection with COVID-19, even among those without prior disease and in any care setting in comparison to those without an infection.
Xie Y et al. Long-term cardiovascular outcomes of COVID-19 Nat Med 2022