Covid-19: cardiovascular diseases increase among people who were infected

People who have never had heart problems and who were considered low risk are also developing heart conditions after Covid-19

A research study published in the journal Nature titled “Long-term cardiovascular outcomes of COVID-19” shows that people who have had Covid-19 are at increased risk of developing cardiovascular complications in the first month to one year after infection. Problems occur even among individuals who were healthy before being afflicted with SARS-CoV-2, as well as among those who had mild Covid-19. Cardiovascular complications include altered heart rhythms, heart inflammation, blood clots, stroke, coronary artery disease, heart attack, heart failure, and even death.

Dr. Ziyad Al-Aly, co-author of the study and Chief of Research and Development Service, VA Saint Louis Health Care System, acknowledges that the findings that cardiovascular complications from Covid can last so long were surprising. I wasn´t expecting this. I also expected this to happen only in people at elevated risk of cardiovascular disease, but it was happening all over the place, among young and old, obese and non-obese, people with and without diabetes, etc.

To carry out this large study, scientists at the University of Washington, in the United States, created a dataset with health information from 153,760 people who tested positive for the new coronavirus in the period between March 1, 2020, and January 15, 2021. Because vaccines were not yet widely available at the time of enrollment, few people in the study were vaccinated before developing Covid-19. The survey does not include data from the Delta and Omicron variants, which began to spread rapidly in the second half of 2021.

Using statistical modeling to analyze heart health over this one-year period, scientists found that heart disease, including heart failure and death, occurred in 4% (about 3 million people in the U.S.) more than those who were not infected with the coronavirus. In addition to evaluating data from these more than 153 thousand individuals who had Covid-19, they also analyzed two sets of people not infected with the virus, technically called control groups: a group of more than 5.6 million patients who did not have the disease during the same period; and a group of more than 5.8 million people who were cardiovascular disease patients from March 2018 to January 2019 (before the pandemic).

Compared with the groups without infections, people who contracted Covid-19 were 72% more likely to have coronary artery disease, 63% more likely to have a heart attack and 52% more likely to have a stroke. Overall, those infected were 55% more likely than those without previous disease to experience a major adverse cardiovascular event, which includes heart attack, stroke, and death. According to the analysis, the risk was elevated even for those younger than 65 and without risk factors such as obesity or diabetes. People who recovered from Covid-19 marked increases in at least 20 cardiovascular problems over the course of a year after infection. Although hospitalization increased the likelihood of future cardiovascular complications, even people who were not hospitalized were at increased risk for many heart conditions.

Asked if the increase in the risk of cardiovascular problems is associated with the imbalance in the immune system caused by Covid-19, which also happens in the framework of other inflammatory diseases, such as cancer, Dr. Al-Aly says it is possible. We were not able to fully understand the mechanisms responsible for the increased risk of cardiovascular disease in people with Covid-19. Some mechanistic pathways may be related to the virus itself and some may be related to the immune response, including some potentially dysregulated immune response or autoimmunity), he points out.

The evidence from this study reinforces that the risks of serious cardiac complications are high from the natural infection and the findings highlight the serious long-term cardiovascular consequences of having a Covid-19 infection, as well as corroborating the importance of getting vaccinated against Covid-19 as a way to prevent heart damage. But, in this case, what about countries with limited resources to access vaccines? Dr. Al-Aly is adamant that it is absolutely important to ensure that vaccines are available everywhere around the world. According to him, vaccination is the foundation of our response to the pandemic, and no country will be completely safe until enough people in the world are vaccinated. This is a crucial point that developed economies need to understand. We all need to work together to ensure the entire world is vaccinated. The study also raises an alert to professionals and health systems to deal with this increase in cardiovascular diseases in populations. Health care professionals should start to think of Covid-19 as a major risk factor for cardiovascular disease and treat people with the disease with that perspective in mind, he emphasizes.

This work, which revealed that infection caused by Covid-19 increases the risks of developing cardiovascular disease, used retrieved data, curated by the United States Department of Veterans Affairs, the largest integrated health care system in the country. Asked about the limitations of the study, in which in the control group, not all people were tested for Covid-19 and, therefore, could have mild infections that were not detected and, given that the database was composed by war veterans, mostly white men, that is, the results also refer to a specific population, Dr. Al-Aly explains that it is possible that some people in control had Covid but were not tested. “So, if that is the case, it would lead to an underestimate of the risk. Although our study consisted primarily of white men, it was very large, with more than 11 million people, with 10% women (1 million) and 20% black (2 million). That is not small. Due to the large size of the study, it included a large number of women and blacks”, he details. Finally, Dr. Al-Aly said that he and his colleagues are now looking at long-term outcomes and other issues related to Covid and long Covid, including post-Covid-19 diabetes and other conditions.