NEJM Journal Watch
Anthony L. Komaroff, MD, reviewing
Risks for chronic disease rose among COVID-19 survivors, compared with risks among contemporary controls.
COVID-19 often causes acute cardiovascular complications, even in young adults. To assess risk for chronic complications, investigators used U.S. Veterans Affairs (VA) databases to estimate new cardiovascular disease that was first diagnosed at least 30 days after initial positive COVID-19 tests. Rates were compared in three groups: 153,760 people with COVID-19, more than 5.5 million people seen in the VA system during the same time who did not have diagnosed COVID-19 (contemporary controls), and almost 6 million individuals seen in a similar window of time in 2017 (pre-pandemic historical controls).
Multivariable adjustments for confounders revealed greatly elevated risks for multiple adverse cardiovascular conditions: stroke (hazard ratio, 1.5), transient ischemic attack (HR, 1.5), atrial fibrillation (HR, 1.7), heart failure (HR, 1.7), ventricular arrhythmias (HR, 1.8), pericarditis (HR, 1.9), cardiac arrest (HR, 2.5), pulmonary embolism (HR, 2.9), and myocarditis (HR, 5.4). Risk for these conditions increased in a graded fashion depending on severity of the initial COVID-19 illness. Excess risks were seen even among previously healthy young adults with mild acute COVID-19 and also among the relatively few women in this VA-based study. Absolute rates of these disorders ranged from 1 to 12 per 1000 people.
COVID-19 causes arterial endothelial damage, infection of myocytes, complement activation with associated coagulopathy, systemic inflammation, and autonomic dysfunction — all mechanisms that could explain the excess risk for cardiovascular disease following COVID-19. This huge, carefully conducted study indicates that post–COVID-19 cardiovascular disease might impose a substantial burden of suffering and cost on societies everywhere. One caveat: Some of these cardiovascular complications could have developed during the first few weeks of illness but were only recognized and formally diagnosed after 30 days.
Xie Y et al. Long-term cardiovascular outcomes of COVID-19. Nat Med 2022 Mar; 28:583.