Findings from a study published in Nature Medicine showed that 1-year risks and burdens of cardiovascular diseases among people who survive the acute phase of coronavirus disease 2019 (COVID-19) are substantial and span several cardiovascular disorders.
“We provide evidence that, beyond the first 30 days of infection, people with COVID-19 exhibited increased risks and 12-month burdens of incident cardiovascular diseases, including cerebrovascular disorders, dysrhythmias, inflammatory heart disease, ischemic heart disease, heart failure, thromboembolic disease and other cardiac disorders,” wrote Yan Xie, VA St Louis Health Care System, St. Louis, Missouri, and colleagues. “These risks and burdens were evident even among individuals who were not hospitalised during the acute phase of the infection and increased in a graded fashion according to the care setting during the acute phase (non-hospitalised, hospitalised and admitted to intensive care).”
Further, the researchers noted that “the risks were evident regardless of age, race, sex and other cardiovascular risk factors, including obesity, hypertension, diabetes, chronic kidney disease and hyperlipidaemia; they were also evident in people without any cardiovascular disease before exposure to COVID-19, providing evidence that these risks might manifest even in people at low risk of cardiovascular disease.”
For the study, the researchers used national healthcare databases from the US Department of Veterans Affairs to built a cohort of 153,760 individuals who survived the first 30 days of COVID-19, as well as two control cohorts: a contemporary control cohort comprising 5,637,647 individuals with no evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and a historical cohort (pre-dating the COVID-19 pandemic) comprising 5,859,411 non-SARS-CoV-2-infected individuals.
Median follow-up time in the COVID-19, contemporary control and historical control groups was 347 (interquartile range, 317–440), 348 (318–441) and 347 (317–440) days, respectively. The COVID-19 group had 159,366 person-years of follow-up, while the contemporary control and historical control groups had 5,854,288 and 6,082,182 person-years of follow-up, respectively.
Overall, compared to the contemporary control group, increased risks of major adverse cardiovascular event (hazard ratio [HR] 1.55 [95% confidence interval (CI) 1.50-1.60]), any cardiovascular outcome (HR 1.63 [1.59-1.68]), a composite of dysrhythmia outcomes (HR 1.69 [1.64-1.75]), inflammatory diseases of the heart or pericardium (HR 2.02 [1.77-2.30]), thromboembolic disorders (HR 2.39 [2.27-2.51]) at 12 months were observed among people with COVID-19.
In particular, people who survived the first 30 days of COVID-19 exhibited increased risk of stroke (HR 1.52 [1.43, 1.62]), acute coronary disease (HR 1.72 [1.56, 1.90]), myocardial infarction (HR 1.63 [1.51, 1.75]) at 12 months compared to those in the contemporary control group.
When the researchers examined the risks and burdens of the pre-specified outcomes in a cohort of people without any cardiovascular disease at baseline, they found that the results were consistent with those shown in the primary analyses. In addition, compared to the contemporary control group, the risks and 12-month burdens of the pre-specified cardiovascular outcomes increased according to the severity of the acute infection.
Similarly, the researchers found that risks and associated burdens of the pre-specified outcomes were also increased among people with COVID-19 compared with the overall historical control group.
“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,” the researchers concluded, adding that “the difference-in-differences analyses, which are designed to further investigate the causality of study findings, show that the increased risks of post-acute COVID-19 cardiovascular outcomes are attributable sequelae to COVID-19 itself,” and that “the results were robust to challenge in multiple sensitivity analyses.”