After COVID-19, unvaccinated at risk of long-term CVD complications

Clinicians should be aware of IM, myocarditis, and HF up to 1 year later in people who have never been vaccinated.

Unvaccinated people who develop COVID-19 are at a significantly increased risk of cardiovascular complications even up to 1 year after infection, compared with unvaccinated men and women who do not contract the virus, a new study shows.

At 12 months, unvaccinated COVID-19 survivors were at increased risk for a range of cardiovascular events, including stroke, arrhythmias, inflammatory heart disease, ischemic heart disease, heart failure, and thromboembolic events, and this excessive risk was observed. in both men and women.

The results indicate that “doctors and [unvaccinated] patients with a history of COVID-19 should pay extra attention to their long-term cardiovascular health,” lead investigator Weijie Wang, MD (2nd Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China), told TCTMD via email. .

To date, several studies have shown that COVID-19 survivors have a higher risk of short-term cardiovascular events. Long-term data from US patients with COVID-19 included in the Veterans Affairs (VA) databases also showed that the risk and burden of cardiovascular disease increases in both those who have been hospitalized and those who have not. Wang noted that while there is evidence of long-term cardiovascular complications in COVID-19 survivors, the VA study is difficult to extrapolate to the general population, given some of the limitations of the database. For example, it consisted largely of white male patients.

“Unfortunately, we’ve seen this before,” said Thomas Maddox, MD, MSc (Washington School of Medicine in St. Louis, MO), past chair of the American College of Cardiology Science and Quality Committee, who commented on the results for TCTMD. “There’s probably some sort of relationship between the virus itself and some effects on the cardiovascular system, whether it’s coronary heart disease, atrial fibrillation, myocarditis or some of the other things we’ve seen happen. It can affect the cardiovascular system in a number of ways. That’s a concern and one thing this study continues to underscore.”

long term data

This latest study was published this week in eClinical Medicineone of the Lancet family of journals and included racially diverse patients from 48 healthcare organizations (HCOs) in the TriNetX Research Network, which includes information on demographics, diagnoses, procedures, medications, laboratory tests, and healthcare utilization. The researchers identified 690,892 unvaccinated people 20 years and older with two or more HCO visits, and the propensity matched the same number of healthy controls who tested negative for SARS-CoV-2 and showed no symptoms of COVID-19.

Compared with controls, those with COVID-19 had higher risks of MACE (HR 1.87; 95% CI 1.82-1.93) and any cardiovascular complications (HR 1.56; 95% CI 1.53- 1.58) in 1 year. In addition, they had a significantly higher risk of a range of cardiovascular outcomes compared to controls:

  • Cerebrovascular complications: stroke (HR 1.61; 95% CI 1.55-1.69) and TIA (HR 1.50; 95% CI 1.35-1.67)
  • Arrhythmias: atrial fibrillation/flutter (HR 2.41; 95% CI 2.30-2.52), tachycardia (HR 1.68; 95% CI 1.63-1.74), bradycardia (HR 1.60; 95% CI 1.52-1.68) and ventricular arrhythmias (HR 1.60); 95% CI 1.54-1.67)
  • Inflammatory heart disease: myocarditis (HR 4.41; 95% CI 2.89-6.72) and pericarditis (HR 1.62; 95% CI 1.45-1.81)
  • Ischemic heart disease: ACS (HR 2.05; 95% CI 1.75-2.39), IM (HR 1.98; 1.83-2.14), ischemic cardiomyopathy (HR 2.81; 95% CI 2 .48-3.19) and angina (1.71; 95% CI 1.55) -1.89)
  • Cardiac disorders: Heart failure (HR 2.30; 95% CI 2.20-2.40), cardiomyopathy (HR 2.41; 95% CI 2.23-2.61), cardiac arrest (HR 1.75; CI 95% 1.53-2.01), cardiogenic shock (HR 1.99; 95% CI 1.60-2.47)
  • Thrombosis: pulmonary embolism (HR 2.65; 95% CI 2.44-2.87) and deep vein thrombosis (HR 1.88; 95% CI 1.75-2.02)

In addition to the higher 1-year CVD incident risk, the probability of survival in all CVD conditions was significantly lower among patients who had COVID-19 than in those who were not infected with SARS-CoV-2.

As the researchers point out, COVID-19 appears to induce a state of hypercoagulability, which in turn can increase the risk of thromboembolic events. COVID-19 can also trigger the cytokine cascade, which includes the release of pro-inflammatory cytokines and chemokines that can damage the cardiovascular system. Electrolyte imbalances can also lead to various tachyarrhythmias, according to Wang and colleagues.

If you’re at risk for heart disease, or have any heart disease, it’s up to you to do everything you can, to take advantage of all the tools we have right now, to avoid getting the disease. Thomas Maddox

Maddox emphasized that people with or at high risk of heart disease are much more likely to develop COVID-19, because these people are less healthy in general and because their immune systems are less able to fight the virus. “If you’re at risk for heart disease, or you have any heart disease, it’s up to you to do everything you can, take advantage of all the tools we have right now, to avoid getting the disease,” he said.

In terms of the study, Maddox suggested that the potential for confounding exists, as suggested by the finding that COVID-19 patients were at risk for all types of CVD. There is relatively good science to explain the relationship between COVID-19 and myocarditis and myocardial infarction, but less so for other clinical outcomes, he said. If COVID-19 survivors had a higher risk for all cardiovascular outcomes, “we could only be selecting people with cardiovascular health issues, but it’s difficult to separate this across all studies.”

Even conservatively accounting for the potential for confusion, Maddox said there is an element of cardiovascular risk with COVID-19 and contracting SARS-CoV-2 should be avoided in any way possible.

Vaccination, Maddox emphasized, reduces the likelihood of developing clinically significant COVID-19. However, even in the event that these people catch the virus, it is inevitably a milder course of illness than if the patients were not vaccinated. Inside and outside the clinic, he encourages those with or at increased risk of cardiovascular disease to be fully vaccinated, to reflect on community transmission rates, and to consider the quality of their connection to the health care system, should they need to be treated.

After COVID-19, unvaccinated at risk of long-term CVD complications

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