#19,109
During the opening salvo of the COVID pandemic we saw an abrupt increase in out-of-hospital cardiac arrests; in early April 2020, the New York Fire Department reported a 400% increase in sudden cardiac arrest deaths (see NBC affiliate Massive Spike in NYC ‘Cardiac Arrest’ Deaths Seen as Sign of COVID-19 Under counting).
While most of these cases were never tested for COVID-19, this trend became so pronounced that the city ordered new Standards Of Care During A Pandemic: CPR & Cardiac Arrest, limiting the use of CPR in the field.
Two months later, JAMA published an original investigation which found 10-fold increase in out-of-hospital cardiac arrests in New York City during the peak of their COVID-19 epidemic.
By mid-summer of that year, it was apparent that COVID was more than just a respiratory virus (see Nature Med. Review: Extrapulmonary manifestations of COVID-19), and can cause blot clots, along with severe cardiovascular damage.
That first summer we saw this cautionary editorial published in JAMA.
Coronavirus Disease 2019 (COVID-19) and the Heart—Is Heart Failure the Next Chapter?
Clyde W. Yancy, MD, MSc1,2; Gregg C. Fonarow, MD3,4
JAMA Cardiol. Published online July 27, 2020. doi:10.1001/jamacardio.2020.3575
Since then, studies showing post-acute impacts of COVID infection have exploded, with many citing repeated COVID infections as increasing the risk of long-term health damage. A few (of many) include:
Nature: Long-term Cardiovascular Outcomes of COVID-19While `Long COVID' and PASC (Postacute Sequelae of COVID) are now officially recognized conditions, researchers are still unravelling their impact.
AHA: COVID-19 May Trigger New-Onset High Blood Pressure
NIH: Study Shows SARS-CoV-2 Infects Coronary Arteries, Increases Plaque Inflammation
EHJ: Accelerated Vascular Ageing After COVID-19 Infection: The CARTESIAN Study
Today we've a study from Sweden's Karolinska Institutet which links `Long COVID' to new or emerging (incident) cardiovascular disease.
Pia Lindberga,b Pia.lindberg@ki.se ∙ Samuel Wiqvistg ∙ Maria Juszczykc,h ∙ Seika Leed ∙ Marta A. Kisield ∙ Caroline Wachtlere,f ∙ et al.
Summary
Background
Long COVID has emerged as a global health challenge, with increasing evidence of cardiovascular sequelae. Most previous studies have focused on hospitalised cohorts, whereas cardiovascular risk in community-managed long COVID cases remains less explored. We aimed to investigate the incidence of major cardiovascular events in individuals with long COVID compared to those without long COVID in a large population-based setting.
Methods
Multimorbidity Integrated Registry Across Care Levels in Stockholm (MIRACLE-S) is a population-based cohort that covers all providers of healthcare for around 2.5 million residents in Stockholm County. Individuals aged 18–65 years with a physician-assigned long COVID diagnosis (ICD-10: U09.9) between October 2020 and January 2025 were identified. Exclusion criteria were hospitalisation for acute COVID-19 or pre-existing cardiovascular disease. Cox proportional hazards models estimated the effect of long COVID on a composite cardiovascular outcome (myocardial infarction, heart failure, cardiac arrhythmias, stroke, peripheral arterial disease), adjusting for demographic, lifestyle, and mental health factors.
Findings
Among 1,217,693 individuals, 8999 (0.7%) had long COVID diagnosis (66% women). Cumulative incidence of any cardiovascular event was higher in long COVID group (women 18.2%, men 20.6%) compared with control group (women 8.4%, men 11.1%). In a fully adjusted model, long COVID was associated with the composite cardiovascular outcome (women HR 2.06, 95% CI 1.92–2.22; men HR 1.33, 1.20–1.48), cardiac arrhythmia (women HR 3.11, 2.85–3.39; men HR 1.61, 1.41–1.85), and coronary artery disease (women HR 1.25, 1.04–1.52; men HR 1.26, 1.05–1.51). Heart failure incidence was elevated in women only (HR 1.25, 1.00–1.55), as also was peripheral artery disease (HR 1.25, 1.05–1.50). Long COVID was not associated with stroke in either sex.
Interpretation
Long COVID is associated with increased risk of incident cardiovascular disease, particularly cardiac arrhythmias, heart failure, and coronary artery disease. These findings underscore the need for systematic follow-up and integration of long COVID into cardiovascular risk assessment.
(SNIP)
Discussion
This population-based cohort study demonstrates that individuals who developed long COVID after mild-to-moderate infection have an elevated risk of future cardiovascular disease analysed as a composite outcome. In particular, cardiac arrhythmias demonstrated markedly increased incidence in women with long COVID, although both sexes were affected. Risk of coronary artery disease was also elevated and in women and men, while heart failure and periphery artery disease were significant in woman patients with long COVID only.These findings are consistent with previous studies showing increased risk of cardiovascular sequelae in long COVID-19, including studies in non-hospitalised populations.2,4,17 The magnitude of excess risk for arrhythmias (HR ∼3.1 in women; HR ∼1.6 in men) is in agreement with earlier epidemiological and clinical research.3,7,18
These findings suggest an elevated burden of cardiovascular morbidity in individuals with long COVID, even in the absence of acute infection requiring hospitalisation.
Long COVID associated with increased risk of cardiovascular disease
People with long COVID are at increased risk of developing cardiovascular disease, according to a new study from Karolinska Institutet published in eClinicalMedicine. The results show that the risk of conditions such as cardiac arrhythmias and coronary artery disease is higher even among those who were not hospitalised during the acute infection.
(SNIP)
During the follow-up period of around four years, people with long COVID were more likely to suffer from cardiovascular disease: 18.2 per cent of women and 20.6 per cent of men experienced some form of cardiovascular event, compared with 8.4 per cent of women and 11.1 per cent of men in the group without long COVID.
When the researchers then adjusted the results for factors such as age, socio-economic status and other known risk factors, the differences remained. Women with long COVID had just over twice the risk of receiving a cardiovascular diagnosis compared with women without long COVID. Men had approximately a third higher risk.
“We found that cardiac arrhythmias and coronary artery disease were more common among both women and men with long COVID. In women, there was also an increased risk of heart failure and peripheral vascular disease.
Despite the preponderance of evidence enumerating the long-term negative health consequences of SARS-CoV-2 infection, much of the world now considers COVID be no worse than the catching `common cold', and that the real health risk lies in taking the vaccine.
As a result, uptake of the vaccine has plummeted, and few bother to take any precautions against infection.
A recent study (see PLoS Med.: Association Between COVID-19 Vaccination and Sudden Death in Apparently Healthy Younger Individuals) found no evidence that COVID-19 vaccines increase the risk of sudden cardiac death in young healthy adults, but they did find a strong link between recent COVID infection and an increased risk of sudden cardiac death.
But since they don't reflect popular opinion, these types of studies tend to be ignored by the media, and by the general public.
