SARS-CoV-2 infection leading to COVID-19 is increasingly associated with cardiovascular dysfunction and complications, as well as respiratory and other systemic diseases. Previous studies reported the incidence of cardiovascular pathologies such as myocarditis, pericarditis, ischemic stroke, arrhythmias and cardiomyopathy in patients with COVID-19, manifesting at different times during the acute and post-acute phase of the infection. These cardiovascular disease (CVD) symptoms were notably persistent in more than half of the patients (∼57%) recruited for observational studies, complaining of cardiac symptoms many weeks after recovery5 with evidence of structural and functional cardiac abnormalities such as myocardial injury. .
This persistence of ongoing signs and symptoms of COVID-19, including symptoms associated with CVD, beyond 4 to 12 weeks after recovery from COVID-19 has been internationally recognized as SARS-CoV-2 infection with post-sequelae. acute or ’long COVID’ . The exact pathophysiology of long COVID-19 is not yet understood, however, the possibility that COVID-19 accelerates the risk of cardiovascular complications over time has been proposed based on preliminary clinical data, warranting more conclusive evidence. .
Interestingly, clinical reports found that cardiac complications were evident even in healthy individuals , such as high-performance athletes and those presenting with mild/asymptomatic COVID-19 symptoms after infection, highlighting the need to evaluate cardiovascular risks. associated with long-term COVID-19 in the general population by comparing infected versus uninfected individuals.
Goals
This study aims to evaluate the short- and long-term associations between COVID-19 and the development of cardiovascular disease (CVD) outcomes and mortality in the general population.
Methods and Results
A prospective cohort of patients with COVID-19 infection between March 16, 2020 and November 30, 2020 was identified from the UK Biobank, and followed for up to 18 months , until August 31, 2021. Based on age (within 5 years) and sex, each case was randomly matched with up to 10 participants without COVID-19 infection from two cohorts: a contemporaneous cohort between March 16, 2020 and November 30, 2020. 2020 and a historical cohort between March 16, 2018 and November 30, 2018.
Characteristics between groups were further adjusted with marginal mean propensity weighting based on the score across stratification. To determine the association of COVID-19 with CVD and mortality within 21 days after diagnosis (acute phase) and after this period (post-acute phase), Cox regression was used.
In the acute phase , COVID-19 patients (n = 7584) were associated with a significantly increased risk of short-term CVD {hazard ratio (HR): 4.3 [95% confidence interval (CI): 2. 6– 6,9]; HR: 5.0 (95% CI: 3.0–8.1)} and all-cause mortality [HR: 81.1 (95% CI: 58.5–112.4); HR: 67.5 (95% CI: 49.9–91.1)] than contemporary (n=75,790) and historical (n=75,774) controls, respectively.
Regarding the post-acute phase , patients with COVID-19 (n = 7139) persisted with a significantly higher risk of long-term CVD [HR: 1.4 (95% CI: 1.2-1.8); HR: 1.3 (95% CI: 1.1–1.6)] and all-cause mortality [HR: 5.0 (95% CI: 4.3–5.8); HR: 4.5 (95% CI: 3.9–5.2) compared to contemporary (n = 71,296) and historical (n = 71,314) controls, respectively.
Conclusions
COVID-19 infection, including long-term COVID-19, is associated with increased short- and long-term risks of cardiovascular disease and mortality. Continued monitoring for signs and symptoms of the development of these cardiovascular complications after diagnosis and until at least one year after recovery may benefit infected patients, especially those with severe disease.
Final message This study demonstrates that patients with COVID-19 are associated with an increased risk of CVD and post-infection mortality (acute phase). These risks continue to increase even up to a year after recovery and are associated with long COVID. Continuous monitoring of CVD signs and symptoms in the short and long term may be beneficial to patients after infection and recovery. Further study is warranted to compare findings in a vaccinated cohort. |
