Long-term cardiovascular risks are substantial in COVID-19 survivors

Although the cardiovascular complications of acute COVID-19 are well described, the post-acute cardiovascular manifestations of COVID-19 are not yet well defined. Most studies to date had only a short duration of follow-up and were limited to hospitalized individuals (who represent the minority of people with COVID-19).1 Using national healthcare databases from the US Department of Veterans Affairs, researchers estimated the risks and one-year burdens of a set of prespecified incident cardiovascular outcomes (i.e., cardiovascular outcomes that developed between baseline and follow-up). The investigators created a cohort of 153,760 individuals with COVID-19, as well as two sets of control cohorts with 5,637,647 (contemporary controls) and 5,859,411 (historical controls) individuals.1 Read: Spironolactone not associated with a significant increase in cancer risk Results showed that beyond the first 30 days after COVID-19 infection, individuals were at increased risk of incident cardiovascular disease, including cerebrovascular disorders, dysrhythmias, ischemic and nonischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease.1 Specific cardiovascular risks and estimated excess 12-month burden of cardiovascular outcomes due to COVID-19 in people who survived beyond the first 30 days of COVID-19 were as follows: Cerebrovascular disorders—increased risk stroke (hazard ratio [HR] = 1.52; burden 4.03 per 1,000 persons at 12 months) and transient ischemic attacks (HR = 1.49; burden 1.84). Dysrhythmias—increased risk of atrial fibrillation (HR = 1.71; burden 10.74), sinus tachycardia (HR = 1.84; burden 5.78), sinus bradycardia (HR = 1.53; burden 4.62), ventricular arrhythmias (HR = 1.84; burden 4.18) and atrial flutter (HR = 1.80; burden 3.10) Inflammatory disease of the heart or pericardium—increased risk of pericarditis (HR = 1.85; burden 0.98) and myocarditis (HR = 5.38; burden 0.31) Ischemic heart disease—increased risk of acute coronary disease (HR = 1.72; burden 5.35), myocardial infarction (HR = 1.63; burden 2.91), ischemic cardiomyopathy (HR = 1.75; burden 2.34) and angina (HR = 1.52; burden 2.50) Other cardiovascular disorders—increased risk heart failure (HR = 1.72; burden 11.61), nonischemic cardiomyopathy (HR = 1.62; burden 3.56), cardiac arrest (HR = 2.45; burden 0.71) and cardiogenic shock (HR = 2.43; burden 0.51). Thromboembolic disorders—increased risk of pulmonary embolism (HR = 2.93; burden 5.47); deep vein thrombosis (HR = 2.09; burden 4.18) and superficial vein thrombosis (HR = 1.95; burden 2.61).1 The risks were seen regardless of age, race, sex and other cardiovascular risk factors, including obesity, hypertension, diabetes, chronic kidney disease and hyperlipidemia. 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.1 The cardiovascular risks and burdens were seen even among individuals who were not hospitalized during the acute phase of COVID-19 infection. The risks and associated burdens increased across the severity spectrum of the acute phase of COVID-19 (i.e., non-hospitalized patients, hospitalized patients, and those admitted to intensive care).1 Read: QUIZ: Test your knowledge of chemotherapy treatments and side effects The authors conclude that the risk and one-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial. They maintain that physicians should consider a history of COVID-19 as a cardiovascular disease risk factor. In addition, the care of patients surviving an acute episode of COVID-19 should include attention to cardiovascular health and disease, as early identification, diagnosis and treatment of cardiovascular issues will be key to lessening the risk of further adverse health consequences later on.1, 2 References 1. Xie Y, Xu E, Bowe B, et al. Long-term cardiovascular outcomes of COVID-19. Nat Med 2022.(accessed March 9, 2022). 2. Abbasi J. The COVID heart—one year after SARS-CoV-2 infection, patients have an array of increased cardiovascular risks. JAMA 2022. Published online March 2, 2022. (accessed March 9, 2022).

Long-term cardiovascular risks are substantial in COVID-19 survivors

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