Long COVID was associated with an increased risk of incident cardiovascular disease among patients without prior cardiovascular disease who weren't hospitalized with severe COVID-19 infections, according to a population-based cohort study.
In the study, investigators included 1.2 million patients aged 18 to 65 years in Stockholm, of whom 0.7% (n = 8,999) had a physician-assigned diagnosis of long COVID; 66% were women.
Using the Multimorbidity Integrated Registry Across Care Levels in Stockholm (MIRACLE-S) cohort, long COVID was defined by the International Classification of Diseases, 10th Revision. Patients with prior cardiovascular disease or hospitalization for severe COVID-19 infections were excluded. Cox proportional hazards models adjusted for demographic, socioeconomic, lifestyle, and mental health factors evaluated incident myocardial infarction, heart failure, cardiac arrhythmias, stroke, and peripheral artery disease.
Patients with long COVID had a higher cumulative incidence of adverse cardiovascular events compared with those without long COVID (18.2% vs 8.4% in women; 20.6% vs 11,1% in men).
In fully adjusted analyses, long COVID was associated with a 2.06 greater likelihood of composite cardiovascular events in women and a 1.33 greater likelihood in men. Cardiac arrhythmias showed the strongest association, resulting in a 3.11 greater likelihood in women and 1.61 greater likelihood in men, followed by coronary artery disease, with a1.25 greater likelihood in women and 1.26 greater likelihood in men.
Both heart failure and periphery artery disease were increased in women (1.25 higher likelihood in both) but not in men. Long COVID was not associated with stroke in either sex.
Baseline characteristics showed that patients with long COVID were older and had a higher prevalence of cardiometabolic and mental health conditions, including obesity, hypertension, hyperlipidemia, diabetes, depression, and anxiety, particularly among women. Absolute event rates were higher across outcomes, driven primarily by arrhythmias and coronary artery disease.
Limitations included a potential underdiagnosis of milder long COVID cases early in the pandemic, reliance on physician-assigned diagnostic codes, and possible detection bias as a result of increased health care use. Residual confounding from unmeasured factors, including vaccination status and reinfection, couldn't be excluded.
“Long COVID is associated with increased risk of incident cardiovascular disease, particularly cardiac arrhythmias, heart failure, and coronary artery disease,” wrote lead study author Pia Lindberg, of the Division of Immunology and Respiratory Medicine in the Department of Medicine Solna and the Center for Molecular Medicine at the Karolinska University Hospital in Sweden, and colleagues.
Several of the study authors reported receiving compensation from LINK Medical for purposes unrelated to the present study. Full disclosures can be found in the study.
Source: eClinicalMedicine
