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Long-term cardiovascular outcomes of COVID-19

Yan Xie, Evan Xu, Benjamin Bowe, Ziyad Al-Aly

2022 · Nature Medicine

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From the abstract

Abstract The cardiovascular complications of acute coronavirus disease 2019 (COVID-19) are well described, but the post-acute cardiovascular manifestations of COVID-19 have not yet been comprehensively characterized. Here we used national healthcare databases from the US Department of Veterans Affairs to build 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, to estimate risks and 1-year burdens of a set of pre-specified incident cardiovascular outcomes. We show that, beyond the first 30 d after infection, individuals with COVID-19 are at increased risk of incident cardiovascular disease spanning several categories, including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease. These risks and burdens were evident even among individuals who were not hospitalized during the acute phase of the infection and increased in a graded fashion according to the care setting during the acute phase (non-hospitalized, hospitalized and admitted to intensive care). Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial. Care pathways of those surviving the acute episode of COVID-19 should include attention to cardiovascular health and disease.

Metadata: Crossref. Abstracts retain their original authors’ rights.

In the conversation

Original HN comments, with labels from simple text rules. A label describes the whole comment and may miss context or irony. Read the discussion to make up your own mind. About the labels

9 selected excerpts · 9 total mentions

someNameIG
Neutral mention · rule
I was more just pointing out that this was in the recovery phase, not during the acute infection. I've seen people use this paper as evidence that a covid infection does not increase the risk of CV incidents. And this seems to be an outlier anyway: > In conclusion, either symptomatic or asymptomatic SARS-CoV-2 infection is associated with an increased risk for late CV outcomes and has a causal effect on all-cause mortality in a late post-COVID-19 period. https://www.ajconline.org/article/S0002-9149(22)00655-5/full... > In summary, using a national cohort of people with COVID-19, we show that risk and 12-month burden of incident cardiovascular disease are substantial and…
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span several cardiovascular disease categories (ischemic and non-ischemic heart disease, dysrhythmias and others). The risks and burdens of cardiovascular disease were evident even among those whose acute COVID-19 did not necessitate hospitalization. https://www.nature.com/articles/s41591-022-01689-3 > The 12-month risk of incidental cardiovascular diseases is substantially higher in the COVID-19 survivors than the non-COVID-19 controls. Clinicians and patients with a history of COVID-19 should pay attention to their cardiovascular health in long term. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5...
Original comment The incidence of myocarditis and pericarditis in unvaccinated Covid patients
timr
Neutral mention · rule
> For everybody or for some people? What is the causal chain? The study it is based on is from Al Aly [1], who is using a dataset of (mostly elderly, unhealthy) veterans who regularly seek hospital care from the US government hospital system (VA). It is an older, sicker population, and no, the results aren't generalizable. Moreover, his methods are dubious. I've dug into one of Al Aly's other paper's downthread [2], and the comments cross-apply. He has a bunch of papers using the same dataset and core methods, and they're all pretty bad, but the press loves them. Eric Topol is either ignorant of their problems, doesn't care, or a little of both. As an editorial aside,…
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Eric Topol really isn't a reliable source of information. He's pretty much on par with Eric Feigl-Ding at this point. He's someone who has surrendered all former scientific credibility to sensationalism. Even if you 100% believe every word in these papers, unless you acknowledge that they're a study of older, sick people, you're sensationalizing the results and misleading the listener. [1] https://www.nature.com/articles/s41591-022-01689-3 [2] https://news.ycombinator.com/item?id=32671383
Original comment U.S. life expectancy drops sharply, the second consecutive decline
bsdetector
Neutral mention · rule
The study, if I found the right one, has tables where they compare myocarditis in Covid patients to non-vaccinated by excluding data after vaccination, 62% of Covid patients and 56% of non-covid group excluded, to show that Covid itself caused damage. I would hardly call half of data coming from vaccinated people "before widely available". https://www.nature.com/articles/s41591-022-01689-3 Also an interesting bit, myocarditis hazard ratio for covid-infected by non-hospital / hospital / ICU vs: Contemporary: 3.47 / 12.13 / 35.57 Historical: 5.67 / 19.82 / 58.11 The other outcomes were basically identical between contemporary and historical. I wonder what caused higher levels of mycarditis in half-vaccinated, uninfected contemporary group? That is a tough one.
Original comment Covid and the Heart: It Spares No One – Johns Hopkins
kragen
Neutral mention · rule
A more accurate headline would be "it spares 93%–97% of people," though the interview meticulously omitted almost all quantifiable information. The hazard ratios in the paper smitty1110 cited https://www.nature.com/articles/s41591-022-01689-3?s=08 are mostly 1.49–1.85, which as I understand it means that people with covid were 1½–2 times as likely to experience the condition, pericarditis or stroke or whatever, than thr control group. The exceptions are things that normally happen only once in a lifetime, like cardiac arrest (HR=2.45), so we're still talking about a tiny fraction of people. This justifies the statement in the paper's abstract, "Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial," but (unless I'm misunderstanding the paper) shows that the interview headline is an irresponsible, sensationalist lie.
Original comment Covid and the Heart: It Spares No One – Johns Hopkins
walterbell
Neutral mention · rule
Paper: https://www.nature.com/articles/s41591-022-01689-3 That's the pool of 60+ year-old veterans who were selected after testing positive and then subsequently monitored for one year. It is likely that many were vaccinated during the 1-year period from Jan 2021 - Jan 2022. e.g. as of July 2021, the VA % vaccinated was about 50%, https://www.usatoday.com/story/news/nation/2021/07/26/va-man... We know that mRNA vaccines have resulted in negative cardiac consequences in some patients, although that has mostly been in younger men.
Original comment Heart-disease risk soars after Covid, even with a mild case
lpolovets
Neutral mention · rule
If I'm reading Figure 5 right in the original paper*, it looks like the biggest cardiac impact is on people who were hospitalized or went to the ICU for covid, and the effect on people who were not hospitalized is present but relatively small. Am I interpreting the data correctly? * https://www.nature.com/articles/s41591-022-01689-3 h/t to @greenyoda for posting elsewhere in this thread.
Original comment Heart-disease risk soars after Covid, even with a mild case
ceejayoz
Neutral mention · rule
The article links to the paper at https://www.nature.com/articles/s41591-022-01689-3. > Our analyses censoring participants at time of vaccination and controlling for vaccination as a time-varying covariate show that the increased risk of myocarditis and pericarditis reported in this study is significant in people who were not vaccinated and is evident regardless of vaccination status.
Original comment Covid-19 takes serious toll on heart health–a full year after recovery
walterbell
Neutral mention · rule
According to Figure 1, https://www.nature.com/articles/s41591-022-01689-3#Sec2 First COVID-19-positive test (T,) between 1 March 2020 and 15 January 2021 n = 162.690 VA vaccination began in late December 2020, hence some of the veterans may have received at least one injection, but would not have been considered vaccinated until 14 days after their second injection, https://blogs.va.gov/VAntage/82728/va-begin-covid-19-vaccina...
Original comment Covid-19 takes serious toll on heart health–a full year after recovery

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