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Covid Survivors at High Risk for Heart Problems

Covid survivors had a greater risk for “cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease.”

According to new research published in Nature Medicine, people who have had Covid-19 have a significantly higher risk of various cardiovascular conditions in the year after infection, even if they weren’t hospitalized for their infection. The researchers analyzed data from 153,760 people with Covid-19 and more than 11 million comparison patients (half from the present day and half historical) in national Veterans Affairs healthcare databases. They looked for a list of various heart conditions from a month after Covid infection up to a year after infection and compared those risks to people without a history of Covid.

Covid survivors had a greater risk for “cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure, and thromboembolic disease,” the researchers found. Although the risk was higher for hospitalized people and still higher for those admitted to the ICU, even people who did not need hospitalization had an increased risk of several conditions.

The researchers estimated that the excess burden of cardiovascular problems in Covid survivors was approximately 45 per 1,000 people. For every 1,000 Covid survivors and 1,000 people without a history of Covid, 45 additional people in the Covid survivors group will have some cardiovascular issue. The conditions with the highest risk were atrial fibrillation, myocarditis, heart failure, sinus tachycardia, acute coronary disease, and pulmonary embolism.

Below is a list of all the conditions with an increased risk and how much of an increase is associated with Covid:

  • Stroke: 1.5 times more likely in Covid survivors than in those without Covid.
  • Any dysrhythmia: 1.7 times more likely.
  • Atrial fibrillation: 1.7 times more likely.
  • Sinus tachycardia: 1.8 times more likely.
  • Sinus bradycardia: 1.5 times more likely.
  • Ventricular arrhythmias: 1.8 times more likely.
  • Atrial flutter: 1.8 times more likely.
  • Pericarditis: 1.85 times more likely.
  • Myocarditis: 5.4 times more likely.
  • Acute coronary disease: 1.7 times more likely.
  • Myocardial infarction: 1.6 times more likely.
  • Ischemic cardiomyopathy: 1.75 times more likely.
  • Angina: 1.5 times more likely.
  • Heart failure: 1.7 times more likely.
  • Non-ischemic cardiomyopathy: 1.6 times more likely.
  • Cardiac arrest: 2.45 times more likely.
  • Cardiogenic shock: 2.4 times more likely.
  • Pulmonary embolism: 2.9 times more likely.
  • Deep vein thrombosis: 2 times more likely.
  • Superficial vein thrombosis: 1.95 times more likely.
  • Major adverse cardiovascular event (MACE, including heart attack, stroke, or any death with cardiovascular involvement): 1.55 times more likely.
  • Any cardiovascular outcome: 1.6 times more likely.

The researchers also broke down the risk according to age, race, sex, obesity, smoking history, hypertension, diabetes, chronic kidney disease, hyperlipidemia, and preexisting cardiovascular disease. The risks were similarly high for those under age 65 as they were for those under age 65. ”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,” the researchers wrote. The risks were similar regardless of all of these factors except sex: Men were more likely than women to have a greater increased risk of cardiovascular conditions. Women still had a higher risk for all the conditions except cerebrovascular disorders, but the extent of the increased risk was less than that for men.

Less surprisingly, those with the highest risk for a cardiovascular problem more than a month after discharge were patients who had been in the ICU. Still, even patients who were not hospitalized had a modestly increased risk of atrial fibrillation, heart failure, pulmonary embolism, and deep vein thrombosis. The only conditions without an increased risk among non-hospitalized Covid patients were heart attack, cardiac arrest, and cardiogenic shock.

“Given the large and growing number of people with Covid-19, the risks and 12-month burdens of cardiovascular diseases reported here might translate into a large number of potentially affected people around the world,” the researchers wrote. ”Governments and health systems around the world should be prepared to deal with the likely significant contribution of the Covid-19 pandemic to a rise in the burden of cardiovascular diseases. Because of the chronic nature of these conditions, they will likely have long-lasting consequences for patients and health systems and also have broad implications on economic productivity and life expectancy.”

In a commentary about the findings, cardiologist Eric Topol, MD, noted that the four coronaviruses associated with the common cold aren’t linked to heart problems, and only a handful of SARS and MERS cases involved any cardiovascular issues. That means the high cardiovascular burden of SARS-CoV-2 is new from a coronavirus infection. It’s not clear how the cardiovascular risks from Covid interact with cases of long Covid. There may be a link, or it could be separate issues.

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