A recent analysis of data from the UK Biobank indicates that COVID-19 infection may elevate the risk of heart attacks, strokes, and overall mortality for up to three years among individuals, regardless of whether they have pre-existing cardiovascular conditions. This finding is outlined in a new study published in the American Heart Association’s journal Arteriosclerosis, Thrombosis and Vascular Biology (ATVB).
According to James Hilser, M.P.H., a doctoral candidate at the University of Southern California Keck School of Medicine and the main author of the study, “We discovered a prolonged risk to cardiovascular health related to COVID, particularly in patients who experienced severe cases requiring hospitalization. The heightened likelihood of a heart attack or stroke persisted for three years after the initial COVID-19 infection. Interestingly, the increased risk in some instances was nearly comparable to having an established cardiovascular risk factor like Type 2 diabetes or peripheral artery disease.”
Previous studies revealed that serious cardiovascular complications could arise in the first month following a COVID-19 infection. This research aimed to determine how long the elevated risk continued and if it diminished after recovery from the virus.
The researchers analyzed health and genetic information from the UK Biobank involving over 10,000 adults. This included around 8,000 individuals who tested positive for COVID-19 from February 1 to December 31, 2020, and about 2,000 who were hospitalized due to the virus in that year. For comparison, a cohort of over 200,000 adults with no history of COVID-19 during that timeframe was also reviewed. Notably, none of the participants had been vaccinated at the time of infection, as COVID-19 vaccines were not available in 2020.
Key findings revealed:
- During the nearly three-year period of follow-up, those who contracted COVID-19 had a risk of heart attack, stroke, and death more than twice as high as the group with no history of the virus. Among adults hospitalized with COVID-19, the risk was nearly four times greater.
- Patients without cardiovascular disease or Type 2 diabetes and who were hospitalized for COVID-19 faced a 21% higher risk of heart attack, stroke, and death compared to individuals with cardiovascular disease but without COVID-19 infection.
- There appeared to be a significant genetic link between non-O blood types and hospitalization for COVID-19. Individuals suffering severe COVID-19 had an increased risk of heart attacks and strokes, particularly among those with non-O blood types (A, B, or AB).
- The risk of heart attack and stroke was approximately 65% higher for adults with non-O blood types compared to those with type O blood. Additionally, initial analyses did not indicate that Rh (positive or negative) blood types significantly affected outcomes in severe COVID-19 cases.
Co-senior study author Stanley Hazen, M.D., Ph.D., from the Cleveland Clinic’s Lerner Research Institute, emphasized, “Globally, more than a billion individuals have had COVID-19. The implications of these findings are substantial and could help explain the rising instances of cardiovascular disease globally.”
Details about the study include:
- The UK Biobank is a large-scale research project comprising 503,325 adults in the UK, aged between 40 to 69 at enrollment from 2006 to 2010, gathering extensive health and biomedical data from participants registered with the NHS.
- This analysis specifically focused on 10,005 adults who tested positive for COVID-19 or were hospitalized with the virus during 2020, with an additional 217,730 adults included for comparison who did not contract COVID-19 during the same period. All participants were matched closely for demographics and health conditions.
- Major adverse cardiovascular events (including heart attacks, strokes, and deaths) were assessed for long-term risk until October 31, 2022, about three years later.
Sandeep R. Das, M.D., M.P.H., who co-chairs the American Heart Association’s COVID-19 CVD Registry committee, remarked, “This paper presents two studies in one. Firstly, hospitalization due to COVID-19 is a significant marker of increased cardiovascular risk, similar to having an existing cardiovascular disease diagnosis. Though establishing a direct cause-effect relationship in past data is challenging, this finding underscores the importance of considering prior COVID hospitalization—even in the absence of CVD history—as a prompt to accelerate prevention efforts for CVD.”
Das further added, “The second aspect of this paper explores the relationship between ABO blood type and COVID outcomes, revealing that proximity to the ABO blood type gene correlates with varying susceptibility to COVID. This is intriguing, and I look forward to research clarifying the specific mechanisms involved.”
Though the study provides valuable insights, there are limitations, such as it was conducted on patients who had the original strain of the virus before vaccines were widely distributed in 2021. Researchers also noted that the UK Biobank does not provide specific data on medication use at the onset of the pandemic in 2020 or at the time of COVID-19 infection. Furthermore, since most participants are of white ethnicity, additional research is necessary to ensure these outcomes are relevant across diverse racial and ethnic groups.
Co-senior study author Hooman Allayee, Ph.D., suggested, “Our findings accentuate the prolonged cardiovascular effects of COVID-19 infection. Considering the heightened risks of heart attack, stroke, and mortality, we must evaluate whether severe COVID-19 should be regarded as a risk factor for CVD akin to Type 2 diabetes or peripheral artery disease—which mandates preventive treatment for cardiovascular health—suggests that individuals with prior COVID infections could benefit from cardiovascular disease prevention measures.”
The study’s co-authors, disclosures, and funding sources are available in the full manuscript.
