COVID-19 infection increases risk of heart attack and stroke

A research team led by the Cleveland Clinic and the University of Southern California (USC) has found that COVID-19 infection may increase the risk of heart attack, stroke and death from any cause for up to three years for people with and without cardiovascular disease. In some cases, the increased risk was almost as high as having a known cardiovascular risk factor such as type 2 diabetes or peripheral artery disease.

Previous research had shown that COVID-19 increases the risk of serious cardiovascular complications within the first month after infection. This latest study, published in the journal Arteriosclerosis, Thrombosis and Vascular Biology (ATVB), examined how long the increased risk lasted and whether it subsided after recovering from COVID-19 infection.

The researchers reviewed health and genetic data in the UK Biobank for more than 10,000 adults, including approximately 8000 who had tested positive for the COVID-19 virus from 1 February to 31 December 2020 and about 2000 who tested positive for the virus in a hospital setting in 2020. A group of more than 200,000 adults who had no history of COVID-19 infection during the same time frame in the UK Biobank were also reviewed for comparison. None of the participants were vaccinated at the time of infection because COVID-19 vaccines were not yet available.

During the nearly three-year follow-up period, the risk of heart attack, stroke and death was more than two times higher among adults who had COVID-19, and nearly four times greater among adults hospitalised with COVID-19, compared with the group with no history of COVID-19 infection. People hospitalised with COVID-19, without cardiovascular disease or without type 2 diabetes, had a 21% greater risk of heart attack, stroke and death compared to people with cardiovascular disease and without COVID-19 infection.

Certain genetic variants are already linked to coronary artery disease, heart attack and COVID-19 infection. The researchers completed a genetic analysis to see if any of these known genetic variants contribute to elevated coronary artery disease risk after COVID-19. None of the known genetic variants were drivers of the enhanced cardiovascular events observed post COVID-19. Instead, the data highlighted an association between elevated risk and blood type.

While previous research had shown that people who have A, B or AB blood types were also more susceptible to contracting COVID-19, this study showed a significant genetic interaction among the non-O blood types and hospitalisation for COVID-19. The risk of heart attack and stroke was about 65% higher in adults with non-O blood types compared to those who had type O blood, while a preliminary analysis did not show that Rh (positive or negative) blood type interacted with severe COVID-19.

“These findings reveal while it’s an upper respiratory tract infection, COVID-19 has a variety of health implications and underscores that we should consider history of prior COVID-19 infection when formulating cardiovascular disease preventive plans and goals,” said co-senior author Dr Stanley Hazen, Chair of Cardiovascular and Metabolic Sciences in Cleveland Clinic’s Lerner Research Institute.

“The association uncovered by our research indicates a potential interaction between the virus and the piece of our genetic code that determines blood type and signals the need for further investigation. A better understanding of what COVID-19 does at the molecular level may potentially teach us about pathways linked to cardiovascular disease risk.”

“Our data suggesting that risk of heart attacks and strokes was especially higher among COVID-19 patients with A, B or AB blood types has significant clinical implications,” added co-senior author Dr Hooman Allayee, of USC’s Keck School of Medicine.

“Given our collective observations and that 60% of the world’s population have these non-O blood types, our study raises important questions about whether more aggressive cardiovascular risk reduction efforts should be considered, possibly by taking into consideration an individual’s genetic makeup.”

The study had several limitations, including that the data was from patients who had the original strain of the COVID-19 virus before vaccines were widely available in 2021. Nevertheless, the authors concluded that the long-term risk associated with COVID-19 “continues to pose a significant public health burden” and that further investigation is warranted.

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