COVID-19 Can Increase Risk of Cardiovascular Disease Up to a Year Later—Even After Mild Illness

The new heart problems showed up even among younger people who had no other risk factors.

COVID-19 Could Cause Long Term Heart Damage, Study Shows
Photo: Alex Sandoval

Even after recovering from a milder case COVID-19, people can still face significantly higher risks for new heart problems up to a year after diagnosis, according to new research. The cardiovascular issues—including heart failure, stroke, and myocarditis—affected people regardless of age or presence of risk factors.

The study, published in the journal Nature Medicine, is the first comprehensive look at the cardiovascular outcomes that can occur following a COVID-19 diagnosis, regardless of severity.

"Until now we had data that COVID infection could affect the heart in the short term," Saurabh Rajpal, MBBS, a cardiologist and assistant professor in the Division of Cardiology at The Ohio State University Wexner Medical Center, tells Health. Dr. Raipal, who was unaffiliated with the new research points to issues like heart inflammation or blood clots in the acute stage of the disease. "However, this research shows that COVID can have lingering effects on the heart," he says.

And the effects of COVID-19 on long-term heart health aren't insignificant. "Consequently, COVID-19 infections have, thus far, contributed to 15 million new cases of heart disease worldwide," Ziyad Al-Aly, MD, one of the study's co-authors, and chief of research and development service at the VA Saint Louis Health Care System said in a press release. "This is quite significant. For anyone who has had an infection, it is essential that heart health be an integral part of post-acute COVID care."

How COVID-19 affects long-term heart health

To investigate the potential long-term cardiovascular effects of having COVID-19, researchers looked at data from national health care databases curated by the US Department of Veteran Affairs (VA). The information was split into three separate groups: people who had been diagnosed with COVID-19 (153,760 individuals), people who did not catch the virus (5,637,647 individuals), and people whose data was collected pre-pandemic (5,859,411 individuals).

Across the board, COVID-19 survivors were at an increased risk for cardiovascular diseases across several categories, including cerebral vascular disorders, dysrhythmia, inflammatory heart disease, ischemic heart disease, thrombotic disorders, and other cardiac disorders. More specifically, being diagnosed with COVID-19 increased a person's risk of heart attack by 63%, stroke by 52%, and heart failure by 72% in a 12-month period, compared to those without the illness.

The findings did not discriminate against age, race, gender, or pre-existing conditions—according to study authors, even people without a history of cardiovascular disease before a COVID-19 diagnosis were at a higher risk after having the illness. Researchers also found that people were affected despite severity of their COVID-19 infection, and cardiovascular risks were evident even in people who weren't hospitalized during the acute phase of their illness, which reflects the majority of people who have COVID-19.

Still, researchers say the study has its limitations: In using data from the VA—which was from mainly white men—the demographics of the study weren't necessarily representative of the US population. It's also possible that those who were part of the control group actually had COVID-19 but didn't know or weren't officially diagnosed with the illness, which could throw off results. And as the COVID-19 pandemic continues, new variants and greater vaccine adherence could lead to a change in these cardiovascular issues.

What to know if you've had COVID-19

Scientists are still learning about the long-term effects of COVID-19 in real time, but this new research suggests that a history of COVID-19 infection should be considered as a risk factor for cardiovascular disease. According to Dr. Al-Aly, physicians should evaluate patients with that in mind. It is worth a conversation with your primary care doctor if you have been infected with COVID-19.

"It is essential to inform your doctor of a prior COVID-19 infection so that he/she can be alerted to the late effects that the virus may have caused," Andrea Mignatti, MD, an interventional cardiologist at Lenox Hill Hospital, who is not affiliated with the study, tells Health. "While COVID-19 is a disease that predominantly affects the lungs, it can also affect other organs, including the heart, kidneys, the nervous system, and blood cells."

"There is no universal consensus around [monitoring the heart after COVID-19]," adds Dr. Al-Aly. "Our understanding of the long-term health consequences of COVID-19 is evolving. What is clear is that people can get heart problems after COVID-19 infection even if they had no heart problems whatsoever before the infection, and even if they had no cardiovascular risk factors."

The good news is that there is a very easy way to reduce the risk of COVID-19-related heart problems, and that is to protect yourself from COVID-19 altogether with the vaccine. "The risk of developing heart problems including myocarditis, arrhythmias, blood clots—both in legs and lungs—heart attacks, bleeding, is significantly higher in patients who did not receive the vaccine, compared to the ones who are vaccinated," says Dr. Mignatti.

Though it's unclear how helpful vaccines are in reducing the risk of cardiovascular disease as a result of breakthrough infections—because, as Dr. Al-Aly notes, "vaccines are not 100% effective"—they're still considered the best option to protect against severe COVID-19 and hospitalization or death from the disease.

Why COVID-19 remains a greater risk factor for myocarditis than vaccines

It'd be remiss not to mention the real (although very rare) risk of heart inflammation as a result from COVID-19 vaccination with an mRNA vaccine like Pfizer-BioNtech or Moderna. The CDC's Advisory Committee on Immunization Practices (ACIP) in June 2021 declared a "likely association" between COVID-19 mRNA vaccines and myocarditis and pericarditis—two rare forms of heart inflammation.

Data from the ACIP meeting shows that the cases of myocarditis and pericarditis occur most often within a week of the second dose of an mRNA vaccine, and typically in younger males, ages 16–24.

But the risks of myocarditis or pericarditis after COVID-19 vaccination overall are much lower than the risks of heart inflammation following a bout with COVID-19 itself. A recent study published in the journal Nature Medicine compared the risk of cardiac events between vaccination and SARS-CoV-2 infection and found that, though there is a slight increased risk of myocarditis within a week of receiving a second dose of an mRNA vaccine, having COVID-19 "substantially increased" the risk of multiple cardiac events (myocarditis, pericarditis, and cardiac arrhythmia).

What's more: While myocarditis can be life-threatening, vaccine-associated myocarditis were mostly "mild and self-limiting," according to researchers. Cardiac events from SARS-CoV-2 infection, however, put patients at a greater risk of hospitalization or death from their condition.

Though not without risks, COVID-19 vaccines can better protect people against cardiovascular issues. "The risk of myocarditis after COVID-19 is much higher than the risk of myocarditis after vaccines," says Dr. Al-Aly. "Vaccines are the safer choice."

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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