A large-scale study conducted in South Korea and Japan confirms a prolonged cardiovascular ride after an infection by SARS-COV-2, whatever the variant, and even after unless forms. However, if the relative risk is significantly high, absolute risk remains low. And vaccination seems to mitigate it.
Five years after the start of the pandemic of COVID-19 A coronavirus disease, sometimes designated COVVID (according to the English acronym from Coronavirus DIEASE) is a disease caused by a coronavirus (VOC). The expression can refer to the following diseases: severe acute respiratory syndrome (SRAS) caused by the SARS-COV virus, the Middle East respiratory syndrome (seas) caused by the MERS-COV virus, 2019 coronavirus disease (COVVI-19) caused by the SARS-COV-2 virus. Research on long-term cardiovascular consequences-beyond a year after infection-remain rare. Existing studies are often based on poorly representative samples, mainly made up of elderly white men, and therefore do not reflect the diversity of populations affected on a global scale, especially Asian populations. In addition, few analyzes have taken into account the influence of the severity of infection, the variant in question or even vaccination on prolonged cardiovascular risk. These gaps justify, according to the authors, the need for the study recently published in the journal Circulation.
A robust methodology, two complementary populations
The study is based on the cross-analysis of two national databases for the 1920s to 2022: the South Korean System K-COV-N, which brings together health data of around 19 million adults, and the Japanese JMDC bases covering more than 12 million insured. All the inclusive individuals were aged 20 or older and had to be free from any cardiovascular event before 2020 or in the month following their infection by SARS-COV-2. After statistical pairing and weighting of variables, the researchers retained a sample of 7.96 million South Korean patients for the “discovery” phase (discovery cohort), and 12.22 million Japanese for the “validation” phase (validation cohort).
The main criterion studied was the occurrence of a first major cardiovascular event in the months following a SARS-COV-2 infection. The analysis focused on eight main categories of conditions: myocardial infarction, stroke, heart failure, myocarditis and pericardites, arrhythmias, thromboembolic events, ischemic cardiopathies, and major cardiovascular events (MACE).
Let us recall that the first data of cohorts concerning the Covid A coronavirus disease, sometimes designated COVVID (according to the English acronym from Coronavirus DIEASE) is a disease caused by a coronavirus (VOC). The expression can refer to the following diseases: severe acute respiratory syndrome (SRAS) caused by the SARS-COV virus, the Middle East respiratory syndrome (seas) caused by the MERS-COV virus, 2019 coronavirus disease (COVVI-19) caused by the SARS-COV-2 virus. In the acute phase demonstrated in 2020 that the SARS-COV-2 can cause direct and indirect cardiovascular lesions, including myocardial lesions, acute coronary syndromes, cardiomyopathies, acute pulmonary hearts, arrhythmias and cardiogenic shocks, as well as thrombotic complications. Here there is no question of acute covid or “long covid” but of a post covid.
Increased cardiovascular risk of 62%
Result: In the discovery Korean cohort, infected people have an increased risk of 62% (CI95% 61-64) to develop a major cardiovascular event compared to non-infected. Among the most frequently observed complications, ischemic heart disease (+81%), heart failure (+79%), and brain disorders (+65%). The risks of inflammatory heart disease (such as pericarditis and myocarditis), rhythm disorders, thrombotic disorders (such as deep venous thrombosis or pulmonary embolism) and major cardiovascular events (such as cardiovascular death, non -fatal stroke or a non -fatal myocardial infarction), are also increased, but to a lesser extent.
A rudeness concentrated in the first months following the infection
The peak of the occurrence of these complications is concentrated in the first six months following the infection, but the risk remains statistically high up to 18 months after the acute phase. Beyond that, the data no longer shows a statistically significant increase. This phenomenon of “temporal attenuation” suggests that the heart can, in many cases, gradually recover from the inflammatory sequelae of the covid.
A severity proportional to the initial form … but not exclusively
Unsurprisingly, the more serious the initial covid-19 has been, the higher the long-term cardiovascular risk. Persons hospitalized or admitted to intensive care present the most important risks. However, the study highlights a worrying fact: even the least severe forms of the disease, not requiring hospitalization, are associated with an elevation of risk. This observation confirms that the thrombotic or inflammatory vascular damage induced by SARS-COV-2 may occur independently of the initial clinical severity.
Relative risk of the long-term incidence of a first major cardiovascular event in the months following a SARS-COV-2 infection. The fat data indicates a significant difference.
Another teaching: the viral period-whether pre-Delta strain Wuhan, Delta or Omicron-does not seem to basically modify the level of risk. The ride is homogeneous, whatever the dominant variants in circulation.
The analyzes, reproduced in the Japanese validation cohort, show a 2.7-time higher risk (95% CI 2.45-2.55) for the main criterion and different categories of events. This risk decreases over time and does not persist after 18 months.
Vaccination plays a major protective role
One of the major contributions of this study is that it confirms the protective effect of vaccination against cardiovascular complications of COVID-19. Patients who have received a complete vaccine scheme, including recall doses, have a reduced risk of approximately 20 to 30 % compared to non -vacinated. This protection seems to play an essential role not only by attenuating the severity of acute infection, but also by limiting the occurrence of vascular events in the medium term.
These results confirm the indirect benefits of vaccination, far beyond the prevention of serious respiratory forms. The vaccine would act by limiting the systemic inflammatory response and the vascular lesions, the vaccine thus protecting the heart and the vessels.
An observation which confirms the interest of vaccination recall campaigns, especially in people already at cardiovascular risks.
A risk to be put into perspective
If the relative risk is notable, the absolute risk of a cardiovascular event remains moderate: 2.12 % in infected patients against 1.31 % in non-infects over the follow-up period. The rate of post-Cavid myocardial infarction only reaches 0.05 %, compared to 0.03 % in non-infects. The authors of the study therefore stress that these results must be interpreted at the scale of a population, and warn against excessive media coverage which would have the effect of generating disproportionate fears.
Implications for patient monitoring
For health professionals, these results justify reinforced monitoring of post-Cavid patients, in particular those with cardiovascular risk factors. The authors invite public health authorities to reconsider prevention messages and to integrate cardiovascular after -effects in the definition of “long covid”.
Sources
- Lee s and al. Burden of Cardiovascular Outcomes After SARS-CoV-2 Infection in South Korea and Japan: A Binational Population-Based Cohort Study. Circulation. 2025 Jun 4. doi: 10.1161/CIRCULATIONAHA.125.073086. Epub ahead of print. PMID: 40464076.
