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Firefighters and paramedics with Anne Arundel County Fire Department load a pediatric Covid-19 patient who is in cardiac arrest into an ambulance after responding to a 911 emergency call on January 17, 2022, in Glen Burnie, Maryland.

Firefighters and paramedics with the Anne Arundel County Fire Department load a pediatric Covid-19 patient who is in cardiac arrest into an ambulance after responding to a 911 emergency call on January 17, 2022, in Glen Burnie, Maryland. (Photo: Alex Edelman/AFP via Getty Images)

Covid Survivors at Higher Long-Term Risk of Cardiovascular Damage: Study

"We're going to see more heart disease, strokes, blood clots, and other problems," warns one epidemiologist.

Kenny Stancil

Covid-19 survivors are at an elevated long-term risk of developing heart disease, strokes, blood clots, and other cardiovascular disorders, according to new peer-reviewed research out Monday.

Published in Nature Medicine, the study finds that individuals who survive Covid-19 are more likely to suffer from cardiovascular disease one year later. That's true even if they "were not hospitalized during the acute phase of the infection," although disease risks and burdens are higher for patients who were hospitalized and especially for those who were admitted to intensive care units (ICUs).

Researchers measured the "substantial" risks and 12-month burdens of detrimental cardiovascular outcomes in individuals with Covid-19 using the healthcare databases of the U.S. Department of Veterans Affairs.

The scholars compared a cohort of individuals who were alive 30 days after testing positive for Covid-19 between March 1, 2020 and January 15, 2021, with two control groups: a contemporary cohort of people with no evidence of coronavirus infection and a historical (2017) cohort of people who did not experience the pandemic. 

The study's cohorts were composed before the widespread availability of Covid-19 vaccines and treatments in the U.S.—global access to these lifesaving tools remains starkly unequal due to Big Pharma's profit-maximizing intellectual property monopolies—and prior to the onset of the Delta and Omicron variants.

"As the pandemic, with all its dynamic features, continues to progress, as the virus continues to mutate and as new variants emerge, as treatment strategies of acute and post-acute Covid-19 evolve and as vaccine uptake improves, it is possible that the epidemiology of cardiovascular manifestations in Covid-19 might also change over time," wrote the authors.

However, they continued, "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."

Beyond the first month after infection, researchers found, individuals with Covid-19 exhibited heightened risks and one-year burdens of a wide range of life-threatening cardiovascular problems, including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure, and thromboembolic disease.

"The risks were evident regardless of age, race, sex, and other cardiovascular risk factors, including obesity, hypertension, diabetes, chronic kidney disease, and hyperlipidemia," the researchers wrote. "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."

Although a few prior studies had investigated "post-acute cardiovascular manifestations of Covid-19," researchers noted, "most were limited to hospitalized individuals (who represent the minority of people with Covid-19), and all had a short duration of follow-up and a narrow selection of cardiovascular outcomes."

The new paper, by contrast, shows that increased risks and one-year burdens of cardiovascular damage are evident among people who were not hospitalized during the acute phase of Covid-19—the care pathway for a majority of individuals with the disease.

However, the paper also stresses that long-term cardiovascular disease risks and associated burdens are significantly higher for Covid-19 patients who were hospitalized and for those treated in ICUs—care settings that unvaccinated individuals remain much more likely to experience.

Zoë Hyde, an epidemiologist and biostatistician at the University of Western Australia who was not involved in the study, pointed out on social media that "the authors have a warning for governments letting the virus spread."

In the paper's discussion section, the researchers wrote that "the broader implications of these findings are clear." They continued:

First, the findings emphasize the need for continued optimization of strategies for primary prevention of SARS-CoV-2 infections; that is, the best way to prevent Long Covid and its myriad complications, including the risk of serious cardiovascular sequelae, is to prevent SARS-CoV-2 infection in the first place. Second, given the large and growing number of people with Covid-19 (more than 72 million people in the United States, more than 16 million people in the United Kingdom and more than 355 million people globally), the risks and 12-month burdens of cardiovascular diseases reported here might translate into a large number of potentially affected people around the world. 

"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," added the scholars. "Addressing the challenges posed by Long Covid will require a much-needed, but so far lacking, urgent and coordinated long-term global response strategy."

The study comes just days after a recent data analysis showed that people in the U.S. are dying from Covid-19 at significantly higher rates than people in other wealthy countries—a finding that prompted fresh criticisms of the nation's vast inequalities and lack of universal healthcare and paid sick leave, among other benefits enjoyed in much of the world.

In a Boston Review essay published Tuesday, Adam Gaffney, a pulmonary and critical care doctor at Cambridge Health Alliance and assistant professor of medicine at Harvard Medical School, argued that "the number of lives lost annually to Covid-19 in the years to come depends in large part on actions we take today."

"As others have argued, there is an ongoing role for public health interventions to reduce transmission of the virus during surges, together with a need for massive investment in our nation's underfunded public health infrastructure," Gaffney wrote. "Yet less has been said about improving our medical care response itself."

"Acknowledging the endemic future of SARS-CoV-2 shouldn't lead us to turn our backs on the medically vulnerable and embrace a 'return to normal,'" he continued. "Instead, we must collectively insist on an effective, ongoing, and sustainable policy response—not only to support and protect those who are most at-risk for developing this particular disease, but to shore up the provision of medical care for us all."

"The central lesson we should draw from our experience with Covid-19 is not that the U.S. healthcare system has been poorly equipped to respond to a crisis," he added. "It's that it has been poorly equipped to serve many critical functions in the provision of meaningful and equitable healthcare to all Americans."

"In addition to public health measures outlined by others," Gaffney wrote, "the expansion of community-based primary care, the redistribution of healthcare infrastructure, and greater operational integration in our hospital system could form the backbone of a medical response that both minimizes the havoc wrought by Covid-19 and improves the provision of care for all conditions for decades to come."

Our work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to republish and share widely.

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