Covid-19 and cardiovascular disease in a total population-study of long-term effects, social factors and Covid-19-vaccination, 2025, Spetz et al.

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Covid-19 and cardiovascular disease in a total population-study of long-term effects, social factors and Covid-19-vaccination

Spoiler: Authors

Spetz, Malin; Natt och Dag, Yvonne; Li, Huiqi; Nyberg, Fredrik; Rosvall, Maria

Abstract​

Understanding more about the risk of cardiovascular disease in the large population-group with mild Covid-19 is essential since the preventive need might be extensive.
This study examined the risk of cardiovascular disease following Covid-19, considering risk periods and prognostic factors i.e., social factors, Covid-19-vaccination and comorbidities.

The study cohort included the Swedish population aged 40-75 years (n = 4,095,414). Covid-19 was associated with elevated hazard ratios for all outcomes; ranging from 1.22 (95% confidence interval:1.14-1.31) for acute myocardial infarction to 4.31 (95% confidence interval:4.09-4.55) for pulmonary embolism.

The increased risk was most evident among hospitalised individuals, however, also individuals with mild Covid-19 had an elevated risk.
Finally, our findings demonstrated increased long-term cardiovascular risk and generally stronger effects of Covid-19 in more vulnerable social groups.
In this work, we demonstrate an increased risk of cardiovascular disease after Covid-19, also among mild cases, findings relevant from both a public health and healthcare perspective.

Web | DOI | PDF | Nature Communications

 

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Fig. 1: Risk of cardiovascular disease following Covid-19.

Data is presented as hazard ratios (HR) with 95% confidence intervals (CI) of various cardiovascular disease outcomes related to Covid-19 (n = 4,095,414). Model 1 (red): Adjusted for age; Model 2 (blue): Adjusted for age, sex, country of birth, income and education; Model 3 (green): Adjusted for age, sex, country of birth, income, education, comorbidities and vaccination against Covid-19.

Fig. 2: Risk of cardiovascular disease following Covid-19 by severity.

Data is presented as hazard ratios (HR) with 95% confidence intervals (CI) of various cardiovascular disease outcomes related to Covid-19 (n = 4,095,414), by severity (i.e., hospitalisation or not) with multiple adjustments.

Fig. 3: Risk of cardiovascular disease and mortality following Covid-19 by risk periods.

Data is presented as hazard ratios (HR) with 95% confidence intervals (CI) of various cardiovascular disease and mortality outcomes related to Covid-19 (n = 4,095,414), by risk periods, compared to the non-infected group with multiple adjustments. Time period after Covid-19 (days): 0–14, 15–30, 31–90, 91–180, 181–365 and 366–730. ICH Intracerebral haemorrhage, CeVD Cerebrovascular disease, AMI Acute myocardial infarction, IHD Ischaemic heart disease, DVT Deep venous thrombosis, PE Pulmonary embolism, CVD Cardiovascular disease. The numerical values of the data shown in the figure are provided in Supplementary Table 15.

 

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This is a massive study of the entire Swedish population in the selected age group.

In our study, encompassing the total population of Sweden ages 40–75 years, Covid-19 was associated with both incident CVD and mortality, even after adjustments for vaccination, co-morbidities and sociodemographic factors. Although the cardiovascular risk was highest during the two weeks after Covid-19, the increased risk remained for some outcomes more than one year after a SARS-CoV-2 infection. Analyses by severity of Covid-19 showed a consistent increased risk for all studied outcomes among those hospitalised due to Covid-19, while non-hospitalised individuals had an increased risk for IHD, thromboembolic disease and mortality.

The increased mortality following mild infections is especially concerning. Maybe letting everyone get infected once a year on average isn’t a good idea after all?