Viral Infections and Risk of Cardiovascular Disease: Systematic Review and Meta‐Analysis, 2025, Kawai et al.

Chandelier

Chandelier

Senior Member (Voting Rights)

Kosuke Kawai, ScD,
Cresencia Felician Muhere, MD,
Elkin V. Lemos, MD, PhD,
and Joel M. Francis, MD, PhD


Abstract​

Background​

We conducted a systematic review and meta‐analysis of studies examining the association of viral infections with the risk of cardiovascular disease, including coronary heart disease (CHD) and stroke.

Methods​

MEDLINE, Embase, Web of Science, African‐Wide Information, and the Cochrane Library database were searched from inception to July 2024.

Results​

We included 155 studies. HIV infection was consistently associated with an elevated risk of CHD (pooled adjusted risk ratio [RR], 1.60 [95% CI, 1.38–1.85]) and stroke (RR, 1.45 [95% CI, 1.26–1.67]).
SARS‐CoV‐2 infection was associated with an increased risk of CHD (RR, 1.74 [95% CI, 1.44–2.11]) and stroke (RR, 1.69 [95% CI, 1.23–2.31]).
In self‐controlled case series studies, laboratory‐confirmed influenza infection was associated with an elevated risk of acute myocardial infarction (pooled incidence rate ratio, 4.01 [95% CI, 2.66–6.05]) and stroke during the first 1 month (incidence rate ratio, 5.01 [95% CI, 3.41–7.37]).
In cohort studies, hepatitis C virus infection was associated with a higher risk of CHD (RR, 1.27 [95% CI, 1.13–1.42]) and stroke (RR, 1.23 [95% CI, 1.04–1.46]).
Herpes zoster was also associated with an elevated risk of CHD (RR, 1.12 [95% CI, 1.08–1.15]) and stroke (RR, 1.18 [95% CI, 1.09–1.27]).
There is insufficient evidence to determine the effect of cytomegalovirus on cardiovascular disease.
Although on a limited basis, hepatitis A virus, herpes simplex virus type 1, respiratory syncytial virus, human papillomavirus, dengue, and chikungunya have been linked to an increased risk of cardiovascular disease.

Conclusions​

Influenza, SARS‐CoV‐2, HIV, hepatitis C virus, and herpes zoster were associated with an increased risk of major cardiovascular events. Vaccines may play an important role in preventing the risk of cardiovascular disease.
 
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AI Summary:
Covid and Flu Can Triple Your Risk of Heart Attack

A new study confirms that several viral infections — including Covid-19, influenza, and shingles — are linked to higher risks of heart disease and stroke.

Main Findings​

The analysis, published in the Journal of the American Heart Association, reviewed over 150 studies. It found that the risk of a heart attack triples in the weeks after a Covid infection and quadruples in the month following the flu. The risk of stroke also rises sharply during these periods.

Chronic viral infections such as hepatitis C, H.I.V., and varicella zoster (the virus causing shingles) were also associated with long-term increases in heart disease and stroke risk. Limited evidence suggested links between cardiovascular problems and infections like RSV, HPV, dengue, and chikungunya.

How Viruses Affect the Heart​

Experts said viruses can harm the heart in different ways. Acute infections cause fever and higher heart rates, which strain the heart and may lead to heart attacks if oxygen demand exceeds supply.

In the long term, inflammation is a key factor. Covid-19 can damage the blood vessel lining, causing inflammation and clots that may block arteries in the heart or brain, leading to heart attacks or strokes. Even viruses that target other organs, such as hepatitis C or H.I.V., can trigger inflammation that destabilizes arterial plaque and promotes clot formation.

Prevention and Risk Reduction​

Doctors emphasized preventing infections as the best protection. Vaccines for flu, Covid, and shingles can lower the risk and severity of illness, potentially reducing heart complications.

Having a viral infection does not guarantee heart disease, but it adds to overall cardiovascular risk. Major risk factors remain high cholesterol, high blood pressure, diabetes, smoking, and aging. Managing these factors through lifestyle changes or medication can help lower total risk.

Dr. Ziyad Al-Aly summarized: viral infections are one of many contributors to heart disease, and focusing on modifiable risks can reduce overall danger.
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newsroom.heart.org

Some acute and chronic viral infections may increase the risk of cardiovascular disease

Research Highlights: A review of 155 scientific studies found influenza and COVID infections raised the risk of heart attack or stroke as much as three-to five-fold in the weeks following the initial infection. Viruses that linger in the body,...
newsroom.heart.org newsroom.heart.org

Research Highlights:

  • A review of 155 scientific studies found influenza and COVID infections raised the risk of heart attack or stroke as much as three-to five-fold in the weeks following the initial infection.
  • Viruses that linger in the body, such as HIV, hepatitis C and varicella zoster virus (the virus that causes shingles), can lead to long-term elevations in the risk of cardiovascular events.
  • The study researchers say preventive measures, including vaccination, may play an important role in reducing the risk of heart attacks and strokes, especially in people who already have heart disease or heart disease risk factors.
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