People with 'Long Covid' at Higher Risk of Heart Disease, Finds New Study | 08 March, 2023

A new study has found a higher risk of heart disease, including stroke, among people experiencing "long Covid".

Not only heart disease, during the follow-up period, people with symptoms of long Covid faced an increase in the relative risk of other health complications such as pulmonary embolism, coronary artery disease, heart failure, asthma and chronic obstructive pulmonary disorder (COPD).

According to the study published in the Journal of the American Medical Association (JAMA) on March 3, individuals with post-Covid condition (PCC) may be at increased risk for adverse outcomes in the year following the initial infection.

Centers for Disease Control and Prevention defines PCC as having new, returning, or ongoing health issues occurring more than four weeks after the onset of the initial infection. This condition among the subset of patients experiencing post-Covid symptoms has also been described as “long Covid”.

The estimates of PCC incidence vary widely, with published reports estimating that between 10 percent and 25 percent of symptomatic patients experience symptoms persisting beyond the acute phase of illness.

A diagnosis of PCC or ‘long Covid’ is based on symptoms, including fatigue, cough, pain (joint, throat, chest), loss of taste or smell, shortness of breath, thromboembolic conditions, neurocognitive difficulties, and depression. It is one of the several studies published so far, which have tried to establish the increased chances of heart disease after a Covid infection. However, the study provides a comprehensive view of individuals with and without initial hospitalisations.

The authors, by leveraging a large health insurance claims database, have ascertained health status before initial Covid-19 diagnosis, including assessment of baseline characteristics such as hypertension, obesity, depression, and COPD.

The case-control study included 13,435 adults in the US with PCC and 26,870 matched adults without Covid-19. It was found that adults with PCC experienced increased risks for a number of cardiovascular outcomes, such as ischemic stroke. “During the 12-month follow-up period, 2.8% of the individuals with PCC versus 1.2% of the individuals without Covid-19 died, implying an excess death rate of 16.4 per 1,000 individuals,” the study stated.

During the follow-up period, the PCC cohort compared with the non-Covid cohort experienced increased healthcare utilisation for cardiac arrhythmia with an increase in relative risk (RR) of 2.35; pulmonary embolism with an increase in RR of 3.64; ischemic stroke with an increase in RR of 2.17; coronary artery disease with an increase in RR of 1.78; heart failure with an increase in RR of 1.97; COPD with an increase in RR of 1.94; and asthma with an increase in RR of 1.95.

Several studies have found increased risks of cardiovascular disease post-Covid. For example, a study by the American Heart Association — of 8,163 patients with Covid-19 treated in the emergency department or hospitalised – found that 1.3 percent of patients developed acute ischemic stroke during their hospital stay.

A European study of 2,292 individuals presenting at the emergency department with mild to moderate Covid found increased thrombosis risk in the subsequent 28 days: a rate of 2.3 percent in the presence of moderate Covid-19 and 0.6 percent for individuals with mild Covid. WHAT IS UNIQUE ABOUT THIS STUDY?
While several studies have been done earlier on a similar subject, the authors of the study said there were limitations to initial studies assessing PCC rates and outcomes.

“Estimates were often based on hospitalised patients who had a higher severity of illness. Many reports were based on patient surveys that did not include comparison groups of similar individuals,” the study stated.

In addition, early reports were often research letters or field reports not subject to peer review. “Finally, individuals at risk for PCC tend to have higher baseline risks due to pre-existing conditions, resulting in selection bias for the exposure cohort,” it stated.

The authors said subsequent to initial reports, additional work on PCC has been published, providing a more rigorous assessment of patient experiences.

“This case-control study provides a 12-month assessment of adverse outcomes for a cohort of individuals with PCC compared with a propensity-matched comparison group with similar baseline risks,” they added.

The findings of the study will be useful in informing care coordination efforts for individuals with PCC, especially when it comes to careful monitoring for cardiovascular and pulmonary risks after the period of acute infection.