Original COVID-19 Strain Greatly Increased Risk for Heart Attack, Stroke, Death

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A new study sheds light on the increased risk of acute cardiovascular events and death in patients infected with the original strain of COVID-19 demonstrating risks in both patients with severe infections or moderate cases.¹

Specifically, patients infected with COVID-19 appeared to have a significant increase for heart attack, stroke, and death for up to 3 years among unvaccinated people early in the pandemic when the original virus emerged.¹

Compared to people with no COVID-19 history, the study found those who developed COVID-19 early in the pandemic had double the risk for cardiovascular events and death, and those patients deemed to have severe cases of infection and were hospitalized had nearly 4 times the risk.¹

“This study sheds new light on the potential long-term cardiovascular effects of COVID-19, a still-looming public health threat,” David Goff, MD, PhD, director for the Division of Cardiovascular Sciences at NIH’s National Heart, Lung, and Blood Institute (NHLBI), said in a statement.¹

NHLBI largely funded the study and the results were published in the American Heart Association’s journal, Arteriosclerosis, Thrombosis, and Vascular Biology.

Study Parameters, Other Findings

Investigators analyzed data from 10,000 people enrolled in the UK Biobank, a large biomedical database of European patients. Patients were ages 40 to 69 at the time of enrollment and included 8,000 who had tested positive for the COVID-19 virus and 2,000 who were hospitalized with severe COVID-19 between Feb. 1, 2020, and Dec. 31, 2020. As this was in the period prior to the authorization of vaccines, the study population was unvaccinated.¹

The investigators compared the 2 COVID-19 subgroups to a group of nearly 218,000 people who did not have the condition. They then tracked the participants from the time of their COVID-19 diagnosis until the development of either heart attack, stroke, or death, up to nearly 3 years.¹

Accounting for patients who had pre-existing heart disease—approximately 11% in both groups—the investigators found that the risk of heart attack, stroke, and death was twice as high among all the COVID-19 patients and four times as high among those who had severe cases that required hospitalization, compared to those who had never been infected. The data further show that, within each of the 3 follow-up years, the risk of having a major cardiovascular event was still significantly elevated compared to the controls; and in some cases, almost as high or even higher than having a known cardiovascular risk factor, such as type 2 diabetes.¹

Do Certain Blood Types Increase Risk for Severe COVID-19, Cardiovascular Risks?

Another interesting component of the study was the potential correlation between certain blood types and severe infection. Specifically, the study is the first to show the increased risk of heart attack and stroke in patients with severe COVID-19 may have a genetic component involving blood type. The investigators write that hospitalization for COVID-19 more than doubled the risk of heart attack or stroke among patients with A, B, or AB blood types, but not in patients with O types, which seemed to be associated with a lower risk of severe COVID-19.

“Hospitalization for COVID-19 represents a coronary artery disease risk equivalent, with post–acute myocardial infarction and stroke risk particularly heightened in non-O blood types,” the investigators wrote. “These results may have important clinical implications and represent, to our knowledge, one of the first examples of a gene-pathogen exposure interaction for thrombotic events.”²

Additionally, the investigators pointed out this was during the earliest strain of the virus without any previous immunity, and the population studied was primarily White. They note it remains unclear if a study population with more racial and ethnic diversity would have affected the results.¹

Another aspect to consider is if the long-term cardiovascular effects will remain for patients with severe COVID-19. The investigators point out the need for additional longitudinal studies to confirm the findings to assess if severe COVID-19 is a significant acute cardiovascular episode risk factor.

“These results, especially if confirmed by longer term follow-up, support efforts to identify effective heart disease prevention strategies for patients who’ve had severe COVID-19. But more studies are needed to demonstrate effectiveness,” Goff said.¹

References

1. https://www.nih.gov/news-events/news-releases/first-wave-covid-19-increased-risk-heart-attack-stroke-three-years-later
2.Allayee, H, et al. COVID-19 Is a Coronary Artery Disease Risk
Equivalent and Exhibits a Genetic Interaction With ABO Blood Type <https://www.ahajournals.org/doi/10.1161/ATVBAHA.124.321001>. [2024] Arteriosclerosis, Thrombosis, and Vascular Biology. DOI: 10.1161/ATVBAHA.124.321001