Long after Covid-19, the heart can still be sick

The commotion last week was great. People who have had Covid-19 are not only at an increased risk of cardiovascular disease in the acute phase of the disease, but in the entire year that follows. That is the conclusion of a large study among American war veterans in Nature Medicine† Twenty illnesses, including heart failure and stroke, were one and a half to four times more common among ex-covid patients in the first year of the pandemic than among veterans who jumped the dance. The more seriously ill they had been, the higher the risk was.

“Astonishing,” American cardiologist Eric Topol called the findings in the scientific journal Science, “worse than I expected.” But researchers also immediately made reservations. To what extent can findings in American veterans be translated to the rest of the world?

“It is the first major study that has been done with data from the real world,” says cardiologist Folkert Asselbergs of UMC Utrecht. “But it’s not about young people, and it’s not about vaccinated people. These are veterans, 90 percent are male, 85 percent are overweight, half are even obese, and they are on average 61 years old. A third have diabetes or elevated cholesterol. The findings cannot be translated to other groups in this way.”

American Veterans

Asselbergs and his colleagues do not see a major increase in cardiovascular diseases in Dutch hospitals. “We have to wait and see whether this increased risk can also be confirmed in the Netherlands.”

The researchers used medical records from more than 150,000 U.S. veterans who had experienced Covid-19 before January 2021. They compared it with data from more than five million veterans who had sought medical help for other reasons during that period, and with data from more than five million veterans who did so in 2017, before SARS-CoV-2.

They looked at the frequency of twenty cardiovascular diseases in the three groups, from thrombosis to arrhythmias, from heart attacks to pulmonary embolism. All conditions were more common in the group who had had Covid-19, especially in people who had been hospitalized. For example, per 1,000 people there were 4 more who had had a stroke, a risk increase of 52 percent. And 12 more people developed heart failure, a 72 percent increase. All told, per 1,000 veterans, there were an average of 45 additional individuals who developed one of the heart conditions studied, compared to the controls.

We should see this as a clear signal

Folkert Asselbergs cardiologist

Asselbergs is not surprised that the risk of heart disease after Covid-19 was also somewhat increased in veterans who had no underlying condition, or who had not been hospitalized. “If a sixty-year-old man has Covid-19, that is quite a stress test. As a result, a previously unnoticed arteriosclerosis can come to the surface earlier. Then it is not specifically due to the virus, but is accelerated by the disease.”

Early in the pandemic, Asselbergs set up a large international study into the effects of Covid-19 on cardiovascular disease. “After six months, we make an ultrasound, a heart film and an MRI scan of every covid patient in a few Dutch hospitals. We’re looking for heart damage. Do people get scar tissue on their hearts? Will they later develop, for example, heart failure or arrhythmias? Will we see a wave of people with heart problems in ten years?”

Trombosebeen

How the virus causes cardiovascular disease is being researched diligently. It became clear early on that an infection blood clotting disorders can give and affect blood vessels. The gateway to cells in the body for the virus, the ACE2 receptor, is located on airway cells, but also on cells in the heart and blood vessel wall. Blood clots sometimes develop in hospital covid patients that lead to a thrombosis, a pulmonary embolism or a cerebral infarction. Cardiovascular disease could also be caused by damage to the heart muscle cells caused by the virus, or by the inflammatory substances that triggered the infection, or even because the virus is still hiding in the tissue.

The study was done in the first year of the pandemic, when other virus variants were circulating, and hardly anyone had been vaccinated yet. It is not yet clear whether the increased risk of cardiovascular disease also exists if people who already have an immune system contract an infection.

Asselbergs: „We must see this as a clear signal and investigate whether this also applies to the Dutch population. And if people who have had Covid-19 develop symptoms, such as chest pain or shortness of breath, we have to take that seriously. That’s the only hard conclusion you can draw.”

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