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Cardiovascular disease risk after a SARS-CoV-2 infection: A systematic review and meta-analysis
Karla Romero Starke1, Pauline Kaboth1, Natalie Rath1
1Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
Insights
Individuals who survive severe SARS-CoV-2 infection face elevated risks for cardiovascular events like pulmonary embolism and myocardial infarction, particularly in the months following illness. Ongoing monitoring and management are crucial for these survivors.
Area of Science:
- Cardiovascular Science
- Infectious Disease Epidemiology
- Public Health
Background:
- The long-term cardiovascular (CVD) risks following SARS-CoV-2 infection, considering disease severity, remain incompletely understood.
- Existing research lacks systematic reviews that analyze CVD risks over time post-infection.
- This study addresses the need for a comprehensive evaluation of CVD risks after COVID-19.
Approach:
- A systematic review and meta-analysis were conducted, adhering to a registered protocol (PROSPERO).
- Searches were performed across major databases (PubMed, Embase, MedRxiv) for relevant studies.
- Data on pulmonary embolism (PE), myocardial infarction (MI), ischaemic stroke (IS), haemorrhagic stroke (HS), and arterial thrombosis were extracted, quality assessed, and pooled risks estimated by time and disease severity.
Key Points:
- Cardiovascular risks were highest in the acute phase post-infection, decreasing over time but remaining elevated for months.
- Pulmonary embolism (PE) risk was significantly elevated up to 4.5 months, myocardial infarction (MI) up to 1 month, and ischaemic stroke (IS) up to 2 months.
- Risk stratification by disease severity indicated that less severe infections were associated with lower CVD risks.
Conclusions:
- Individuals surviving SARS-CoV-2 infection, especially severe cases, require vigilant management due to persistent CVD risks.
- The heightened risk period extends significantly, particularly within the first nine months post-infection.
- Proactive clinical management strategies are essential to mitigate long-term cardiovascular sequelae of COVID-19.
Objectives:
To our knowledge, there is no systematic review examining CVD risks after a SARS-CoV-2 infection over time, while also taking into account disease severity. All evidence on the risk for pulmonary embolism (PE), myocardial infarction (MI), ischaemic stroke (IS), haemorrhagic stroke (HS), and arterial thrombosis following infection was evaluated.
Methods:
The protocol was registered with PROSPERO. We searched Pubmed, Embase, MedRxiv and screened the titles/abstracts and full texts. We extracted the included studies, assessed their quality, and estimated pooled risks by time after infection and according to disease severity.
Results:
Risks were highest in the acute phase [PE: 27.1 (17.8-41.10); MI: 4.4 (1.6-12.4); stroke: 3.3 (2.1-5.2); IS: 5.6 (2.1-14.8); HS: 4.0 (0.1-326.2)] compared to the post-acute phase [PE: 2.9 (2.6-3.3); MI: 1.4 (1.1-1.9); stroke: 1.4 (1.0-2.0); IS: 1.6 (0.9-2.7)]. Highest risks were observed after infection confirmation, dropping during the first month post-infection (e.g. PE: RR(7 days) = 31; RR(1 month) = 8.1). A doubled risk was still observed until 4.5 months for PE, one month for MI and two months for IS. Risks decreased with decreasing disease severity.
Conclusions:
Because of increased risk of CVD outcomes, management of persons who survived a severe SARS-CoV-2 infection is required, especially during the first nine months post-infection.
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