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Accelerated vascular ageing after COVID-19 infection: the CARTESIAN study
Rosa Maria Bruno1,2, Smriti Badhwar1, Leila Abid3
1INSERM U970, Paris Cardiovascular Research Centre-PARCC, Université Paris Cité, 56 Rue Leblanc, Paris 75015, France.
Insights
COVID-19 survivors show accelerated vascular aging, particularly women, indicated by increased arterial stiffness. This vascular damage may persist long-term, highlighting the need for cardiovascular monitoring post-infection.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Vascular Biology
Background:
- COVID-19 survivors may face long-term cardiovascular issues due to vascular damage.
- Accelerated vascular aging is a potential complication following SARS-CoV-2 infection.
Purpose of the Study:
- To investigate if COVID-19 infection leads to accelerated vascular aging.
- To identify factors contributing to vascular aging post-COVID-19.
Main Methods:
- Prospective, multicentric cohort study across 34 centers in 16 countries.
- Included COVID-19-negative controls and three groups of SARS-CoV-2 exposed individuals (non-hospitalized, ward, ICU).
- Carotid-femoral pulse wave velocity (PWV) measured as the primary outcome for arterial stiffness.
Main Results:
- All COVID-19 positive groups exhibited significantly higher PWV compared to controls.
- PWV increase was pronounced in women, with persistent symptoms correlating to higher PWV.
- COVID-19 positive groups showed stable PWV over 12 months, while controls had progression.
Conclusions:
- COVID-19 is linked to long-term, accelerated vascular aging.
- Women appear particularly susceptible to developing vascular aging after COVID-19.
- Persistent symptoms in women are associated with increased arterial stiffness post-COVID-19.
Background And Aims:
Increasing evidence suggests that COVID-19 survivors experience long-term cardiovascular complications possibly through development of vascular damage. The study aimed to investigate whether accelerated vascular ageing occurs after COVID-19 infection, and if so, identify its determinants.
Methods:
This prospective, multicentric, cohort study, included 34 centres in 16 countries worldwide, in 4 groups of participants-COVID-19-negative controls (ⅰ) and three groups of individuals with recent (6 ± 3 months) exposure to SARS-CoV-2: not hospitalized (ⅱ), hospitalized in general wards (ⅲ), and hospitalized in intensive care units (ⅳ). The main outcome was carotid-femoral pulse wave velocity (PWV), an established biomarker of large artery stiffness.
Results:
2390 individuals (age 50 ± 15 years, 49.2% women) were recruited. After adjustment for confounders, all COVID-19-positive groups showed higher PWV (+0.41, +0.37, and +0.40 m/s for groups 2-4, P < .001, P = .001 and P = .003) vs. controls [PWV 7.53 (7.09; 7.97) m/s adjusted mean (95% CI)]. In sex-stratified analyses, PWV differences were significant in women [PWV (+0.55, +0.60, and +1.09 m/s for groups 2-4, P < .001 for all)], but not in men. Among COVID-19 positive women, persistent symptoms were associated with higher PWV, regardless of disease severity and cardiovascular confounders [adjusted PWV 7.52 (95% CI 7.09; 7.96) vs. 7.13 (95% CI 6.67; 7.59) m/s, P < .001]. A stable or improved PWV after 12 months was found in the COVID+ groups, whereas a progression was observed in the COVID- group.
Conclusions:
COVID-19 is associated with early vascular ageing in the long term, especially in women.
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