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Risk factors for long-term cardiovascular post-acute sequelae of COVID-19 infection: A nested case-control study in

Qiuyan Yu1,2, Min Fan1, Celia Jiaxi Lin3

  • 1Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.

NPJ Cardiovascular Health
|March 3, 2026
PubMed

Insights

COVID-19 hospitalization and peripheral vascular disease increase cardiac PASC risk. COVID-19 vaccination and frequent healthcare visits are protective factors against cardiac PASC, especially for high-risk individuals.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • Post-acute sequelae of SARS-CoV-2 (PASC) can affect multiple organ systems, including the cardiovascular system.
  • Cardiac-related PASC presents a significant health burden following COVID-19 infection.
  • Understanding risk factors for cardiac PASC is crucial for targeted prevention and management strategies.

Purpose of the Study:

  • To investigate the risk factors associated with cardiac-related PASC.
  • To identify specific pre-existing conditions and demographic factors that predispose individuals to cardiac PASC.
  • To evaluate the potential protective effects of COVID-19 vaccination and healthcare utilization on cardiac PASC development.

Main Methods:

  • A nested case-control study design was employed using electronic health records from the Hong Kong Hospital Authority.
  • Cases were defined as patients with at least one cardiac-related PASC diagnosis, and controls were matched individuals without cardiac PASC.
  • Multivariable conditional logistic regression analysis was used to identify associations between risk factors and cardiac-related PASC, with incidence density sampling for control selection (1:10 ratio).

Main Results:

  • COVID-19-associated hospitalization (aOR: 1.41) and peripheral vascular disease (aOR: 2.98) were significantly associated with an increased risk of cardiac-related PASC.
  • Higher doses of COVID-19 vaccination demonstrated a protective effect (2 doses: aOR 0.68; ≥3 doses: aOR 0.56).
  • Increased healthcare utilization visits (aOR: 0.95) were also linked to a reduced likelihood of developing cardiac-related PASC.

Conclusions:

  • Peripheral vascular disease and hospitalization due to COVID-19 are identified as key risk factors for cardiac-related PASC in this Chinese population cohort.
  • COVID-19 vaccination confers protection against cardiac PASC, highlighting its importance in mitigating post-infection cardiovascular complications.
  • Prioritizing vaccination for high-risk individuals is recommended to reduce the incidence of cardiac-related PASC.

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