Time-Critical Cardiovascular Risk After COVID-19: A Population-Based Analysis Across Variant Eras

Area of Science:

• Cardiology
• Infectious Diseases
• Epidemiology

Background:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been linked to increased cardiovascular risk.
• Understanding the temporal patterns and variant-specific differences in this risk is crucial for patient management.

Purpose of the Study:

• To define the timing and intensity of cardiovascular risk following SARS-CoV-2 infection across different pandemic eras (pre-Delta, Delta, Omicron).
• To assess how age and SARS-CoV-2 variants influence cardiovascular outcomes post-infection.

Main Methods:

• A population-based retrospective cohort study of 162,471 adults infected with SARS-CoV-2 from March 2020 to December 2023.
• Utilized the Rochester Epidemiology Project, analyzing major adverse cardiovascular events, thrombotic events, and dysrhythmias using ICD-10 codes.
• Employed multivariable Cox regression to assess age- and variant-specific risks, accounting for the competing risk of death.

Main Results:

• Cardiovascular events clustered within 30 days post-infection, with risk declining thereafter.
• Older adults (≥80 years) faced substantially higher early cardiovascular risk during the pre-Delta and Delta eras compared to Omicron.
• Thrombotic events and dysrhythmias exhibited similar early, age-dependent patterns, with dysrhythmia rates peaking in older adults during the Delta era.

Conclusions:

• Cardiovascular events post-COVID-19 are concentrated in the initial 30 days, with significant variations by age and pandemic era.
• The findings support a clinically relevant, time-sensitive hazard window for cardiovascular monitoring, particularly in older populations.
• Targeted, time-sensitive cardiovascular monitoring is recommended for higher-risk populations following SARS-CoV-2 infection.