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Juan Lama
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COVID-19 is associated with higher risks of cardiovascular disease and death in the short- and long-term, according to a study in nearly 160,000 participants published today in Cardiovascular Research, a journal of the European Society of Cardiology (ESC). Compared to uninfected individuals, the likelihood of COVID-19 patients dying was up to 81 times higher in the first three weeks of infection and remained five times higher up to 18 months later. "COVID-19 patients were more likely to develop numerous cardiovascular conditions compared to uninfected participants, which may have contributed to their higher risks of death," said study author Professor Ian C.K. Wong of the University of Hong Kong, China. "The findings indicate that patients with COVID-19 should be monitored for at least a year after recovering from the acute illness to diagnose cardiovascular complications of the infection, which form part of long COVID." This study compared the occurrence of cardiovascular conditions and death in infected versus uninfected individuals recruited before December 2020, when no vaccines were available in the UK. More than 7,500 patients with COVID-19 infection diagnosed from March 16, 2020 to November 30, 2020 were identified from UK Biobank. Each patient was matched with up to 10 individuals without COVID-19 during the study period (March 16, 2020 to the end of follow-up on August 31, 2021) and a historical cohort before the pandemic (March 16, 2018 to November 30, 2018). Each uninfected group had more than 70,000 participants who were similar to the COVID-19 group for age, sex, smoking, diabetes, high blood pressure, cardiovascular and other health conditions, body mass index, ethnicity, and deprivation. In all three groups, the average age was 66 years and there were nearly equal numbers of women and men. Professor Wong explained, "The historical control cohort was included to rule out the effect of routine healthcare services being reduced or canceled during the pandemic, which led to worsening health and increased mortality even in uninfected people." Data were obtained from medical and death records for outcomes including major cardiovascular disease (a composite of heart failure, stroke and coronary heart disease); numerous cardiovascular conditions such as stroke, atrial fibrillation and myocardial infarction; death from cardiovascular disease; and all-cause death. Associations were evaluated for the acute phase (within 21 days of COVID-19 diagnosis) and the post-acute phase (starting at 22 days after diagnosis and continuing up to 18 months). Participants with a history of a particular outcome were excluded from that analysis. Compared with the two uninfected cohorts, patients with COVID-19 were approximately four times more likely to develop major cardiovascular disease in the acute phase and 40% more likely in the post-acute phase. Compared to uninfected individuals, the risk of death in COVID-19 patients was up to 81-fold higher in the acute phase and five-fold higher in the post-acute phase. Patients with severe COVID-19 were more likely to develop major cardiovascular disease or die than non-severe cases. COVID-19 patients had a greater likelihood of several cardiovascular conditions compared with uninfected participants in both the short- and long-term including myocardial infarction, coronary heart disease, heart failure, and deep vein thrombosis. Risks of some cardiovascular conditions—for example stroke and atrial fibrillation—were elevated in COVID-19 patients in the short-term but then returned to normal levels. Professor Wong said, "This study was conducted during the first wave of the pandemic, and future research should evaluate subsequent outbreaks. Previous research has indicated that COVID-19 vaccination may prevent complications, and further studies are needed to investigate its effectiveness in reducing the risks of cardiovascular disease and death after COVID-19 infection in patients with COVID-19 vaccination compared to those without vaccination." ESC spokesperson Professor Héctor Bueno of the National Centre for Cardiovascular Research (CNIC), Madrid, Spain said, "COVID-19 has had a huge impact on patients with cardiovascular disease, who were less likely to receive optimal care during the pandemic and more likely to die from the infection. This study shows that COVID-19 also increases the risk of having cardiovascular complications and dying in the first weeks after the infection and remains high for months, suggesting that specific cardiovascular monitoring may be appropriate in these patients." Cited study published in Cardiovascular Research (Jan. 19, 2023): https://doi.org/10.1093/cvr/cvac195
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Juan Lama
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In a recent study published in the British Medical Journal, researchers evaluated the association between coronavirus disease 2019 (COVID-19) vaccination and long COVID symptoms among adults residing in United Kingdom (UK) communities with positive COVID-19 history before vaccination. COVID-19 vaccines have been effective in decreasing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, transmission, hospitalizations, and deaths. The likelihood of long COVID may be lower among individuals who are infected by SARS-CoV-2 after vaccination; however, the association between COVID-19 vaccination and long COVID symptoms is not clear. About the study In the present community-based observational cohort study, researchers assessed the likelihood of experiencing long COVID symptoms and the impact of long COVID on the performance of daily activities among UK community residents with SARS-CoV-2 infections before COVID-19 vaccination. The study comprised 18-to-69-year-old individuals who had participated in the COVID-19 Infection Survey, which involved UK households (excluding communal establishments such as care homes. hospitals, care homes, prisons, and residence halls). Vaccination data (vaccine doses, vaccination date, and vaccine manufacturers) were obtained from the COVID-19 Infection Survey and the National Immunisation Management System for participants residing in England. At each monthly follow-up visit, the participants were asked if they experienced any symptoms of long COVID (described as symptoms persisting for a minimum of four weeks after suspected or confirmed COVID-19 which could not be explained by any other health condition). The survey respondents also provided self-collected nasopharyngeal and oropharyngeal swab samples for reverse transcription-polymerase chain reaction (RT-PCR) testing at each follow-up visit. The primary outcome measure was the presence of long COVID symptoms for a minimum of 12 weeks after SARS-CoV-2 infection and during follow-up between February 3 and September 5, 2021. The secondary outcome measure was limitations in performing daily activities due to long COVID. In addition, the team evaluated 10 symptoms that were most frequently reported during follow-ups and if the participants experienced >3 or >5 of the 21 long COVID symptoms included in the survey. All the participants were vaccinated with either a single dose of an adenovirus vector COVID-19 vaccine (ChAdOx1 nCoV-19) or messenger ribonucleic acid (mRNA) vaccine (BNT162b2 or mRNA-1273) after testing SARS-CoV-2-positive. The survey questions asked about symptoms of long COVID which persisted for >4 weeks after SARS-CoV-2 infection; however, for the analysis, a 12-week period was used, in accordance with the World Health Organization (WHO) definition of the post-COVID-19 condition and the UK clinical case definition of the post-COVID-19 syndrome. Results Among the 28,356 study participants, the average age was 46 years and 56% (n=15,760) of them were females. The majority of the participants (89%) were Whites. The average follow-up periods were 141 days and 67 days after the first and second COVID-19 vaccinations, respectively. A total of 6,729 participants (24%) experienced symptoms of long COVID a minimum of once during the follow-up period. After the first vaccination, a 13% reduction was observed in the likelihood of long COVID symptoms, followed by elevations and reductions in the trajectory of long COVID symptoms (ranging between 0.3% and 1.2% weekly). After the second vaccination, a 9% initial reduction was observed in the likelihood of long COVID symptoms, followed by further reductions of 0.8% weekly. Long COVID symptoms resulting in limitation of daily activities were reported by 4,747 participants (17%) a minimum of once during the follow-up period. The first vaccination was associated with an initial 12% decrease in the likelihood of daily activity limitation which was followed by an uncertain trajectory (0.9%weekly) till the second vaccination. The second vaccination was associated with an initial 9% decrease in the likelihood of daily activity limitation, followed by -0.5% weekly till termination of the follow-up period. No statistically significant differences were found in the association between COVID-19 vaccinations and long COVID symptoms by health-related factors, sociodemographic characteristics, hospitalization with acute SARS-CoV-2 infections, vaccination type (mRNA or adenovirus vector vaccine), or duration between COVID-19 and its vaccination. The odds of experiencing >3 or >5 symptoms of long COVID initially decreased after the first and the second vaccination. After the first vaccination, the largest decreases were noted for anosmia (−13%), ageusia (−9%), and poor sleep (−9%). After the second vaccination, the most significant decreases were noted for fatigue (−10%), headaches (−9%), and poor sleep (−9%). Overall, the study findings showed that the odds of long COVID symptoms decreased after SARS-CoV-2 vaccination, with sustained immunity after the second vaccination, at least during the mean 67-day- follow-up period. The results underpin the importance of vaccination to reduce the long COVID healthcare burden. However, further research with more extended periods of follow-up is required. Research Published in BMJ (May 18, 2022): https://doi.org/10.1136/bmj-2021-069676
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Juan Lama
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The post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection—also referred to as Long COVID—have been described, but whether breakthrough SARS-CoV-2 infection (BTI) in vaccinated people results in post-acute sequelae is not clear. In this study, we used the US Department of Veterans Affairs national healthcare databases to build a cohort of 33,940 individuals with BTI and several controls of people without evidence of SARS-CoV-2 infection, including contemporary (n = 4,983,491), historical (n = 5,785,273) and vaccinated (n = 2,566,369) controls. At 6 months after infection, we show that, beyond the first 30 days of illness, compared to contemporary controls, people with BTI exhibited a higher risk of death (hazard ratio (HR) = 1.75, 95% confidence interval (CI): 1.59, 1.93) and incident post-acute sequelae (HR = 1.50, 95% CI: 1.46, 1.54), including cardiovascular, coagulation and hematologic, gastrointestinal, kidney, mental health, metabolic, musculoskeletal and neurologic disorders. The results were consistent in comparisons versus the historical and vaccinated controls. Compared to people with SARS-CoV-2 infection who were not previously vaccinated (n = 113,474), people with BTI exhibited lower risks of death (HR = 0.66, 95% CI: 0.58, 0.74) and incident post-acute sequelae (HR = 0.85, 95% CI: 0.82, 0.89). Altogether, the findings suggest that vaccination before infection confers only partial protection in the post-acute phase of the disease; hence, reliance on it as a sole mitigation strategy may not optimally reduce long-term health consequences of SARS-CoV-2 infection. The findings emphasize the need for continued optimization of strategies for primary prevention of BTI and will guide development of post-acute care pathways for people with BTI. A new analysis using the US Department of Veterans Affairs national healthcare databases demonstrates that Long COVID can occur after breakthrough SARS-CoV-2 infection; however, the risk of death attributable to COVID and incidence of post-acute sequelae were substantially reduced (but not fully eliminated) compared to unvaccinated individuals. Published in Nature Medicine (May 25, 2022): https://www.nature.com/articles/s41591-022-01840-0
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