COVID-19 Is Associated with Increased Vascular Risk

In our practice, our patients have been reducing the risk of COVID-19 by following our cardiovascular evaluations for years.

Harlan M. Krumholz, MD, SM, reviewing Katsoularis I et al. Lancet 2021 Jul 29

Population-based studies in Sweden suggest that COVID-19 is an independent risk factor for acute myocardial infarction and ischemic stroke.

COVID-19 is associated with cardiovascular and thrombotic complications. However, questions remain about the magnitude of the risk and which patients have the highest risk. Therefore, Swedish investigators undertook a self-controlled case series (in which the case also acts as the control) and matched cohort study (for a comparison with the background population) to define the risks for acute myocardial infarction (AMI) and ischemic stroke after COVID-19 onset.

The researchers analyzed records of all 86,742 people diagnosed with COVID-19 in Sweden from February 1 to September 14, 2020, which they linked with national inpatient, outpatient, cancer, and death registries. For the matched cohort study, they identified 348,481 controls, matched by age, sex, and county.

In the self-controlled case series, compared with control time periods, the incidence rate ratios for AMI and ischemic stroke were 2.9 and 3.0, respectively, for the first week following COVID-19 onset (excluding the first day), 2.5 and 2.8 for the second week, and 1.6 and 2.1 for weeks 3 through 4. In the matched cohort analysis, the odds ratios for the two weeks following COVID-19 (excluding the first day) were 3.4 for AMI and 3.6 for ischemic stroke. For both events, patients with more comorbidities had a higher risk.

This nationwide study provides evidence that COVID-19 is a risk factor for AMI and ischemic stroke. We need to learn how long this risk persists and what we can do to mitigate it. Meanwhile, clinicians should be on alert for these events in people recently suffering from COVID-19.