Covid-19 linked to accelerated heart disease risk

A new study, which has found that Covid-19, caused by the Sars-CoV-2 virus is linked to accelerated plaque buildup in the coronary arteries, increasing the risk of heart-related complications, has brought back grim memories of the pandemic. The findings were published last week in Radiology, the journal of the Radiological Society of North America. “Covid-19, caused by Sars-CoV-2, is initially characterised by acute lung injury and respiratory failure,” explained the study’s senior author, Junbo Ge, MD, professor and director of the Cardiology Department at Zhongshan Hospital, Fudan University in Shanghai, China. “However, emerging evidence indicates Covid-19 also involves an extreme inflammatory response that can affect the cardiovascular system.”
Dr Ge noted that this inflammation continues beyond the first month of infection, raising the risk of severe cardiovascular issues and even death. To understand this impact, researchers used coronary CT angiography (CCTA) to examine changes in the tissue surrounding the coronary arteries. They analysed signs of inflammation, plaque buildup, and the presence of high-risk arterial blockages. The retrospective study included patients who underwent CCTA between September 2018 and October 2023. The final study group of 803 patients (mean age, 63.9 years, 543 men) included 329 patients (41%) imaged before the Covid-19 pandemic and 474 patients imaged during the pandemic. Of those, 25 patients were infected with Sars-CoV-2 before imaging.
The research team analysed a total of 2,588 coronary artery lesions, including 2,108 lesions among Sars-CoV-2 patients and 480 lesions among uninfected patients. For all patients, researchers compared baseline and follow-up measurements of plaque volume changes, the presence of high-risk plaque, and inflammation. They also analysed the relationship between Sars-CoV-2 and cardiovascular events, such as a heart attack or revascularisation procedure. At baseline, the mean stenosis, or narrowing of the artery, per lesion was 31.3%. Only 8.1% of lesions had diameter stenosis of 50% or more. Compared to the uninfected patients, the plaque volumes grew faster in Sars-CoV-2 patients. Lesions in patients with Sars-CoV-2 infection had a higher incidence of developing into high-risk plaques (20.1% versus 15.8%) and coronary inflammation (27% versus 19.9%). Patients with Covid-19 also had a higher risk of target lesion failure (10.4% versus 3.1%), an indicator of increased heart attack or stroke risk.
“Inflammation following Covid-19 can lead to ongoing plaque growth, particularly in high-risk, noncalcified plaques.” Dr Ge said. “Patients with Sars-CoV-2 infection are at increased risk for myocardial infarction, acute coronary syndrome, and stroke for up to a year.” He added that these effects persist during the aftermath of Covid-19, regardless of comorbidities such as age, hypertension, and diabetes. “Effective management strategies for these patients are imperative,” Dr Ge said.
The findings suggest that Sars-CoV-2 infection may exacerbate cardiovascular risk by accelerating the progression of susceptible plaques and coronary inflammation. However, a more comprehensive understanding of the biological mechanisms is required to formulate preventative and therapeutic approaches. “It’s crucial to anticipate a heavier cardiovascular patient burden in the future as most infected individuals recover from acute Sars-CoV-2 infection,” Dr Ge added.
Incidentally, a US National Institutes of Health-funded study, which focused on the original Sars-CoV-2 strain and featuring unvaccinated participants during the pandemic, and published in October 2024, had revealed that the first wave of Covid-19 increased risk of heart attack, stroke up to three years later. The findings, among people with or without heart disease, had confirmed previous research showing an associated higher risk of cardiovascular events after a Covid-19 infection but were the first to suggest the heightened risk might last up to three years following initial infection, at least among people infected in the first wave of the pandemic. Compared to people with no Covid-19 history, the study found those who developed Covid-19 early in the pandemic had double the risk for cardiovascular events, while those with severe cases had nearly four times the risk. The findings were published in the journal *Arteriosclerosis, Thrombosis, and Vascular Biology.