Since nearly the start of the pandemic, scientists have known that a Covid-19 infection increases the risk of heart problems. A growing body of research now suggests that this risk can last until well after the infection has cleared.
One recent study, conducted by researchers at the University of Southern California and Cleveland Clinic, found that a Covid-19 infection doubled the risk of a major cardiovascular event for up to three years afterward. What’s more, the study found that infections severe enough to require hospitalization increased the likelihood of cardiac events as much as — or more than — having previously had a heart attack did.
“A lot of people are at even greater risk of heart attack than they were before,” said Dr. David Goff, director for the cardiovascular sciences division at the National Heart, Lung and Blood Institute, which provided funding for the study. “And heart disease is already the leading cause of death on our planet before the pandemic. So this is really concerning.”
Given the volume of evidence now linking Covid-19 to heart inflammation, heart failure, arrhythmia and other cardiovascular issues, experts said, doctors should be taking a closer look at patients’ Covid history.
People who had a severe infection “should be considered at high risk for future cardiovascular events,” said Dr. Stanley Hazen, the chair of the department of cardiovascular and metabolic sciences at Cleveland Clinic and one of the authors of the new study.
The Science on Covid and the Heart
Anyone who has had an infection faces an elevated risk of heart problems, and research shows this risk is highest around the time of initial infection and for those who had the most severe disease, said Dr. Ziyad Al-Aly, chief of research and development at the Veterans Affairs St. Louis Healthcare System.
Dr. Al-Aly analyzed data from a national V.A. database and compared outcomes after one year of patients who had a Covid infection and of those who did not. For every 1,000 patients, there were 23 more “major adverse cardiac events,” almost 20 more cases of irregular heartbeat and 10 more incidents related to blood clotting disorders in the Covid group than the control group. By the three-year mark, the risk of heart problems had fallen to base-line levels for patients who had not been hospitalized but remained somewhat elevated for those who had.
Dr. Al-Aly’s research has also shown that the incidence of long-term heart problems associated with Covid has dropped since the beginning of the pandemic, as the virus mutated into somewhat milder strains and more people got vaccinated.
Though people are still getting sick from Covid and developing long-term health issues from it, Dr. Al-Aly said, “it’s undeniably much, much less than before.”
The new study, which analyzed a large data set from Britain of patients age 50 and up, reaffirmed some of the earlier findings, showing that those hospitalized for Covid-19 were almost four times as likely to have a heart attack or stroke or die over the following three years as those who did not have an infection.
Unlike other research, though, the study found that for all patients who had a Covid infection, the elevated risk persisted at relatively the same level for as long as follow-up data was available — nearly three years.
“That’s actually one of the more surprising findings,” Dr. Hazen said. “There’s no signs of attenuation of that risk.”
How Does Covid Cause Heart Disease?
Scientists aren’t entirely sure how exactly a Covid infection causes cardiovascular disease, but they suspect a few pathways are at play.
The virus can damage the endothelial cells that line blood vessels, leading to inflammation, Dr. Goff said. This could cause a plaque that has already built up from cholesterol and other materials to break apart, form a clot and block a blood vessel, in turn leading to a heart attack or stroke.
That type of blockage can cause sudden death or downstream damage to heart muscles and other tissue, ultimately leading to heart failure or an arrhythmia, Dr. Goff explained.
Even without pre-existing plaque buildup, Dr. Al-Aly said, there is growing evidence that an infection can activate an inflammatory pathway that makes platelets clump up and form clots that can clog blood vessels.
It’s also possible that in some cases, the body may not completely get rid of the virus, creating low-grade chronic inflammation that could damage heart tissues and subsequently lead to heart disease, he said.
The new study found that people with a non-O blood type — A, B or AB — have an especially increased risk for heart disease after a Covid-19 infection, though having an O blood type doesn’t eliminate the risk entirely. It’s not clear why this is the case, Dr. Hazen said, but it appears that blood type may be linked to clotting risk.
How to Protect Your Heart
The first thing you should do is to get your vaccine or booster, doctors said. Vaccines reduce the severity of an initial infection, making you less likely to end up in the hospital. Vaccines also boost the immune system’s ability to clear the virus, Dr. Al-Aly said, reducing the odds of a persistent infection that causes chronic inflammation.
Beyond vaccination, doctors recommend taking the connection between Covid and heart disease seriously — especially if you had a severe infection or already have a risk factor like high cholesterol, high blood pressure or diabetes.
After you have recovered from Covid, “see your doctor, so you know your numbers,” Dr. Goff said.
More research needs to be done on how, exactly, Covid increases heart disease risk and what treatments might effectively reduce that risk, Dr. Goff said. But doctors and patients already have some tools at their disposal.
For example, when someone is at increased risk for heart disease because of elevated cholesterol or diabetes, doctors may recommend statins.
Low-dose aspirin also can help prevent blood clotting in high-risk patients. In the new study, patients who reported taking aspirin before getting Covid were less likely to have a heart attack or stroke after the infection than patients who did not.
If you have had a severe Covid infection, Dr. Goff said, you can reduce your risk of heart disease by eating a healthy diet, such as the DASH diet, getting plenty of physical activity, maintaining a normal body weight, avoiding cigarette smoking and secondhand smoke and getting good rest every night.
And even if you haven’t had a severe Covid infection, these measures will help protect your heart, too.
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