“This study builds on prior research linking COVID-19 to systemic inflammation and long-term cardiovascular complications,” says study senior author Junbo Ge, MD, a professor and the director of the cardiology department at Zhongshan Hospital at Fudan University in Shanghai, China.
“COVID-19 is not just a respiratory illness: It has lasting cardiovascular consequences,” Dr. Ge says. “Even mild infections may accelerate atherosclerosis and increase heart attack risk.”
COVID-19 Poses Long-Term Health Risks
How COVID-19 Affects the Arteries
To see how the coronavirus that causes COVID-19, SARS-CoV-2, might affect coronary arteries that supply blood to the heart, Ge and his collaborators reviewed scans of the heart and blood vessels in about 800 older adults, taken between September 2018 and October 2023.
Participants, who were 64 years old on average, had at least two examinations performed about three years apart. A total of 690 adults with an associated 2,108 coronary plaques had confirmed COVID-19 over this time period, and 113 adults with 480 coronary plaques did not.
Ge and his team compared how plaque volumes changed between initial scans and follow-up imaging. The findings showed that plaque volumes grew faster in participants who had COVID-19.
In participants with COVID-19, the incidence of lesions (abnormal growths in blood vessels) developing into high-risk plaques that are likely to break away and cause a clot was just over 20 percent, compared with almost 16 percent in participants who didn’t have COVID-19.
“Inflammation following COVID-19 can lead to ongoing plaque growth, particularly in high-risk, noncalcified plaques,” says Ge.
The investigative team also found a 27 percent incident rate for coronary inflammation in the COVID group, versus just under 20 percent in the non-COVID group.
“While systemic inflammation was expected to influence atherosclerosis, the magnitude of plaque progression underscores the profound impact of COVID-19,” says Ge. “The study shows that even nonhospitalized COVID-19 patients face heightened risks of plaque progression and cardiovascular events.”
Taking Action to Protect the Heart
“The results are intriguing and correspond in some ways to research we’ve done looking at plaque on a cellular level to see why patients who have viral infections like flu and SARS have an increased risk of heart attack,” says Dr. Nguyen.
She stresses, however, that this study is limited because it’s retrospective — looking at already existing imaging and data, rather than directly following a group of participants. Furthermore, patients were all Asian and selected from a single health center, reducing any generalization of results to other populations.
Also, the analysis did not take lifestyle factors into account.
“There is no information about diet and exercise, for example,” says Nguyen, pointing out that a lack of physical activity and poor eating habits could be contributing factors to negative heart health outcomes in some of these participants.
Ge urges people who get COVID-19 to talk to their healthcare providers and prioritize their heart health post-recovery. Steps to take include:
- Pursuing heart-healthy diets, exercise, and smoking cessation
- Taking steps to manage heart disease risk factors, including high blood pressure, diabetes, and LDL cholesterol
- Considering statins or other anti-inflammatory agents under medical guidance
- Getting regular heart screenings and imaging if they’re at high-risk for heart attack or stroke
- Staying vigilant for symptoms of heart distress, including chest pain and shortness of breath