The emergence of COVID-19 pandemic caused as a result of severe acute respiratory syndrome-coronavirus marked a global health crisis with over 770 million cases of infection and 6 million deaths by September 6, 2023. Around 6.2% of the recovered individuals, however, face lingering symptoms such as fatigue or respiratory problems. Although interstitial pneumonitis and severe acute respiratory distress syndrome are the main effects of COVID-19 on the lungs, the virus also affects other organs, especially the cardiovascular system. Despite this, previous studies assessing cardiovascular outcomes in post-acute COVID-19 patients were limited by insufficiently adjusting for preexisting cardiovascular conditions among hospitalized individuals.
To overcome this limitation, a team of scientists led by Dr. Won-Young Kim, along with Professor Sun‑Young Jung from Chung-Ang University, Korea, conducted a nationwide population-based cohort study. They aimed to explore the risk of cardiovascular outcomes among individuals who survived acute COVID-19 hospitalization without preexisting cardiovascular conditions. The results of their study was published online on 20 October, 2023, in BMC Medicine.
The researchers used hospitalized patients with non-COVID-19 pneumonia as a historical comparison control group. Explaining the rationale for this study design further, Dr. Kim says, "Previous studies that assessed the risk of cardiovascular outcomes after COVID-19 selected general hospital admission as controls, neglecting the potential cardiovascular risks following non-COVID-19 pneumonia hospitalization. In addition, the demographic composition of previous studies (based on mostly White and older male populations) may limit the generalizability of the results."
The study utilized the Korean National Health Insurance Service database, encompassing nearly 97% of Korea's population. The database offered comprehensive details on demographics, diagnoses, treatments, and outcomes, linked to confirmed cases and vaccination information. The research focused on two groups—the first comprised 132,784 adults hospitalized for COVID-19 between October 2020 and September 2021, while the second consisted of a historical control group of 31,173 adults hospitalized for non-COVID pneumonia between January and December 2019.
The primary outcome measured was major adverse cardiovascular events, with secondary outcomes encompassing specific cardiovascular conditions and mortality. Various other subgroup and sensitivity analyses were conducted along with statistical analyses.
Interestingly, the researchers found no increased incidence of post-acute cardiovascular issues in those adults hospitalized with COVID-19 compared to those hospitalized for non-COVID-19 pneumonia. COVID-19 survivors exhibited lower risks of all-cause mortality, congestive heart failure, and cardiac arrest, but faced notably higher risks of acute myocarditis and deep vein thrombosis. Further, younger COVID-19 patients, especially those without cardiovascular risk factors, showed elevated risks of cardiovascular complications, implying that COVID-19 may be an independent risk factor in this subgroup. Sensitivity analyses with preexisting cardiovascular disease and subgroup assessments confirmed these trends, emphasizing the impact of COVID-19 on cardiovascular outcomes. Additionally, non-vaccinated COVID-19 patients exhibited increased risks of various adverse cardiovascular events.
Discussing the results further, Dr. Kim remarks, "Our results suggest that COVID-19 vaccination may prevent cardiovascular outcomes. This supports vaccination, especially for patients with preexisting cardiovascular disease."
This study is the first to compare the risk of cardiovascular outcomes between COVID-19 and non-COVID-19 pneumonia among the East Asian population. While prior Western studies suggested elevated cardiovascular risks post-COVID-19, this research has revealed low risks in Korean patients following acute COVID-19 hospitalizations. Going ahead, these findings can offer valuable insights for healthcare practitioners and policymakers to devise effective strategies for the long-term care of COVID-19 patients.
Authors: Min‑Taek Lee1, Moon Seong Baek2, Tae Wan Kim2, Sun‑Young Jung1,3, and Won‑Young Kim2
1Department of Global Innovative Drugs, The Graduate School of Chung-Ang University, Chung‑Ang University, Seoul, Republic of Korea
2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung‑Ang University Hospital, Chung‑Ang University College of Medicine, Seoul, Republic of Korea
3College of Pharmacy, Chung‑Ang University, Seoul, Republic of Korea
About Chung-Ang University
Chung-Ang University is a private comprehensive research university located in Seoul, South Korea. It was started as a kindergarten in 1916 and attained university status in 1953. It is fully accredited by the Ministry of Education of Korea. Chung-Ang University conducts research activities under the slogan of "Justice and Truth." Its new vision for completing 100 years is "The Global Creative Leader." Chung-Ang University offers undergraduate, postgraduate, and doctoral programs, which encompass a law school, management program, and medical school; it has 16 undergraduate and graduate schools each. Chung-Ang University's culture and arts programs are considered the best in Korea.
About Professor Won-Young Kim
Won-Young Kim is an Associate Professor of Division of Pulmonary and Critical Care Medicine at Chung-Ang University Hospital. His research focuses on the inflammatory disorders such as sepsis and acute respiratory distress syndrome. He has served as a principal investigator on several funded projects related to vitamin C for septic shock. He is also interested in epidemiology of COVID-19.
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