Risk of Major Adverse Cardiovascular Events After SARS-CoV-2 Infection in British Columbia: A Population-Based Study

Héctor Alexander Velásquez García; Stanley Wong; Dahn Jeong; Mawuena Binka; Zaeema Naveed; James Wilton; Nathaniel Mark Hawkins; Naveed Zafar Janjua

doi:10.1016/j.amjmed.2024.04.010

Risk of Major Adverse Cardiovascular Events After SARS-CoV-2 Infection in British Columbia: A Population-Based Study

Am J Med. 2024 Apr 24:S0002-9343(24)00237-7. doi: 10.1016/j.amjmed.2024.04.010. Online ahead of print.

Authors

Héctor Alexander Velásquez García¹, Stanley Wong², Dahn Jeong¹, Mawuena Binka¹, Zaeema Naveed¹, James Wilton², Nathaniel Mark Hawkins³, Naveed Zafar Janjua⁴

Affiliations

¹ Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, British Columbia V5Z 4R4, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada.
² Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, British Columbia V5Z 4R4, Canada.
³ Division of Cardiology, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada.
⁴ Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, British Columbia V5Z 4R4, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada; Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, British Columbia V6Z 1Y6, Canada. Electronic address: naveed.janjua@bccdc.ca.

PMID: 38670520
DOI: 10.1016/j.amjmed.2024.04.010

Abstract

Background: COVID-19 is associated with increased risk of post-acute cardiovascular outcomes. Population-based evidence for long periods of observation is still limited.

Methods: This population-based cohort study was conducted using data (2020-2021) from the British Columbia COVID-19 Cohort. The exposure of interest was severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, identified through reverse transcription-polymerase chain reaction (RT-PCR) assay. Individuals who tested positive (exposed) on RT-PCR were matched to negative controls (unexposed) on sex, age, and RT-PCR collection date in a 1:4 ratio. Outcomes of interest were incident major adverse cardiovascular events and acute myocardial infarction, identified more than 30 days after RT-PCR collection date. The association between SARS-CoV-2 infection and cardiovascular risk was assessed through multivariable survival models. Population attributable fractions were computed from Cox models.

Results: We included 649,320 individuals: 129,864 exposed and 519,456 unexposed. The median duration of follow-up was 260 days; 1,786 events (0.34%) took place among the unexposed, and 702 (0.54%) in the exposed. The risk of major adverse cardiovascular events was higher in the exposed (adjusted hazard ratio [aHR] 1.34; 95% confidence interval [CI], 1.22-1.46), with greater risk observed in those who were hospitalized (aHR 3.81; 95% CI, 3.12-4.65) or required intensive care unit admission (aHR 6.25; 95% CI, 4.59-8.52) compared with the unexposed group. The fraction of cardiovascular events attributable to SARS-CoV-2 was 7.04% (95% CI, 4.67-9.41%). Comparable results were observed for acute myocardial infarction.

Conclusions: SARS-CoV-2 infection was associated with higher cardiovascular risk, with graded increase across the acute COVID-19 severity, contributing to 7% of incident major adverse cardiovascular events. These findings suggest that long-term monitoring of cardiovascular risk is required in COVID-19 survivors.

Keywords: Long COVID; cardiovascular risk; population-based cohort; survival analysis.