Velásquez García Héctor Alexander, Wong Stanley, Jeong Dahn, Binka Mawuena, Naveed Zaeema, Wilton James, Hawkins Nathaniel Mark, Janjua Naveed Zafar
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.
Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, British Columbia V5Z 4R4, Canada.
Am J Med. 2025 Mar;138(3):524-531.e34. doi: 10.1016/j.amjmed.2024.04.010. Epub 2024 Apr 24.
COVID-19 is associated with increased risk of post-acute cardiovascular outcomes. Population-based evidence for long periods of observation is still limited.
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.
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.
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.
2019冠状病毒病（COVID-19）与急性后期心血管疾病风险增加相关。基于人群的长期观察证据仍然有限。
本基于人群的队列研究使用了不列颠哥伦比亚省COVID-19队列（2020 - 2021年）的数据。感兴趣的暴露因素是严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染，通过逆转录聚合酶链反应（RT-PCR）检测确定。RT-PCR检测呈阳性（暴露）的个体与阴性对照（未暴露）个体按1:4的比例在性别、年龄和RT-PCR采集日期上进行匹配。感兴趣的结局是RT-PCR采集日期超过30天后发生的主要不良心血管事件和急性心肌梗死。通过多变量生存模型评估SARS-CoV-2感染与心血管风险之间的关联。从Cox模型计算人群归因分数。
我们纳入了649,320名个体：129,864名暴露个体和519,456名未暴露个体。随访的中位持续时间为260天；未暴露个体中发生了1,786起事件（0.34%），暴露个体中发生了702起（0.54%）。暴露个体发生主要不良心血管事件的风险更高（调整后风险比[aHR] 1.34；95%置信区间[CI]，1.22 - 1.46），与未暴露组相比，住院患者（aHR 3.81；95% CI，3.12 - 4.65）或需要入住重症监护病房的患者（aHR 6.25；95% CI，4.59 - 8.52）的风险更高。归因于SARS-CoV-2的心血管事件比例为7.04%（95% CI，4.67 - 9.41%）。急性心肌梗死的结果与之相似。
SARS-CoV-2感染与更高的心血管风险相关，随着急性COVID-19严重程度的增加而逐渐升高，导致7%的主要不良心血管事件发生。这些发现表明，COVID-19幸存者需要对心血管风险进行长期监测。
