New studies from the United States and Poland detail COVID-19's cardiovascular toll, with one suggesting that infected children face significantly higher odds of conditions such as high blood pressure and heart failure and the other revealing that post-infection heart symptoms are common in adults.
Even kids at low risk had higher rates of heart conditions
A University of Pennsylvania–led research team used electronic health records from 19 US children's hospitals participating in the Researching COVID to Enhance Recovery (RECOVER) consortium to estimate the risk of cardiovascular disease 1 to 6 months after COVID-19 infection from March 2020 to September 2023, with at least 6 months of follow-up.
Of the more than 1.2 million participants aged 0 to 20 years, 297,920 (24.6%; 13,646 with congenital heart defects [CHDs]) had COVID-19, and 915,402 (75.4%; 46,962 with CHDs) were uninfected controls. The average patient age was 7.8 years, and 51.4% were male.
The findings were published today in Nature Communications.
Relative to controls, children and adolescents who had COVID-19 were at significantly greater risk for high blood pressure (1.5% vs 1.1% in controls), abnormal ventricular rhythms (0.9% vs 0.7%), myocarditis (0.1% vs 0.02%), heart failure (1.6% vs 1.2%), cardiomyopathy (0.6% vs 0.4%), cardiac arrest (0.5% vs 0.4%), thromboembolism (0.9% vs 0.7%), chest pain (1.2% vs 0.6%), and palpitations (0.4% vs 0.3%).
Awareness of the heightened risk of cardiovascular disorders after SARS-CoV-2 infection can lead to timely referrals, diagnostic evaluations, and management to mitigate long-term cardiovascular complications in children and adolescents.
The findings were similar in patients with and without CHDs, but those with CHDs had a higher risk of atrial fibrillation. Risks were consistent regardless of age, sex, race, obesity status, COVID-19 severity, and SARS-CoV-2 variant.
Overall, the CHD group had higher absolute risks of any post-COVID cardiovascular outcome than those without CHDs (5.6% for infected patients vs 4.0% for controls with CHD; 2.2% and 1.3%, respectively, in those without CHD).
"Even children and adolescents without a history of any cardiovascular outcomes before SARS-CoV-2 infection showed increased risks, suggesting a broad potential impact on those previously considered at low risk of cardiovascular disease," the study authors wrote.
"Awareness of the heightened risk of cardiovascular disorders after SARS-CoV-2 infection can lead to timely referrals, diagnostic evaluations, and management to mitigate long-term cardiovascular complications in children and adolescents," they added.
No difference on cardiac testing
The second study, published this week in BMC Infectious Diseases followed up with 1,080 adult participants from a COVID-19 registry in Poland after infection with a pre-Omicron SARS-CoV-2 variant or Omicron up to January 2022.
A follow-up visit at 3 to 6 months post-infection consisted of symptom monitoring and testing with ambulatory blood pressure monitoring (ABPM), Holter electrocardiography (ECG), and echocardiography. A total of 504 patients also took the Generalized Anxiety Disorder 2-item (GAD-2) test and the Patient Health Questionnaire-2 (PHQ-2) starting in June 2022.
The average patient age was 56.9 years, 68.9% were women, 75.2% were vaccinated against COVID-19, 53.1% were infected during Omicron predominance, 44.4% had high blood pressure (hypertension), and 18.0% had abnormal cholesterol levels.
At least one of the analyzed symptoms was noted in 586 patients (54.3%, including patients with any COVID-19 severity), indicating cardiac long COVID; those without cardiac symptoms served as controls. The most common symptom was fatigue (38.9%). Palpitations occurred in 17.6% of patients, and 1.8% reported fainting episodes. Nearly half of patients had only one cardiac symptom (45.7%), while 0.6% had all investigated symptoms.
Patients with palpitations had stronger premature ventricular contractions than those without palpitations, but they also had lower average systolic and diastolic blood pressure.
The comparative analysis of adults with and without cardiac long COVID showed no differences on ABPM, Holter ECG, or echocardiography. The lack of difference may be due to the asymptomatic nature of some cardiac complications and a too-short follow-up to allow cardiac damage to be reflected on standard cardiovascular tests, the researchers said.
Link between mental illness, cardio symptoms
Patients with cardiac symptoms had higher scores on the PHQ-2 and GAD-2 and higher percentages of responses indicating increased risk of anxiety or depression. In this group, 290 (57.4%) reported one or more analyzed symptoms. Patients with PHQ-2 scores of at least 3 had higher heart rates.
Patients with or without comorbidities should still undergo regular cardiological checks to detect potential later complications, such as long-term cardiovascular symptoms.
Potential mechanisms linking mental illness to cardiovascular symptoms in long-COVID patients may include chronic inflammation, autonomic nervous system dysregulation, and endothelial dysfunction, the authors said.
"Prolonged stress and anxiety can lead to elevated cortisol levels, which may exacerbate hypertension and arrhythmias," they wrote. "Additionally, shared pathways such as oxidative stress and immune dysregulation could further explain the interplay between these conditions, which is critical for developing holistic and integrated treatment strategies."
Risk factors for cardiac long COVID were female sex, asthma, and COVID-19 vaccination.
"Patients with or without comorbidities should still undergo regular cardiological checks to detect potential later complications, such as long-term cardiovascular symptoms," the authors advised. "Clinical practice should also include broad patient education, informing them about potential cardiovascular symptoms after COVID-19 infection, regardless of the dominant variant, and emphasizing the importance of early reporting of any concerning symptoms."
