• Comprehensive Ophthalmology

    Review of: Long-term cardiovascular outcomes of COVID-19

    Xie Y, Xu E, Bowe B, et al. Nature Medicine, March 2022

    The risk of cardiovascular and cerebrovascular disease significantly increased for those who tested positive for COVID-19 during the 12 months following the positive test.

    Study design

    The US Department of Veterans Affairs (VA) national healthcare databases served as the source for the study’s 3 cohorts: 153,760 individuals who tested positive for COVID-19 from March 2020 to January 2021 and remained alive 30 days after the positive test; 5,637,647 individuals who encountered the VA in 2019 and were still alive in March 2022 comprised the contemporary control group; and, 5,859,411 individuals who used the VA in 2017 and were still alive in March 2018 comprised the historical group. Examining data on outpatient and inpatient encounters, outpatient pharmacy, medication administration, lab results provided information on cardiovascular outcomes for all 3 groups. Follow-up for the COVID-19 cohort began 30 days following a positive test and ended in October 2021. For the contemporary cohort, fictional positive test dates were randomly assigned so that the same proportion of people would be enrolled on specific dates as in the COVID-19 cohort and followed until October 2021. Similarly, individuals in the historical group were randomly assigned fictional positive test dates minus 2 years and followed until October 2019.


    The results showed that people with COVID-19 were at least 50% more likely to exhibit incident cardiovascular and cerebrovascular disorders, dysrhythmias, inflammatory heart disease, ischemic heart disease, heart failure, thromboembolic disease, and other cardiac disorders. At the highest risk level, the COVID-19 group was 193% more likely to develop a pulmonary embolism and 102% more likely to develop inflammatory conditions of the heart and pericardium. The results are true even for those who weren’t hospitalized for COVID-19 infection or did not have evidence of cardiovascular disease prior to COVID-19.


    With the majority White and male study population, demographics limited this study. Because healthcare databases were used to conduct this study, the data does not completely rule out misclassification bias of selected variables.

    Clinical significance

    The evidence points to a substantial increased risk of cardiovascular disease that includes ischemic and non-ischemic heart disease. As physicians we should be attentive to cardiovascular health in COVID-19 survivors, even in individuals who were not hospitalized.