The latest research showed that coronavirus infection may accelerate the aging of blood vessels, potentially increasing cardiovascular risk by roughly the equivalent of five years. A study in the European Heart Journal reported that the effect was strongest in women and in people with Long Covid, and that the changes tended to stabilize or lessen over time.
Researchers analyzed data from 2,390 participants recruited between September 2020 and February 2022 at 34 centers in 16 countries, including Austria, Australia, Brazil, Canada, Cyprus, France, Greece, Italy, Mexico, Norway, Turkey, the UK, and the US. Participants were grouped by COVID-19 severity (never infected, mild illness, hospitalized on a ward, or admitted to intensive care), and underwent measurements at six and twelve months after infection. Vascular age was assessed by carotid–femoral pulse wave velocity (PWV), where higher values indicate stiffer, older vessels. Analyses accounted for factors such as age and sex.
On average, people who had COVID-19 had higher PWV than those never infected, including those with mild illness. The differences were pronounced in women, while men showed little or no statistically robust change. The effect was greater in those with Long Covid. In the intensive care group, vessel stiffness regressed toward normal by 12 months. Vaccinated individuals showed milder changes than those unvaccinated. Researchers noted that an increase of about 0.5 m/s in PWV is clinically relevant and roughly comparable to five years of vascular aging, corresponding to an estimated 3% increase in cardiovascular risk in a 60-year-old woman.
“We know that Covid can directly affect blood vessels. We believe that this may result in what we call early vascular ageing, meaning that your blood vessels are older than your chronological age and you are more susceptible to heart disease. If that is happening, we need to identify who is at risk at an early stage to prevent heart attacks and strokes,” said Professor Rosa Maria Bruno of Université Paris Cité, according to EurekAlert. “Women have a faster and stronger immune response, which can protect them from infections. However, the same response may also increase vascular damage after the original infection,” said Bruno, according to EurekAlert. “There are several possible explanations for the vascular effects of Covid. The Covid-19 virus acts on specific receptors in the body, called the angiotensin-converting enzyme 2 receptors, that are present on the lining of the blood vessels. The virus uses these receptors to enter and infect cells. This may result in vascular dysfunction and accelerated vascular ageing. Our body’s inflammation and immune responses, which defend against infections, may be also involved,” said Bruno, according to EurekAlert.
“This large, multicentre, prospective cohort study enrolled 2390 participants from 34 centres to investigate whether arterial stiffness, as measured by PWV, persisted in individuals with recent COVID-19 infection,” said Dr. Behnood Bikdeli and colleagues, according to EurekAlert. “Sex-stratified analyses revealed striking differences: females across all COVID-19-positive groups had significantly elevated PWV, with the highest increase (+1.09 m/s) observed in those requiring ICU admission,” said Bikdeli and colleagues, according to EurekAlert. “The CARTESIAN study makes the case that COVID-19 has aged our arteries, especially for female adults. The question is whether we can find modifiable targets to prevent this in future surges of infection, and mitigate adverse outcomes in those afflicted with COVID-19-induced vascular ageing,” said Bikdeli and colleagues, according to EurekAlert. Bruno added that vascular aging is measurable and can be addressed with lifestyle changes and blood pressure- and cholesterol-lowering therapies, and that the team planned to follow participants to determine whether accelerated vascular aging translated into more heart attacks and strokes.
“One must look very closely whether these groups were really equal to say whether the cause of this acceleration of aging lay in COVID,” said Dominik Rath, a cardiologist at University Hospital Tübingen, according to Stern. “After the 12-month visit, the aging processes had relatively strongly regressed—what could mean that hospitalization per se or the stay in the intensive care unit also plays a relevant part,” said Rath, according to Stern.
“Nevertheless, this study is a certain wake-up call,” said Heribert Schunkert, vice president of the German Heart Foundation, according to DW. “It is necessary to check carefully whether these groups were really the same to determine whether the coronavirus was the cause of the accelerated aging,” said Schunkert, according to DW. “Many people were affected by a COVID infection. We wanted to avoid everything to prevent aging. That makes you sit up and take notice,” said Schunkert, according to Bild.
“The findings strongly suggest that after having COVID, the elasticity of the arteries is clearly worse than usual. It was somewhat surprising that the effect was observed only in women. However, it is difficult to say what the practical risk of arterial stiffness to arterial diseases is,” said Juhani Airaksinen, emeritus professor of cardiology, according to Iltalehti Rakkaus. “Blood pressure should therefore be managed with lifestyle changes and, if necessary, with medications,” said Airaksinen, according to Iltalehti Rakkaus. He noted that infected participants were older and generally sicker than controls and that baseline stiffness was unknown, which could influence results. “A positive aspect is that some changes partially improved within less than a year,” said Airaksinen, according to Iltalehti Rakkaus. He added that pulse wave velocity has been used for decades but is not part of routine outpatient care.
Researchers cautioned that it was unclear whether the observed effect reflected large changes in a few individuals or small changes across many. They suggested that higher mortality in men during the pandemic could have introduced survivor bias, potentially masking effects in male participants. They also noted that many people experienced prolonged symptoms after COVID-19, including post-acute COVID-19 syndrome, which affected up to 40% of initial survivors, and called for further studies to clarify mechanisms and long-term risks.
