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Barcelona researchers find an increased risk for cardiovascular problems after recovery from COVID

The virus SARS-CoV-2 causes an illness called COVID-19. Vaccines and booster doses that greatly reduce the risk of COVID-19-related complications, including serious illness, hospitalization and death, are available.

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Studies done in people without HIV have found that after recovery from acute COVID-19 some people become at heightened risk for cardiovascular events such as heart attack and stroke.

A team of researchers in Barcelona, Spain, collected and analysed health-related information from adults with HIV, some of whom developed COVID-19. Researchers had access to detailed medical information from participants, including the following:

  • results of testing for SARS-CoV-2
  • reasons for any hospitalizations
  • COVID-19 vaccination
  • presence of comorbidities (including cardiovascular disease)
  • CD4+ cell counts in people with HIV

Researchers were particularly interested in the length of time after an episode of acute COVID-19 that it took participants to experience what they called a “cardiovascular event,” which they defined as one or more of the following:

  • heart attack
  • stroke
  • abnormal heart rhythm
  • heart failure
  • inflammatory heart disease (myocarditis, pericarditis)
  • injury or blockage of blood vessels away from the heart such as closer to the limbs (peripheral vascular disease)
  • excessive clotting of blood, leading to reduced flow of blood to organs/tissues
  • other cardiac disorders

Researchers focused on the years 2020 to 2022.

In the study, there were 4,199 people with HIV and 14,004 people without HIV. The average age of the whole study population was 47 years; 82% were men and 18% were women.

Results

Cardiovascular events that occurred during the study were distributed as follows:

  • people with HIV who developed COVID-19 – 5% had a cardiovascular event
  • people with HIV who did not get COVID-19 – 4% had a cardiovascular event

The most common cardiovascular events were as follows:

  • heart attack
  • heart failure
  • stroke

People with HIV who developed COVID-19 were twice as likely to get excess blood clots, which affected the flow of blood, and heart failure than people with HIV who did not develop COVID-19.

Even when researchers reanalyzed the data and excluded people with any previous diagnoses of cardiovascular disease, people with HIV were still at heightened risk for cardiovascular problems after recovering from acute COVID-19 (compared to people who were not diagnosed with COVID-19).

People who were hospitalized because of COVID-19 were more likely to have subsequent cardiovascular events in a shorter timespan compared to people who had never been hospitalized for COVID-19.

Risk factors

The researchers found that the following factors were associated with an increased risk for cardiovascular events after a person had been diagnosed with COVID-19:

  • age 40 or older
  • heterosexual men (vs. gay and bisexual men)
  • having chronic liver or kidney disease
  • having a history of previous cardiovascular events
  • having cancer

Bear in mind

Researchers found that, overall, people with HIV who had been diagnosed with COVID-19 had a 30% increased risk for cardiovascular events compared to people with HIV who did not get diagnosed with COVID-19.

This risk was greatest for the first six months after acute COVID-19 but persisted at a lower level for up to 12 months after acute COVID-19 had occurred.

Even people with HIV who were not at heightened risk for cardiovascular disease became at risk for cardiovascular events after they developed COVID-19.

In context

The results from the Barcelona study should not be surprising. Studies from Denmark, Sweden and the U.S. in people without HIV found that there was a significantly increased risk of cardiovascular events up to a year after acute COVID-19, whether or not people had been hospitalized for COVID-19.

Ideas for care

The Barcelona researchers recommended that clinicians consider the increased risk for cardiovascular events (found in the present study) that can occur in people with HIV after they have recovered from acute COVID-19, “regardless of COVID-19 severity or the presence of [preexisting] cardiovascular disease. “

The researchers stated that their study underscores the importance of COVID-19 vaccination and booster doses for people with HIV and other populations at risk for cardiovascular disease.

The researchers recommended “assessing and managing cardiovascular disease risk among people with HIV recovering from COVID-19 and initiating timely [cardiovascular disease] prevention and treatment options for these individuals.”

—Sean R. Hosein

REFERENCE:

Martín-Iguacel R, Moreno-Fornés S, Bruguera A, et al. Major cardiovascular events after COVID-19 in people with HIV. Clinical Microbiology and Infection. 2024; in press.