Journal
CIRCULATION
Volume 146, Issue 12, Pages 892-906Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCULATIONAHA.122.060785
Keywords
COVID-19; electronic health records; myocardial infarction; pulmonary embolism; stroke; thrombosis; venous thrombosis
Funding
- UK Research and Innovation [MC_PC_20058, MC_PC_20030, MC_PC_20059]
- Longitudinal Health and Wellbeing COVID-19 National Core Study
- British Heart Foundation as part of the British Heart Foundation Data Science Center [SP/19/3/34678]
- Data and Connectivity National Core Study by Health Data Research UK
- Office for National Statistics
- National Institute for Health and Care Research (NIHR)/UK Research and Innovation
- Medical Research Council [MR/V028367/1]
- Health Data Research UK - Health Data Research UK Ltd [HDR-9006]
- UK Medical Research Council
- Engineering and Physical Sciences Research Council
- Economic and Social Research Council
- Department of Health and Social Care (England)
- Chief Scientist Office of the Scottish Government Health and Social Care Directorates
- Health and Social Care Research and Development Division (Welsh Government)
- Public Health Agency (Northern Ireland)
- British Heart Foundation [RG/13/13/30194, RG/18/13/33946]
- Wellcome Trust
- British Heart Foundation Cambridge CRE [RE/13/6/30180]
- NIHR Cambridge Biomedical Research Center [BRC-1215-20014]
- ADR Wales program
- Economic and Social Research Council [part of UK Research and Innovation] [ES/S007393/1]
- Wales COVID-19 Evidence Center - Health and Care Research Wales
- BigData@Heart Consortium - Innovative Medicines Initiative-2 Joint Undertaking [116074]
- British Heart Foundation-Turing Cardiovascular Data Science 419 Award [BCDSA/100005]
- International Alliance for Cancer Early Detection, a partnership among Cancer Research UK [C18081/A31373]
- Canary Center at Stanford University
- University of Cambridge
- OHSU Knight Cancer Institute
- University College London
- University of Manchester
- NIHR Bristol Biomedical Research Center
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol [MC_UU_00011/1]
- NIHR ARC West
- Health Data Research UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics [NIHR BTRU-2014-10024]
- Health Data Research UK-Turing Wellcome PhD Programme in Health Data Science
- British Heart Foundation-Turing Cardiovascular Data Science Award [BCDSA/100005]
- Chief Scientist's Office [CAF/01/17]
- Stroke Association [SA CV 20/100018]
- University College London UK Research and Innovation Center for Doctoral Training in AI-Enabled Healthcare studentship [EP/S021612/1]
- Medical Research Council Clinical Top-Up
- NIHR Biomedical Research Center at University College London Hospital National Health Service Trust
Ask authors/readers for more resources
Incidence of vascular diseases remains elevated up to 49 weeks after COVID-19 diagnosis, with a faster decline for arterial thromboses than VTEs. Patients hospitalized with COVID-19, non-White individuals, and those without previous events are at higher risk. Policies to prevent severe COVID-19, including vaccination, early post-discharge review, risk factor control, and secondary preventive agents, are supported by these findings.
Background: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a prothrombotic state, but long-term effects of COVID-19 on incidence of vascular diseases are unclear. Methods: We studied vascular diseases after COVID-19 diagnosis in population-wide anonymized linked English and Welsh electronic health records from January 1 to December 7, 2020. We estimated adjusted hazard ratios comparing the incidence of arterial thromboses and venous thromboembolic events (VTEs) after diagnosis of COVID-19 with the incidence in people without a COVID-19 diagnosis. We conducted subgroup analyses by COVID-19 severity, demographic characteristics, and previous history. Results: Among 48 million adults, 125 985 were hospitalized and 1 319 789 were not hospitalized within 28 days of COVID-19 diagnosis. In England, there were 260 279 first arterial thromboses and 59 421 first VTEs during 41.6 million person-years of follow-up. Adjusted hazard ratios for first arterial thrombosis after COVID-19 diagnosis compared with no COVID-19 diagnosis declined from 21.7 (95% CI, 21.0-22.4) in week 1 after COVID-19 diagnosis to 1.34 (95% CI, 1.21-1.48) during weeks 27 to 49. Adjusted hazard ratios for first VTE after COVID-19 diagnosis declined from 33.2 (95% CI, 31.3-35.2) in week 1 to 1.80 (95% CI, 1.50-2.17) during weeks 27 to 49. Adjusted hazard ratios were higher, for longer after diagnosis, after hospitalized versus nonhospitalized COVID-19, among Black or Asian versus White people, and among people without versus with a previous event. The estimated whole-population increases in risk of arterial thromboses and VTEs 49 weeks after COVID-19 diagnosis were 0.5% and 0.25%, respectively, corresponding to 7200 and 3500 additional events, respectively, after 1.4 million COVID-19 diagnoses. Conclusions: High relative incidence of vascular events soon after COVID-19 diagnosis declines more rapidly for arterial thromboses than VTEs. However, incidence remains elevated up to 49 weeks after COVID-19 diagnosis. These results support policies to prevent severe COVID-19 by means of COVID-19 vaccines, early review after discharge, risk factor control, and use of secondary preventive agents in high-risk patients.
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