Long-term Cardiovascular, Cerebrovascular, and Other Thrombotic Complications in COVID-19 Survivors: A Retrospective Cohort Study

Author:

Lim Jue Tao12ORCID,Liang En Wee234,Tay An Ting5,Pang Deanette5,Chiew Calvin J25,Ong Benjamin56,Lye David Chien Boon1267,Tan Kelvin Bryan158

Affiliation:

1. Lee Kong Chian School of Medicine, Nanyang Technological University

2. National Centre for Infectious Diseases

3. Duke-NUS Graduate Medical School, National University of Singapore

4. Department of Infectious Diseases, Singapore General Hospital

5. Singapore Ministry of Health

6. Yong Loo Lin School of Medicine, National University of Singapore

7. Department of Infectious Diseases, Tan Tock Seng Hospital

8. Saw Swee Hock School of Public Health, National University of Singapore

Abstract

Abstract Background Growing evidence suggests that some coronavirus disease 2019 (COVID-19) survivors experience a wide range of long-term postacute sequelae. We examined the postacute risk and burden of new-incident cardiovascular, cerebrovascular, and other thrombotic complications after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a highly vaccinated multiethnic Southeast Asian population, during Delta predominance. Methods This cohort study used national testing and healthcare claims databases in Singapore to build a cohort of individuals who had a positive SARS-CoV-2 test between 1 September and 30 November 2021 when Delta predominated community transmission. Concurrently, we constructed a test-negative control group by enrolling individuals between 13 April 2020 and 31 December 2022 with no evidence of SARS-CoV-2 infection. Participants in both groups were followed up for a median of 300 days. We estimated risks of new-incident cardiovascular, cerebrovascular, and other thrombotic complications using doubly robust competing-risks survival analysis. Risks were reported using 2 measures: hazard ratio (HR) and excess burden (EB) with 95% confidence intervals. Results We included 106 012 infected cases and 1 684 085 test-negative controls. Compared with the control group, individuals with COVID-19 exhibited increased risk (HR, 1.157 [1.069–1.252]) and excess burden (EB, 0.70 [.53–.88]) of new-incident cardiovascular and cerebrovascular complications. Risks decreased in a graded fashion for fully vaccinated (HR, 1.11 [1.02–1.22]) and boosted (HR, 1.10 [.92–1.32]) individuals. Conversely, risks and burdens of subsequent cardiovascular/cerebrovascular complications increased for hospitalized and severe COVID-19 cases (compared to nonhospitalized cases). Conclusions Increased risks and excess burdens of new-incident cardiovascular/cerebrovascular complications were reported among infected individuals; risks can be attenuated with vaccination and boosting.

Funder

Ministry of Education

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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