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Publication Briefs

Increased Risk for Cardiovascular Conditions among Veterans for Up to One Year Following COVID-19 Infection

Post-acute sequelae of COVID-19 can involve the pulmonary and several extrapulmonary organs, including the cardiovascular system. A comprehensive assessment of post-acute COVID-19 sequelae of the cardiovascular system at 12 months is not yet available, and studies of post-acute COVID-19 sequelae across the spectrum of care settings of acute infection (non-hospitalized, hospitalized and admitted to intensive care) are also lacking. This study evaluated the risks and 12-month burdens of cardiovascular outcomes among 153,760 Veterans who survived the first 30 days of COVID compared to 5,637,647 VA healthcare users with no COVID and 5,859,411 Veterans who used VA healthcare before the COVID pandemic (2017). Veterans were followed longitudinally in their individual cohorts and according to care setting of the acute infection (i.e., non-hospitalized, hospitalized and admitted to intensive care). Investigators also assessed patient demographics and health characteristics (i.e., obesity, smoking, hypertension, diabetes, chronic kidney disease). Cardiovascular conditions examined included: cerebrovascular disorders, dysrhythmia, inflammatory heart disease, ischemic heart disease, other cardiac disorders (i.e., heart failure), and thrombotic disorders (e.g., deep vein thrombosis).


  • COVID-19 increased the risk of developing cardiovascular conditions – spanning several categories – within the first month to one year after infection. The risk increased even in Veterans without previous heart conditions and in those with mild COVID-19 infection.
  • Overall, heart disease was seen in 4% more people who contracted COVID-19 than in those without. COVID-19 patients were 72% more likely to suffer from coronary artery disease, 63% more likely to have a heart attack, and 52% more likely to have a stroke.


  • This study highlights the serious long-term cardiovascular consequences of COVID-19 infection and emphasizes the importance of getting vaccinated as a way to prevent heart damage. Health systems should prepare for a significant contribution of COVID-19 to a rise in the burden of cardiovascular diseases and the potential long-lasting consequences for patients and the health system.


  • Because VA electronic health records were used, misclassification bias and residual confounding could not be ruled out.
  • Some Veterans might have had COVID-19 but were not tested for it – and would have been in the control group. If present in large numbers, they might have biased the results toward null.

This research was partly funded by VA. All authors are part of the VA St. Louis Health Care. Dr. Al-Aly is an HSR&D investigator and is Director of the Clinical Epidemiology Center and Chief of Research and Development at VA St. Louis.

Xie Y, Xu E, Bowe B, and Al-Aly Z. Long-Term Cardiovascular Outcomes of COVID-19. Nature Medicine. February 7, 2022. Published online, Open Access.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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