What Doctors Want You to Know About COVID-19 and Heart Attack, Stroke Risk

Research has repeatedly linked COVID-19 with the potential for developing cardiovascular issues, but new data takes things one step further: COVID-19 could increase your risk of heart attack or stroke up to three years after infection.

That's the major takeaway from a study published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology . For the study, researchers analyzed data from 10,000 people enrolled in the UK Biobank, a large biomedical database, including 8,000 who tested positive for COVID-19. Of those, 2,000 were hospitalized with severe COVID between February 1, 2020, and December 31, 2020. As there were no vaccines available at the time, none of the patients were vaccinated.

When compared to people who didn't have COVID-19, the researchers found that the risk of heart attack, stroke, and death was twice as high in people who had the virus and four times as high in those who were hospitalized with a severe form of COVID-19.

The risk of these serious health complications was still elevated three years later. "This is an extraordinary finding," says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine.

Meet the experts: William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine; infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security; Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York.

Given that the virus continues to spread (take the COVID summer wave as an example) and the many variants since the virus first made headlines, it's understandable to have questions about what these findings mean for your own cardiovascular health. Here's what doctors want you to know.

Why are heart attacks increasing after COVID?

It's important to point out that the study didn't find that the rate of heart attacks has been increasing overall since the COVID-19 pandemic began. However, it did find a link between having one of the original strains of the virus and a greater risk of developing cardiovascular complications.

Heart disease, which includes heart attack and stroke, is the leading cause of death in the U.S., according to the Centers for Disease Control and Prevention (CDC).

It's not entirely clear why heart attacks may increase after someone has had COVID-19, but there are some theories based on the way the virus may impact the heart.

COVID effects on the heart

Research has found that COVID-19 can infect the cells that line the walls of blood vessels. SARS-CoV-2, the virus that causes COVID-19, has also been detected in plaques that form in arteries that may rupture and cause heart attacks and stroke in those infected with the virus.

"COVID tends to cause clots—it can cause clots in large vessels and small vessels," says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York. "If you have these clots, it will increase the risk of heart attack or stroke."

In general, COVID-19 causes inflammation in the body, says infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security. "A COVID infection sets off an inflammatory cascade that can impact the cardiovascular system," he says. But this isn't unique to COVID-19. "This also occurs with other viruses, like influenza and RSV," Dr. Adalja says.

But Dr. Schaffner says that the flu and RSV usually increase the risk of heart attack and stroke for a month to two months after you have the infection—not three years. "This may be a phenomenon similar to long COVID , where there's a slow smoldering inflammation that continues that can infect the blood vessels that go to heart," he says.

Can COVID cause a sudden heart attack?

A heart attack happens when blood flow to the heart is blocked or severely reduced, according to the CDC . The most common cause of heart attack is coronary artery disease (CAD), which happens when plaque builds up in the arteries that supply blood to the heart.

It is possible to have COVID-19 and experience a sudden heart attack. "In some cases, the inflammation can lead to instability of plaques in the coronary arteries and can lead to heart attacks," Dr. Adalja says. People may have a build-up of those plaques prior to having COVID-19, Dr. Russo points out—and something about the virus may prompt a cascade that leads to heart attack.

But Dr. Schaffner says that "the 'sudden' part is not so clear."

Do I need to worry if I caught a more recent COVID variant?

The study specifically looked at people who had COVID-19 early in the pandemic, before there were vaccines or population immunity. As a result, Dr. Russo says it's hard to say whether the risk of cardiovascular disease is as high in people who get the virus now vs. back then.

"There is some uncertainty whether these findings are applicable in the Omicron era or not, as we think the virus has become less virulent over time" he says. "I have little doubt they will be, but the effects may not be as great."

Given that there is a high population immunity to COVID-19, from vaccines and natural infection, the severity of the virus may be less in people who get infected, Dr. Adalja says. As a result, someone may end up experiencing less inflammation if they're infected with COVID-19 today versus when the pandemic first started.

Still, Dr. Adalja says it's important for people to remember that COVID-19 can cause more than a respiratory infection. "Infectious diseases like COVID can have cascading impacts on multiple organ systems," he says.

If you're concerned about the risk of developing cardiovascular complications from COVID-19, Dr. Schaffner recommends getting the new COVID vaccine . "If you needed another reason to get your COVID booster, here it is," he says.

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