COVID-19 and Cardiovascular Health: How SARS-CoV-2 Increases Risk of Heart Disease

SARS-CoV-2 Infection Linked to Rapid Plaque Growth in Coronary Arteries: Implications for Cardiovascular Health

A recent study published in Radiology, the journal of the Radiological Society of North America (RSNA), has revealed a concerning association between SARS-CoV-2 infection and rapid plaque growth in coronary arteries, significantly increasing the risk of cardiovascular events. This finding highlights the long-term effects of COVID-19 on the cardiovascular system, extending beyond the acute respiratory symptoms commonly associated with the disease.

While COVID-19 primarily manifests as a respiratory disease, it is increasingly evident that the SARS-CoV-2 virus can affect multiple organ systems, including the cardiovascular system. The inflammation induced by the virus appears to have a particularly detrimental effect on the arteries, leading to accelerated plaque buildup, increased coronary inflammation, and a higher incidence of high-risk plaque development. This finding is significant because high-risk plaques—those that are noncalcified and prone to rupture—are a major cause of myocardial infarction (heart attacks) and stroke.

The study provides new evidence of this phenomenon, showing that even individuals who have recovered from the acute phase of COVID-19 may still experience ongoing cardiovascular risk due to the lingering effects of the virus. This underscores the need for continued cardiovascular monitoring in COVID-19 patients, even after their respiratory symptoms have resolved.

Study Design: Coronary CT Angiography (CCTA) and Plaque Analysis

The study included a total of 803 patients who underwent coronary CT angiography (CCTA) between September 2018 and October 2023. The patients, with an average age of 63.9 years, included 543 men and 260 women. Among them, 329 patients had undergone CCTA prior to the COVID-19 pandemic, while 474 patients were imaged during the pandemic. Out of these, 25 patients were infected with SARS-CoV-2 before their imaging.

The researchers focused on analyzing coronary artery lesions—abnormalities or blockages in the coronary arteries—by measuring plaque volume changes, plaque burden, and the presence of high-risk plaque. They also assessed the presence of coronary inflammation, a key indicator of atherosclerosis (the buildup of fatty deposits in the arteries). In total, 2,588 lesions were examined, with 2,108 lesions in the SARS-CoV-2 group and 480 lesions in the uninfected group.

Key Findings: Accelerated Plaque Growth and Increased Cardiovascular Risk

The results of the study were striking. When compared to uninfected individuals, patients who had contracted SARS-CoV-2 experienced significantly faster plaque volume growth. This suggests that the virus accelerates the process of atherosclerosis, potentially leading to more severe forms of coronary artery disease. In particular, lesions in the SARS-CoV-2 group had a higher incidence of developing into high-risk plaques (20.1% versus 15.8%) and coronary inflammation (27% versus 19.9%).

The study also found that SARS-CoV-2 infection was linked to a higher risk of target lesion failure, which occurs when a coronary artery lesion cannot be treated effectively with medical or surgical intervention. This condition is a major risk factor for heart attacks and strokes. The rate of target lesion failure was significantly higher in SARS-CoV-2 patients (10.4%) compared to uninfected patients (3.1%).

The inflammation caused by COVID-19 can lead to the ongoing growth of plaque, particularly in high-risk, noncalcified plaques. These types of plaques are more likely to rupture, triggering the formation of blood clots that can block blood flow and lead to heart attacks or strokes. Consequently, patients who have recovered from COVID-19 may still be at heightened risk for these events for up to a year after their infection.

Long-Term Cardiovascular Effects of SARS-CoV-2

The findings of this study suggest that the cardiovascular effects of SARS-CoV-2 infection are not limited to the acute phase of the illness. Even after the respiratory symptoms have resolved, the inflammatory response triggered by the virus continues to affect the cardiovascular system. This can lead to the rapid progression of coronary artery disease and an increased risk of severe cardiovascular events.

These effects are observed regardless of other risk factors such as age, hypertension, or diabetes. This means that even relatively healthy individuals who have recovered from COVID-19 may be at risk for long-term cardiovascular complications. As such, the study underscores the importance of developing effective management strategies for COVID-19 patients, both during and after their recovery, to mitigate the risk of cardiovascular disease.

Implications for Cardiovascular Disease Prevention and Management

Given the study's findings, it is crucial that healthcare providers remain vigilant in monitoring the cardiovascular health of COVID-19 patients, particularly those who have had moderate to severe cases of the disease. Regular cardiovascular assessments, including coronary CT angiography, could help identify patients at higher risk of plaque progression and cardiovascular events, allowing for timely intervention.

Furthermore, preventive measures aimed at reducing the risk of cardiovascular disease should be implemented in COVID-19 survivors. This may include lifestyle modifications, such as improved diet, exercise, and smoking cessation, as well as pharmacological interventions to control inflammation and prevent plaque buildup. Statins, for example, are commonly used to reduce cholesterol levels and prevent further plaque formation.

Further research is needed to understand the precise biological mechanisms behind the accelerated plaque growth and inflammation observed in COVID-19 patients. By uncovering these mechanisms, researchers can develop more targeted therapeutic strategies to protect the heart during and after SARS-CoV-2 infection.

Study Reference: https://pubs.rsna.org/doi/10.1148/radiol.240876

Conclusion: A Growing Concern for Cardiovascular Health

The link between SARS-CoV-2 infection and rapid plaque growth in coronary arteries presents a significant concern for public health. While COVID-19 is primarily known for its respiratory effects, this study reveals that the virus can also have a lasting impact on the cardiovascular system, increasing the risk of heart attacks, strokes, and other severe cardiovascular events. As the world continues to recover from the pandemic, it is essential that healthcare systems and professionals remain aware of the potential long-term cardiovascular effects of COVID-19 and take proactive steps to manage the cardiovascular health of survivors.

Given the increasing burden of cardiovascular disease worldwide, these findings highlight the need for continued vigilance in monitoring the heart health of COVID-19 patients, particularly as many may not show symptoms of cardiovascular problems until later in life. As more data emerges, healthcare professionals will be better equipped to manage the long-term cardiovascular risks faced by COVID-19 survivors.