Infection with severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is associated with a significantly increased risk of cardiovascular events for at least three months following diagnosis.^1-4 The figure below, adapted from Lim et al. (2021),⁵ illustrates the interrelationship between cardiovascular and metabolic dysfunction as a consequence of SARS‑CoV‑2 infection.

Figure 1. Pathogenic Mechanisms Associated With Cardiometabolic Disease After COVID-19 Infection^2,5-23

Increased reactive oxygen species (ROS) and cytokines play a key role in initiating this process. Paired with viral activation of the renin-angiotensin-aldosterone system (RAAS) via increased expression of angiotensin II (Ang II), this can cause insulin resistance, hyperglycaemia and vascular endothelial damage, all of which contribute to the arterial plaque deposition (atherosclerosis). Atherosclerosis is recognised as the primary underlying disease process that leads to cardiovascular events, such as myocardial infarction²⁴ and thromboembolism.²⁵ Findings published by Journal of the American Medical Association (JAMA) emphasise this correlation, concluding their research by stating that “acute ischemic stroke could be part of the next wave of complications of COVID-19.”²⁶

Boxes shaded in pink (hypertension) and peach (overweightness and obesity) are indicative of risk factors associated with cardiometabolic disease, independent of SARS-CoV-2 infection. Importantly, pre-existing diabetes mellitus has been associated with more severe illness from COVID-19,^27-30 demonstrating the burden of compounding risk factors on the deterioration of cardiometabolic health post-infection.

This is not to say that individuals without existing cardiovascular disease (CVD) and diabetes mellitus are not also affected by COVID-19 in terms of risk of cardiometabolic disease. A population-based study in the United Kingdom, involving 428,650 participants and just as many matched controls, found that the incidence of diabetes mellitus was increased by 81% in acute COVID-19 and remained elevated by 27% from weeks 4 to 12 weeks thereafter before declining in patients without pre-existing diabetes mellitus or CVD. Acute COVID-19 was associated with a near six-fold increase in cardiovascular diagnoses, mainly from pulmonary embolism, atrial arrhythmias and venous thromboses, though myocardial infarction, heart failure and stroke also increased.² Similar findings have been published in other research articles, correlating increased incidence of cardiovascular outcomes⁴ and diabetes mellitus³¹ to COVID-19 infection.

From this evidence,^2,31 the three-month window of recovery post-COVID-19 infection is where healthcare practitioners could potentially best serve to mitigate the risks of cardiometabolic complications. Making diet, weight management and physical activity² a priority over this period is likely to be of even greater importance for those with pre-existing risk factors, namely hypertension and obesity.

References

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