By Kathleen Berger, Executive Producer for Science and Technology
Early in the COVID-19 pandemic, Ziyad Al-Aly, MD, chief of research and development at the VA St. Louis Health Care System and a clinical epidemiologist at Washington University, wanted to do his part but he never guessed what he would later find.
“At that time, we did not even know that long COVID existed. We just knew that the house is on fire,” said Al-Aly.
Without even realizing how far the flames had spread, Al-Aly became that first responder, jumping into long COVID research. Among his post-COVID concerns – heart conditions after COVID-19.
“We started getting reports from a lot of patients having heart problems, chest pain, arrhythmia – basically an abnormal heart rhythm – etcetera. So, we decided to take a comprehensive look at the cardiovascular manifestations of SARS-CoV-2 infections,” said Al-Aly.
Al-Aly embarked on an extensive study, which would soon lead to more studies of other long COVID conditions and concerns. But first things first, the heart.
“I went into this project thinking that we’re going to find that people who had high-risk factors for cardiovascular disease – people who smoked a lot, people with high rates of obesity, people having high cholesterol or people who had family history of heart problems- that if these people got COVID-19, COVID-19 is going to push them over the edge and manifest with high risk of cardiovascular problems.”
He would soon find out the truth from big data analytics. Al-Aly’s research team analyzed de-identified medical records in a database maintained by the U.S. Department of Veterans Affairs, the nation’s largest integrated health-care delivery system. The researchers created a controlled dataset that included health information of 153,760 people who had tested positive for COVID-19 sometime from March 1, 2020, through Jan. 15, 2021, and who had survived the first 30 days of the disease. Very few of the people in the study were vaccinated prior to developing COVID-19, as vaccines were not yet widely available at the time of enrollment. But in a later study conducted by Al-Aly, he found that vaccination against the virus that causes COVID-19 reduced the risk of getting long COVID by 15% compared to unvaccinated people. So, long COVID is still a problem for the vaccinated too.
For the heart study, statistical modeling was used to compare cardiovascular outcomes in the COVID-19 dataset with two other groups of people not infected with the virus: a control group of more than 5.6 million patients who did not have COVID-19 during the same time frame; and a control group of more than 5.8 million people who were patients from March 2018 through January 2019, well before the virus spread and the pandemic settled in.
After the analysis of federal health data regarding cardiovascular complications, what Al-Aly had found was not what he expected.
“We found it did not matter if you’re young or old. It did not matter if you had prior history of cardiovascular disease. It did not matter if you smoked or not. It did not matter if you had obesity or not. All these groups, regardless of whether they had high risk of cardiovascular disease or not, whenever they got exposed to COVID-19, they still manifested with increased risk of cardiovascular problems,” Al-Aly explained. “Nobody is really spared the adverse consequences of having COVID-19 infection.”
Al-Aly discovered COVID-19 infection increases the risk of heart disease by nearly 5%.
“The single digit 5% of people with COVID-19 who will get long COVID, that translates to millions of people in the U.S., and many, many more around the world.”
Overall, those infected with COVID-19 were 55% more likely than those without COVID-19 to suffer a major adverse cardiovascular event which include heart attack, stroke and death. He discovered the increased risk of developing cardiovascular complications happens within the first month to a year after infection. The research shows that even the people with mild or asymptomatic COVID-19 infections can develop heart conditions up to a year later. Such complications include disruptive heart rhythms, inflammation of the heart, blood clots, stroke, coronary artery disease, heart attack, heart failure or even death.
The study does not include data involving the virus’s delta and omicron variants, which began spreading rapidly in the latter half of 2021, but Al-Aly is tackling studies about long COVID after infections from variants currently.
