COVID-19 Vaccination Can Reduce Cardiovascular Risk Post-Infection, Study Finds

Article

Using data from nearly 2 million US patients with a documented COVID-19 infection, a new study provides an overview of the impact of vaccination, both full and partial, on risk of MACE following infection.

Girish N. Nadkarni, MD, MPH

Girish N. Nadkarni, MD, MPH
Image Courtesy: Mount Sinai

Vaccination against COVID-19 was associated with a reduced cardiovascular risk post-COVID-19 infection, according to new research from the Icahn School of Medicine.1

An analysis of data from nearly 2 million patients in the US, results of the study indicate full and partial vaccination were associated with 41% and 24% relative reductions in risk of major adverse cardiovascular events (MACE) following COVID-19 infection, respectively, when compared to risk among unvaccinated patients.1

“We sought to clarify the impact of previous vaccination on cardiovascular events among people who develop COVID-19 and found that, particularly among those with comorbidities, such as previous MACE, type 2 diabetes, high cholesterol, liver disease, and obesity, there is an association with a lower risk of complications. While we cannot attribute causality, it is supportive evidence that vaccination may have beneficial effects on a variety of post-COVID-19 complications,” said senior investigator Girish N. Nadkarni, MD, MPH, director of The Charles Bronfman Institute of Personalized Medicine and system chief in the Division of Data Driven and Digital Medicine at the Icahn School of Medicine at Mount Sinai.2

Citing a previous study conducted using a Korean-based registry, Nadkarni and a team of colleagues at the Icahn School of Medicine launched the current study with the intent of exploring associations of vaccination with cardiovascular outcomes following COVID-19 infection among a US-based population. With this in mind, the current study was designed to leverage data from the National COVID Cohort Collaborative and Cox proportional hazards models to estimate risk of vaccination with MACE.1

Created in 2020, the National Institutes of Health’s National COVID Cohort Collaborative is billed as being among the largest collections of secured and deidentified clinical data in the US for COVID-19 research.3 Through a search of the database for patients aged 18-90 years infected with SARS-CoV-2 between March 1, 2020 and February 1, 2022, investigators identified 1,934,294 patients for inclusion in their analyses. Of note, the follow-up period for the study was up to 180 days after infection.1

The overall cohort had a mean age of 45.2 years, 55.9% were women, 81.3% were White, 15.5% were Black, 2.4% were Asian, and 0.2% were Native Hawaiian or Pacific Islander. Of the 1,934,294 patients identified for inclusion, 10.1% (n=195,136) were fully vaccinated, 1.2% (n=22,707) were partially vaccinated, and 88.7% (n=1,716,451) were not vaccinated. For the purpose of analysis, fully vaccinated was defined as having received 2 or mRNA vaccines or 1 Johnson and Johnson vaccine 14 days before SARS-CoV-2 infection and partially vaccinated was defined as having received only 1 mRNA vaccine or their second mRNA or 1 Johnson and Johnson vaccine within 14 days of infection.1

Upon analysis, a diagnosis of MACE occurred among 0.7% (n=13,948) of patients included in the study, with MACE occurring among 0.7% (n=12,733) of non-vaccinated patients, 0.7% (n=160) of partially vaccinated patients (0.7%), and 0.5% (n=1055) of fully vaccinated patients. The median time to MACE among the cohort was 17 (Interquartile Range [IQR], 3-67) days, with 3175 patients dying following MACE. Initial analysis demonstrated significant differences in comorbidities among those with MACE compared to their counterparts without previous MACE, including previous MACE (29.1% vs 0.9%; P <.001), type 2 diabetes (33.9% vs 7.5%; P <.001), hyperlipidemia (50.7% vs 14.4%; P <.001), ischemic heart disease (40.6% vs 3.9%; P <.001), liver disease (4.0% vs 0.8%; P <.001), and obesity (29.4% vs 16.4%; P <.001).1

In adjusted models, results indicated both full (Adjusted hazard ratio [aHR], 0.59 [95% CI, 0.55-0.63]; P <.001) and partial (aHR, 0.76 [95% CI, 0.65-0.89]; P=.001) were associated with a reduced risk of MACE relative to their counterparts with no vaccination. Further analysis suggested an increased risk of MACE was observed for male sex (aHR, 1.45 [95% CI, 1.41-1.51]; P <.001), increasing age, and comorbidities, particularly previous MACE (aHR, 8.16 [95% CI, 7.79-8.55]; P <.001).1

“To our surprise, even partial vaccination was associated with lower risk of adverse cardiovascular events,” said study investigator Joy Jiang, an MD/PhD candidate in the Nadkarni Lab.2 “Given the magnitude of SARS-CoV-2 infection worldwide, we hope our findings could help improve vaccination rates, especially in individuals with coexisting conditions.”

References

  1. Jiang J, Chan L, Kauffman J, et al. Impact of Vaccination on Major Adverse Cardiovascular Events in Patients With COVID-19 Infection. J Am Coll Cardiol.https://doi.org/10.1016/j.jacc.2022.12.006
  2. COVID-19 vaccination linked to fewer cardiac events. EurekAlert. February 2023. https://www.eurekalert.org/news-releases/980058. Accessed February 20, 2023.
  3. National Covid Cohort Collaborative (N3C). National Center for Advancing Translational Sciences. https://ncats.nih.gov/n3c. Published September 26, 2022. Accessed February 20, 2023.
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