A diagnosis of long COVID is associated with an increased risk of cardiovascular disease, particularly cardiac arrhythmias, heart failure, and coronary artery disease, even among patients who were not hospitalized for COVID-19, according to a new prospective cohort study published in eClinicalMedicine.
For the study, a team led by researchers from the Karolinska Institutet looked at data from a population-based health registry in the Stockholm, Sweden, region. They identified adults aged 18 to 65 years who had a diagnosis of long COVID (but had not been hospitalized for acute COVID) and no pre-existing cardiovascular disease from October 2020 to January 2025. Of the roughly 1.2 million people in the registry, around 9,000 (0.7%) had been diagnosed as having long COVID; two-thirds of them were women.
Women had more heart problems than men
During the roughly four-year follow-up period, the researchers found that cardiovascular events were more common in participants with long COVID than in those without it. Among women, 18.2% of those with long COVID experienced a cardiovascular event, compared with 8.4% of women without. Among men, 20.6% with a long-COVID diagnosis had a cardiovascular event, compared with 11.1% of those without.
After adjustment for age, socioeconomic factors, and other risk factors, differences in risk remained. The strongest association was seen for cardiac arrhythmias: Women with long COVID had more than triple the risk, while men had a 61% increased risk. In both sexes, the risk of coronary artery disease was roughly 25% higher in those with a long-COVID diagnosis.
Women also had increased risks of heart failure (25%) and peripheral artery disease (25%). The study did not find a clear link between long COVID and stroke in either women or men.
“We found that cardiac arrhythmias and coronary artery disease were more common among both women and men with long COVID. In women, there was also an increased risk of heart failure and peripheral vascular disease,” lead author Pia Lindberg, RN, a PhD student, said in a Karolinska news release.
Mild COVID still increases risk
Long COVID is increasingly recognized as a significant public health concern, affecting an estimated 10% to 30% of people. Initially, researchers and clinicians focused on fatigue and respiratory and autonomic nervous system issues as the main symptoms of long COVID, but growing evidence suggests that infection may have lasting effects on the cardiovascular system, likely driven by endothelial dysfunction, chronic inflammation, and myocardial injury.
The new findings are important, in part because they explore the relationship between COVID infection and an increased risk of cardiovascular disease in patients who were not hospitalized for COVID, whereas most previous research has focused on patients who were hospitalized for their infection.
The results “suggest that cardiovascular risk screening of individuals with long COVID should not be limited to previously hospitalised patients but may be warranted in broader community settings,” write the authors. “Long COVID should be integrated into cardiovascular risk assessment frameworks and health system planning, with particular attention to sex-specific patterns of risk.”
