CV Events Following COVID-19 Vaccination

Oct 04, 2024
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Authors:
Xu Y, Li H, Santosa A, et al.
Citation:
Cardiovascular Events Following Coronavirus Disease 2019 Vaccination in Adults: A Nationwide Swedish Study. Eur Heart J 2024;Sep 30:[Epub ahead of print].
Summary By:
Debabrata Mukherjee, MD, FACC

Quick Takes

  • This nationwide cohort study reports decreased risks of several serious CV outcomes after COVID-19 vaccination, likely related to the protection of vaccination against severe COVID-19.
  • However, increased risks were observed for two relatively mild CV conditions, i.e., extrasystoles and TIA.
  • Overall, these results clearly underscore the protective benefits of complete vaccination, especially for the elderly.

Study Questions:

What are the risks of several cardiovascular (CV) and cerebrovascular events following coronavirus disease 2019 (COVID-19) vaccination in a Swedish nationwide register-based cohort?

Methods:

The investigators assessed post-vaccination risk of myocarditis/pericarditis, dysrhythmias, heart failure, myocardial infarction, and cerebrovascular events (transient ischemic attack [TIA] and stroke) in several risk windows after each vaccine dose among all Swedish adults (n = 8,070,674). Hazard ratios (HRs) with 95% confidence intervals (95% CIs) compared with unvaccinated adults were estimated from Cox regression models adjusted for potential confounders.

Results:

For most studied outcomes, decreased risks of CV events post-vaccination were observed, especially after dose three (HRs for dose three ranging from .69 to .81), while replicating the increased risk of myocarditis and pericarditis 1-2 weeks after COVID-19 mRNA vaccination. Slightly increased risks, similar across vaccines, were observed for extrasystoles (HR, 1.17 [95% CI, 1.06-1.28] for dose one and HR, 1.22 [95% CI, 1.10-1.36] for dose two, stronger in elderly and males) but not for arrhythmias, and for TIA (HR, 1.13; 95% CI, 1.05-1.23, mainly in elderly) but not for stroke.

Conclusions:

The authors report that the risk of myopericarditis (mRNA vaccines only), extrasystoles, and TIA was transiently increased after COVID-19 vaccination, but full vaccination substantially reduced the risk of several more severe COVID-19-associated CV outcomes.

Perspective:

This nationwide cohort study reports decreased risks of several serious CV outcomes after COVID-19 vaccination, likely related to the protection of vaccination against severe COVID-19. However, increased risks were observed for two relatively mild CV conditions, i.e., extrasystoles and TIA. The study also confirmed previously reported slightly increased risks of myocarditis and pericarditis shortly after COVID-19 mRNA vaccination. Overall, these results clearly underscore the protective benefits of complete vaccination, especially for the elderly.

Clinical Topics: COVID-19 Hub, Prevention

Keywords: COVID-19, COVID-19 Vaccines, Heart Disease Risk Factors


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