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Cardiovascular Events Following COVID-19 Vaccination in Adults
TAKE-HOME MESSAGE
- In this population-based cohort study, COVID-19 vaccination was associated with increased risks of myopericarditis (specifically with mRNA vaccines), extrasystoles, and transient ischemic attack. However, vaccinated individuals had substantially lower risks of atrial fibrillation, all arrhythmias, stroke, heart failure, and myocardial infarction than unvaccinated individuals.
- These findings underscore the substantial net cardiovascular benefits of complete COVID-19 vaccination. Therefore, COVID-19 vaccination, along with other age- and context-appropriate vaccinations, is strongly recommended to maintain cardiovascular and overall health.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND AND AIMS
While the rationale for coronavirus disease 2019 (COVID-19) vaccination is to reduce complications and overall mortality, some cardiovascular complications from the vaccine itself have been demonstrated. Myocarditis and pericarditis are recognized as rare acute adverse events after mRNA vaccines in young males, while evidence regarding other cardiovascular events remains limited and inconsistent. This study assessed the risks of several cardiovascular and cerebrovascular events in a Swedish nationwide register-based cohort.
METHODS
Post-vaccination risk of myocarditis/pericarditis, dysrhythmias, heart failure, myocardial infarction, and cerebrovascular events (transient ischaemic attack and stroke) in several risk windows after each vaccine dose were assessed among all Swedish adults (n = 8 070 674). Hazard ratios (HRs) with 95% confidence intervals (95% CIs) compared with unvaccinated were estimated from Cox regression models adjusted for potential confounders.
RESULTS
For most studied outcomes, decreased risks of cardiovascular 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 transient ischaemic attack [HR 1.13 (95% CI 1.05-1.23), mainly in elderly] but not for stroke.
CONCLUSIONS
Risk of myopericarditis (mRNA vaccines only), extrasystoles, and transient ischaemic attack was transiently increased after COVID-19 vaccination, but full vaccination substantially reduced the risk of several more severe COVID-19-associated cardiovascular outcomes, underscoring the protective benefits of complete vaccination.
Additional Info
Disclosure statements are available on the authors' profiles:
Cardiovascular events following coronavirus disease 2019 vaccination in adults: a nationwide Swedish study
Eur Heart J 2024 Sep 30;[EPub Ahead of Print], Y Xu, H Li, A Santosa, B Wettermark, T Fall, J Björk, M Börjesson, M Gisslén, F NybergFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
In a recent study,1 we demonstrated a reduced risk of several serious cardiovascular outcomes linked to COVID-19 following vaccination against COVID-19. The reduction in risk was more pronounced with each additional vaccine dose, up to a third dose, underscoring the need for physicians to advocate for complete vaccination.
Similar findings have been reported in other studies. For example, two recent studies from the UK showed similar protective effects against both arterial and venous thromboembolic events using two different approaches, and an analysis based on data from the UK, Spain, and Estonia also supports these effects.2-4 Indeed, the increased incidence of cardiovascular events after COVID-19 infection is well-established,5 similar to that with other infections such as influenza. A plausible explanation for the reduction in these events post vaccination is that vaccination prevents COVID-19 infection and/or reduces the severity of COVID-19 infection.
What do these findings mean for patients and physicians? These results clarify that the benefits of vaccination extend beyond COVID-19 infection prevention to include protection against severe acute disease and post-COVID complications.6 COVID-19 vaccination significantly reduces the risk of cardiovascular events associated with COVID-19, such as myocardial infarction, stroke, and heart failure, with the most benefit seen following full vaccination up to three doses. Importantly, despite the known transient increase in the risk of perimyocarditis — particularly in younger people and males, which our study confirms and which might lead to concerns about cardiovascular safety with vaccination — our findings provide reassuring evidence regarding a broad range of serious cardiovascular outcomes. These results support the use of full vaccination, and physicians are advised to continue recommending COVID-19 vaccination for relevant risk groups, particularly for patients at elevated cardiovascular risk due to underlying disease or risk factors.
References