Thread by @indehisce

1/ A fresh, running thread on COVID’s well-documented cardiovascular harms for anyone who needs links when discussing the rise in heart failure and strokes among younger and middle-aged people since 2020:

2/ “At the end of a year, there were 45 additional cardiovascular events—such as stroke or heart failure—per 1,000 people among those who tested positive for COVID.”
scientificamerican.com/article/even-m…

3/ “Patients with COVID-19 were at increased risk of a broad range of cardiovascular disorders including cerebrovascular disorders, dysrhythmias, ischemic and non–ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease.”
jamanetwork.com/journals/jama/…

4/ “But new evidence has revealed that anyone infected with COVID is at higher risk for heart issues—including clots, inflammation, and arrhythmias—a risk that persists even in relatively healthy people long after the illness has passed.”
publichealth.jhu.edu/2022/covid-and…

5/ “Children and teens who’ve had COVID are at greater risk for blood clots, heart problems, kidney failure, and Type 1 diabetes, according to a new report released Thursday by U.S. health officials.”
fortune.com/2022/08/04/cov…

6/ “Heart-disease risk soars after COVID—even with a mild case: Massive study shows a long-term, substantial rise in risk of cardiovascular disease, including heart attack and stroke, after a SARS-CoV-2 infection.”
nature.com/articles/d4158…

7/ “The increased risk was observed even among those who had a mild case of COVID-19. It also wasn't limited to people with pre-existing risks for heart disease or other cardiovascular problems.”
npr.org/sections/healt…

8/ “COVID-19 can lead to heart problems among people who never had heart issues before.”
my.clevelandclinic.org/health/article…

9/ “But even people who had not been hospitalized had increased risks of many conditions, ranging from an 8% increase in the rate of heart attacks to a 247% increase in the rate of heart inflammation.”
nature.com/articles/d4158…

10/ “Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial.”
nature.com/articles/s4159…

11/ “Mocco, who has spent his career studying strokes and how to treat them, said he was ‘completely shocked’ by the analysis. He noted the link between COVID-19 and stroke ‘is one of the clearest and most profound correlations I’ve come across.’”
washingtonpost.com/health/2020/04…

12/ “In the week after a COVID-19 diagnosis, the risk of a first heart attack increased by three to eight times. The risk of a first stroke caused by a blood clot multiplied by three to six times.”
health.harvard.edu/heart-health/c…

13/ “‘We are definitely seeing a huge increase in younger stroke survivors who are post-COVID diagnosis,’ Kinzinger says. ‘We know that vascular complications go along with COVID infections, which can lead to strokes and other cardiovascular issues.’”
healthcare.utah.edu/healthfeed/pos…

14/ “Researchers found that rates of many conditions, such as heart failure and stroke, were substantially higher in people who had recovered from Covid than in similar people who had not been infected.”
ft.com/content/26e073…

15/ “But although the evidence is still coming into focus, it is already becoming clearer to clinicians and health leaders in medical systems around the world that they are coping with a higher burden of disease in the population”
ft.com/content/26e073…

16/ “Young patients with no risk factors for stroke may have an increased risk if they have contracted COVID-19, whether or not they are showing symptoms of the disease.”
sciencedaily.com/releases/2020/…

17/ “Researchers already know that people with COVID-19, especially severe disease, are more likely to develop clots. The virus can infect cells lining the body’s 100,000 kilometres of blood vessels, causing inflammation and damage that triggers clotting.”
nature.com/articles/d4158…

18/ “We believe that, in otherwise healthy, young patients who present with stroke during the pandemic, the diagnosis of COVID-19 should be thoroughly investigated.”
thelancet.com/article/S1474-…

19/ “‘In the post-COVID era, COVID might become the highest risk factor for cardiovascular outcomes,’ greater than well-documented risks such as smoking and obesity, says Larisa Tereshchenko, a cardiologist and biostatistician at the Cleveland Clinic”
science.org/content/articl…

20/ “Either symptomatic or asymptomatic SARS-CoV-2 infection is associated with increased risk of late cardiovascular outcomes and has causal effect on all-cause mortality in a late post-COVID-19 period.”
medrxiv.org/content/10.110…

21/ “Indeed, as the months since their infections have turned into years, people who initially had mild or even some asymptomatic coronavirus cases are pouring into cardiology practices across the country.”
washingtonpost.com/health/2022/02…

22/ “The SARS-CoV-2 virus can infect specialized pacemaker cells that maintain the heart’s rhythmic beat, setting off a self-destruction process within the cells, according to a preclinical study”
news.weill.cornell.edu/news/2022/04/a…

23/ “Collectively, these young, healthy individuals had mild COVID-19 but were subsequently found to have unsuspected cardiac pathology.”
science.org/doi/10.1126/sc…

24/ “The data suggest that patients from less affluent areas may have been at greater risk for serious complications such as stroke because of their inability to carry out protective measures such as social distancing or working at home, Dmytriw says.”
sciencedaily.com/releases/2022/…

25/ “The stroke patients who tested positive for COVID-19 were often younger, had multiple large vessels blocked, and often had worse outcomes than our usual patients. This international study confirms those early, alarming observations.”
jefferson.edu/about/news-and…

26/ “Ongoing inflammatory cardiac involvement may, at least in part, explain the lingering cardiac symptoms in previously well individuals with mild initial COVID-19 illness.”
nature.com/articles/s4159…

27/ “‘Our research found this association both before and during vaccine availability, showing that the risk was not stemming from vaccination,’ said Vincent Lo Re III, MD, MSCE, an associate professor of Infectious Diseases and Epidemiology at Penn”
pennmedicine.org/news/news-rele…

28/ “Now it has become clear that COVID-19’s cardiovascular damage doesn’t resolve as soon as a patient recovers from the initial infection. For some patients, MRI scans show signs of inflammation months after clearing the virus.”
nationalgeographic.com/science/articl…

29/ “Although the risks were highest in patients with more severe illness, even those with mild Covid had a threefold increased risk of DVT and a sevenfold increased risk of pulmonary embolism.”
theguardian.com/world/2022/apr…

30/ “Their study included only patients without previously known cardiac conditions, comorbidities, or abnormal lung function tests at the baseline assessment and who had not been hospitalized for acute COVID-19 at any point.”
medpagetoday.com/infectiousdise…

31/ “This finding is important because it may cause future heart damage and may herald a considerable burden of heart failure in a few years from now.”
cardiac-imaging.org/covid19-faq.ht…

32/ “In this article, the authors report a novel association between heart inflammation and prolonged shortness of breath, palpitations and chest pain, which are common after mild COVID-19.”
nature.com/articles/s4159…

33/ “Associations between COVID-19 and thrombotic events did not vary markedly by age or sex, but were greater in people of Black or Asian race than those of White race, and in people without than with a history of vascular events.”
ahajournals.org/doi/10.1161/CI…

34/ “Subjects in the post-acute COVID-19 phase present autonomic dysregulation...and impaired heart rate variability, which are associated with central aortic stiffness, ventricular-arterial impairment, and left ventricular function impairment.”
link.springer.com/article/10.100…

35/ “[R]ather than extreme inflammation which they had expected to find, inflammation signals had been suppressed in the hearts of the COVID-19 patients, while markers for DNA damage and repair were much higher than in people who had died from the flu.”
brisbanetimes.com.au/national/queen…

36/ Cont’d from above: “He said the way the DNA damage presented was similar to the way chronic diseases such as diabetes or even cancer presented, with the tissues of the heart putting out DNA damage signals.”

The study described in the Brisbane Times:
onlinelibrary.wiley.com/doi/10.1111/im…

37/ “‘As many as 10% to 30% may develop long COVID following SARS-CoV-2 infection. In these individuals, symptoms such as chest pain, shortness of breath, and palpitations draw attention to the cardiovascular system,’ said Dr. Gluckman.”
ama-assn.org/delivering-car…

38/ “Significantly, the risk of some of these complications is stronger in younger adults. ...As the virus becomes more immune-evasive, our arsenal is shrinking, not expanding, despite what the CDC and political leaders may claim.”
fortune.com/2022/10/06/str…

39/ “36% of the AIS patients in our study were <55 years of age and 46% were <65 years of age (Tables V and VI in the Data Supplement). These proportions are considerably higher than the population-based reports before the pandemic (12.9%–20.7%).”
ahajournals.org/doi/10.1161/ST…

40/ In the above tweet, “AIS” stands for “acute ischemic stroke” and the Data Supplement cited in the quoted passage is here:
ahajournals.org/doi/suppl/10.1…

41/ “[During SARS-CoV-2 infection], endothelial cells encompassing the intima in arteries, capillaries, veins, and the endocardium bind the viral particles via their ACE2 receptors and consequently become severely inflamed, damaged, and/or destroyed.”
academic.oup.com/jalm/article/6…

42/ “After COVID-19, our theory is the blood vessels are quite injured and they’re trying to not only heal themselves, but they’re also reaching out and trying to find healthy tissue that’s remained after the illness,” [Dr. Douglas Fraser] said.
cbc.ca/news/canada/lo…

43/ “Vascular transformation blood biomarkers were significantly elevated in Long-COVID, with angiogenesis markers (ANG-1/P-SEL) providing classification accuracy of 96%. Vascular transformation blood biomarkers hold potential for diagnostics”
molmed.biomedcentral.com/articles/10.11…

44/ “[P]resence of microclotting, together with relatively high levels of six inflammatory molecules known to be key drivers of endothelial and clotting pathology, points to thrombotic endotheliitis as a key pathological process in Long COVID.”
medrxiv.org/content/10.110…

45/ “The spikes in heart attack deaths have tracked with surges of COVID-19 infection—even during the presumed less-severe omicron phase of the pandemic. Furthermore, the data showed the increase was most significant among individuals ages 25-44”
medicalxpress.com/news/2022-10-c…

46/ “The excess death, [i.e.] the difference between the observed and the predicted mortality rates, was most pronounced for the youngest (25–44 years) aged decedents, ranging from 23% to 34% for the youngest compared to 13%–18% for the oldest age groups.”
onlinelibrary.wiley.com/doi/10.1002/jm…

47/ “Non-hospitalized Covid patients were 2.7 times more likely to develop dangerous clots called venous thromboembolisms and were more than 10 times more likely to die than individuals who avoided the disease”
bloomberg.com/news/articles/…

48/ “[P]atients hospitalized with Covid were 28 times more likely to develop blood clots, 22 times more likely to suffer heart failure and 17 times more likely to have a stroke, according to the study.”
cnbc.com/2022/10/25/peo…

49/ “Overall, available evidence supports a distinct mechanistic role for COVID-19 in driving higher VTE [venous thromboembolism—i.e., blood clots in veins] rates which occurs across disease severities and extends beyond the early postinfection phase.”
heart.bmj.com/content/heartj…

50/ “This study provides evidence that cardiomyocytes are a target of SARS-CoV-2 in the human heart and support the conclusion that SARS-CoV-2 infection of cardiomyocytes and resultant... inflammation contribute to the cardiac manifestations of COVID-19.”
doi.org/10.1016/j.jacb…

51/ “COVID-19 infection can lead to a delayed hyperinflammatory response... Based on epidemiologic data, we hypothesize that there is likely a delay of at least one month from the timing of initial COVID-19 infection to the development of stroke.”
pedneur.com/article/S0887-…

52/ “Our study suggests that prior COVID-19 infection, but not acute infection, is correlated with a risk for stroke in the pediatric population. The risk for stroke appears to be distinct from the risk for [Multisystem Inflammatory Syndrome in Children].”
doi.org/10.1016/j.pedi…

53/ “Compared with similar trauma patients who tested negative for COVID, positive, asymptomatic COVID trauma patients had [h]igher rates of myocardial infarction and cardiac arrest (3.2% vs 0.9%)”
news-medical.net/news/20221017/…

54/ “[High-field MRI] examination of brain tissue demonstrates microvascular damage in structures plausibly related to neurologic manifestations of COVID-19, consistent with endothelial activation and widespread vascular injury observed in other organs.”
science.org/doi/10.1126/sc…

55/ “We conclude that cardiac involvement in COVID-19 is an angiocentric macrophage-driven inflammatory process, distinct from classical anti-viral inflammatory responses, and substantially underappreciated by conventional histopathologic analysis.”
link.springer.com/article/10.100…

56/ Above, cont’d: “A systematic follow-up of non-fatal COVID-19 and long-COVID cases [would help detect] post-acute cardiac symptoms and fibrotic remodeling also in mild cases of disease due to the irreversible alterations of the cardiac vasculature.”
link.springer.com/article/10.100…

57/ “The activating interplay of thrombosis [blood clotting] and inflammation (thromboinflammation) has been established as a major underlying pathway, driving not only cardiovascular disease but also autoimmune disease and most recently, COVID-19.”
ahajournals.org/doi/10.1161/AT…

58/ Above, cont’d: “Endothelial dysfunction and thromboinflammation have emerged early on as the key pathogenic mechanisms driving COVID-19 pathology... COVID-19–specific coagulopathy is epitomized by elevated levels of [several glycoproteins involved in blood clotting].”

59/ “Our results confirm a hypercoagulable state in patients with PCS related to an increase in [amounts of a key blood-clotting protein relative to an enzyme that degrades it, and an increase in the generation of a separate enzyme involved in clotting]”
jthjournal.org/article/S1538-…

60/ “These results [reflect] hypercoagulability and acquired coagulopathies in patients with COVID-19, and suggest that monocytes from moderate COVID-19 patients upregulate a pro-thrombotic gene expression signature upon secondary SARS–CoV–2 sensing.”
nature.com/articles/s4146…

61/ “[Stellenbosch Univ physiological sciences chair] posits that lingering viral remnants may damage the cells that line the blood vessels, prompting the formation of inflammation and microclots, which could in turn make the immune system attack itself.”
time.com/6238147/microc…

62/ “Results presented in the current paper point to a significant failure in the fibrinolytic process [enzymatic breakdown of intravascular fibrin in blood clots] during COVID-19 and also in patients with lingering Long COVID/PASC symptoms.”
cardiab.biomedcentral.com/articles/10.11…

63/ “60% of children who recovered from asymptomatic or mildly symptomatic COVID-19 still exhibit mild subclinical systolic cardiac impairment after an average follow-up of 148 ± 68 days from disease onset.”
doi.org/10.3390/jcm120…

64/ “Cardiac MRI studies revealed cardiac impairment in 78% of 100 individuals who had a prior COVID-19 episode... and in 58% of participants with long COVID (studied 12 months after infection), reinforcing the durability of cardiac abnormalities.”
nature.com/articles/s4157…

65/ “‘COVID-19 infection worsens pre-existing heart conditions, and increases the risk of developing more than 20 heart conditions including heart attack, blood clots, heart failure and stroke,’ [Dr. Amanda Buttery, Heart Foundation of Australia] said.”
smh.com.au/national/fatal…

66/ “The incidence of hospitalisation with cerebral infarction was twice as high after COVID‐19 onset as during the baseline period. Other investigators have estimated the risk of stroke to be 2–13 times as high for people with COVID‐19.”
mja.com.au/journal/2023/2…

67/ Above, cont’d: “The pathophysiology of cerebrovascular involvement is unclear, but may be related to substantial endothelial disruption in highly vascularised organs such as the brain.”
mja.com.au/journal/2023/2…

68/ “The excess death, [i.e.] the difference between the observed and the predicted mortality rates, was most pronounced for the youngest (25–44 years) aged decedents, ranging from 23% to 34% for the youngest compared to 13%–18% for the oldest age groups.”
onlinelibrary.wiley.com/doi/10.1002/jm…

69/ “COVID-19 is associated with higher risks of cardiovascular disease and death in the short- and long-term, according to a study in nearly 160,000 participants published today in Cardiovascular Research, a journal of the European Society of Cardiology”
escardio.org/The-ESC/Press-…

70/ “COVID-19 has both direct and indirect impacts on cardiovascular health. As we learned, the virus is associated with new clotting and inflammation.”
scitechdaily.com/covid-toll-big…

71/ “The narrative that COVID-19 had only respiratory sequelae led to a delayed realization of the neurological, cardiovascular and other multisystem impacts of COVID-19.”
nature.com/articles/s4157…

72/ “The increase in U.S. heart attack deaths continued through the omicron surge, even though the variant is thought to cause milder illness, and spikes of heart attack deaths have aligned with the timing of COVID-19 surges in the U.S.”
today.com/health/covid-h…

73/ “This lends credence to the hypothesis that direct infection may lead to the heart-related sequelae observed in some COVID-19 patients...SARS–CoV–2 may establish a viral reservoir in these anatomical sites, leading to ongoing tissue-specific pathology”
nature.com/articles/s4146…

74/ “Cardiac fibrosis complicates SARS–CoV–2 infections and has been linked to arrhythmic complications in survivors.”
ahajournals.org/doi/full/10.11…

75/ Cont’d: “[Post-infection cardiac scarring may lead to] enhanced arrhythmogenesis, even sudden cardiac death. As such, COVID‐19–induced cardiac fibrosis may have critical long‐term public health implications for health care systems and policy makers.”
ahajournals.org/doi/full/10.11…

76/ Like all muscles, hearts rely on calcium to contract properly. At a major biophysics conference just this week, Columbia University’s Dr. Andrew Marks presented autopsy evidence of abnormalities in the way COVID-19 patients’ hearts handle calcium.
time.com/6256674/covid-…

77/ “The damage caused by inflammation during a Covid infection appears to prop these channels open, letting too much calcium leak from the cells of the heart... [The leaks impair] heart function and even cause fatal arrhythmias, or irregular heartbeats.”
nbcnews.com/health/heart-h…

78/ “Heart tissue from [casualties of COVID] shows increased levels of oxidative stress and inflammation, and changes in calcium levels due to damage to the system that regulates them in the heart. Such alterations can lead to arrhythmia or heart failure”
fortune.com/well/2023/02/1…

79/ “With regard to mortality, 2.8% of the PCC [post-COVID condition] cohort vs 1.2% of the NC [non-COVID] cohort died during the follow-up period. This difference implies an excess death rate of 16.4 per 1000 individuals.”
jamanetwork.com/journals/jama-…

80/ “The finding that the longer the period from COVID-19 infection the worse the vascular impairment was surprising, as we expected inflammation burden associated with COVID-19 to decrease with time.”
mdpi.com/2077-0383/12/6…

81/ “COVID-19 is a pro-inflammatory, clot forming disease and we now see its effect in the coronary arteries... These new insights point to the need for clinicians to be meticulous with blood thinning strategies, early interventions and patient follow-up.”
eurekalert.org/news-releases/…

82/ Long COVID patients were about twice as likely to seek care for cardiovascular problems like blood clots, abnormal heartbeats or stroke in the year after infection, compared to similar patients who’d avoided COVID-19. — U.S. insurance database analysis
apnews.com/article/covid1…

83/ “An analysis of electronic medical records for more than 45,000 people found that COVID-19 infection was significantly associated with the development of high blood pressure, according to new research published in Hypertension.”
medicalxpress.com/news/2023-08-a…

84/ “SARS–CoV–2, the virus that causes COVID–19, can directly infect the arteries of the heart and cause the fatty plaque inside arteries to become highly inflamed, increasing the risk of heart attack and stroke,” according to a study funded by the NIH.
nih.gov/news-events/ne…

85/ “Our data establish that SARS–CoV–2 infects coronary vessels, inducing plaque inflammation that could trigger acute cardiovascular complications and increase the long-term cardiovascular risk.”
nature.com/articles/s4416…

86/ “A postmortem study reported that severe vascular injury, including microthrombosis, was nine times more prevalent in COVID–19 lungs than in patients with influenza.”
nature.com/articles/s4416…

87/ “SARS–CoV–2 induces a strong pro-atherogenic inflammatory response... This pro-inflammatory response may contribute to the instability of atherosclerotic plaques and the increased incidence of ischemic cardiovascular complications in patients”
nature.com/articles/s4416…

88/ “Overall, the currently available evidence suggests that COVID-19 is associated with a high risk of cardiovascular complications regardless of individual demographic characteristics or cardiovascular morbidities.”
cureus.com/articles/18179…

89/ “SARS-CoV-2, the virus that causes COVID-19, directly infects the arteries of the heart.”
archive.ph/2023.11.07-165…

90/ “Our findings suggest that COVID-19 infection may lead to persistent endothelial dysfunction and hypercoagulability, portending increased severity of coronary artery ectasia and coronary thrombosis even after recovery from the initial infection.”
academic.oup.com/eurheartj/arti…

91/ “This study demonstrates that SARS–CoV–2 persistently infects the heart opportunistically causing cardiac dysfunction triggered by detrimental stimuli such as ischemia, potentially predicting a post COVID-19 era heart failure pandemic.”
cell.com/iscience/fullt…

92/ “The increase of cardiovascular [and cerebrovascular] risk associated with COVID-19 might be extended for years and not limited to the acute phase of the infection.”
academic.oup.com/cardiovascres/…