Accelerated vascular ageing after COVID-19 infection: the CARTESIAN study
Rosa María Bruno, Smriti Badhwar, Leïla Abid, Mohsen Agharazii, Fabio Anastasio, Jérémy Bellien, Otto Burghuber, Luca Faconti, Jan Filipovský, Lorenzo Ghiadoni, Cristina Giannattasio, Bernhard Hametner, Alun D. Hughes, Ana Jerončić, Ignatios Ikonomidis, Mai Tone Lønnebakken, Alessandro Maloberti, Christopher Mayer, María Lorenza Muiesan, Anna Paini, Andrie G. Panayiotou, Chloe Park, Chakravarthi Rajkumar, Carlos G. Ramos Becerra, Bart Spronck, Dimitrios Terentes‐Printzios, Yeşim Tunçok, Thomas Weber, Pierre Boutouyrie, the CARTESIAN Investigators, Herta Almhofer, Kathen Danninga, Margot Algner, Martin Wernhart, Thomas Weber, Bernhard Hametner, Christopher C Mayer, Otto Burghuber, Mohammad Azizzadeh, Marie-Kathrin Breyer, Luiz Aparecido Bortolotto, José Fernando Vilela-Martin, Rogério Toshiro Passos Okawa, Jaqueline Lyrio Bermudes Okawa, Weimar Kunz Sebba Barroso, Emmanuel Gomes Ciolac, Vanessa Teixeira do Amaral, Briandy Fernández-Marrero, Rémi Goupil, Mohsen Agharazii, Catherine Fortier, Andrie G. Panayiotou, Galatia Photiou, Jan Filipovský, Otto Mayer, Jitka Seidlerová, Petr Pazdiora, Jana Hirmerová, Lucie Šustková, Simona Bílková, Július Gelžinský, Veronika Kordíková, Štěpán Mareš, Renata Cífková, Peter Wohlfahrt, Jana Kavalírová, Rosa María Bruno, Pierre Boutouyrie, Hakim Khettab, Junior Justin, Diego Moriconi, Saverio Fabbri, Jean‐Sébastien Hulot, Antoine Fayol, Marie Courbebaisse, Béatrice Parfait, David Lebeaux, Gérard Friedlander, Jérémy Bellien, Robinson Joannidès, Michèle Iacob, Anne‐Marie Leroi, Athanase Bénétos, Ioannis Georgiopoulos, Dimitrios Terentes-Printzios, Georgia Christopoulou, Konstantinos Tsioufis, Vasiliki Gardikioti, Charalambos Vlachopoulos, Ignatios Ikonomidis, Vaia Lambadiari, Alkaternini Kountouri, Κ Katogiannis, Ana Jerončić, Mario Podrug, Mirela Pavičić-Ivelja, Pjero Koren, Maria Lorenza Muiesan, Anna Paini, Massimo Salvetti
Abstract
BACKGROUND AND AIMS: Increasing evidence suggests that COVID-19 survivors experience long-term cardiovascular complications possibly through development of vascular damage. The study aimed to investigate whether accelerated vascular ageing occurs after COVID-19 infection, and if so, identify its determinants. METHODS: This prospective, multicentric, cohort study, included 34 centres in 16 countries worldwide, in 4 groups of participants-COVID-19-negative controls (ⅰ) and three groups of individuals with recent (6 ± 3 months) exposure to SARS-CoV-2: not hospitalized (ⅱ), hospitalized in general wards (ⅲ), and hospitalized in intensive care units (ⅳ). The main outcome was carotid-femoral pulse wave velocity (PWV), an established biomarker of large artery stiffness. RESULTS: 2390 individuals (age 50 ± 15 years, 49.2% women) were recruited. After adjustment for confounders, all COVID-19-positive groups showed higher PWV (+0.41, +0.37, and +0.40 m/s for groups 2-4, P < .001, P = .001 and P = .003) vs. controls [PWV 7.53 (7.09; 7.97) m/s adjusted mean (95% CI)]. In sex-stratified analyses, PWV differences were significant in women [PWV (+0.55, +0.60, and +1.09 m/s for groups 2-4, P < .001 for all)], but not in men. Among COVID-19 positive women, persistent symptoms were associated with higher PWV, regardless of disease severity and cardiovascular confounders [adjusted PWV 7.52 (95% CI 7.09; 7.96) vs. 7.13 (95% CI 6.67; 7.59) m/s, P < .001]. A stable or improved PWV after 12 months was found in the COVID+ groups, whereas a progression was observed in the COVID- group. CONCLUSIONS: COVID-19 is associated with early vascular ageing in the long term, especially in women.