COVID-19 Vaccination May Reduce Post-infection Risk for Major Cardiovascular Events

Vaccination against COVID-19, whether full or partial, was associated with reductions in post-infection risk for major adverse cardiovascular (CV) events (MACE) in an analysis of the most extensive datasets on COVID-19 maintained in the US.

©alexmlx/Adobe stock

Investigators from the Icahn School of Medicine at Mount Sinai in New York City tapped data on 1.9 million US patients aged 10 to 90 years who were infected with SARS-CoV-2 between March 1, 202,0 and February 1, 2022. When they compared subsequent risk of MACE between those who had vs those who had not received any vaccination, full COVID-19 vaccination led to a 41% relative reduction in risk and partial vaccination to a 24% relative reduction in risk of subsequent MACE.

In their work to better understand the impact of vaccination on future CV events, the researchers found “that, particularly among those with comorbidities, such as previous MACE, type 2 diabetes, high cholesterol, liver disease, and obesity, there is an association with a lower risk of complications.

"While we cannot attribute causality, it is supportive evidence that vaccination may have beneficial effects on a variety of post-COVID-19 complications,” said senior investigator Girish N. Nadkarni, MD, MPH, director of The Charles Bronfman Institute of Personalized Medicine and system chief in the Division of Data Driven and Digital Medicine at the Icahn School of Medicine at Mount Sinai, in a Mount Sinai statement.

Nadkarni and colleagues write that their findings appear to confirm those of a similar analysis conducted using the Korean nationwide COVID-19 registry and the Korean National Health Insurance Service database, results of which were published in July 2022 in JAMA.

Reflecting that study’s sources of population-wide data, the Mount Sinai team mined the National Institutes of Health’s National COVID Cohort Collaborative (N3C), the largest collections of secured and deidentified clinical data in the US for COVID-19 research, according to the authors. The search of the database between March 1, 2020 (date of inception) and February 1, 2022, identified 1 934 294 individuals who had been infected with SARS-CoV2 during that period. The study follow-up period was up to 180 days after infection.

The final cohort had a mean age of 45.2 years, 55.9% were women, 81.3% were White, 15.5% were Black, 2.4% were Asian, and 0.2% were Native Hawaiian or Pacific Islander. Among the 1 934 294 participants vaccination status was as follows:

• Fully vaccinated 10.1% (n=195 136) received ≥2 mRNA vaccines or 1 Johnson and Johnson vaccine 14 days before SARS-CoV-2 infection
• Partially vaccinated 1.2% (n=22 707) received only 1 mRNA vaccine or their second mRNA or 1 Johnson and Johnson vaccine within 14 days of infection
• Unvaccinated 88.7% (n=1 716 451)

FINDINGS

The team reports that MACE occurred among 0.7% (n=13 948) of the full cohort. Based on vaccination status, MACE occurred among 0.5% (n=1055) of fully vaccinated patients, 0.7% (n=160) of partially vaccinated persons, and 0.7% (n=12 733) of unvaccinated persons.

The median time to MACE among the cohort was 17 days, with 3175 patients dying following a CV event.

After multivariable adjustment, both full (adjusted hazard ratio [aHR], 0.59 [95% CI, 0.55-0.63]; P <.001) and partial (aHR, 0.76 [95% CI, 0.65-0.89]; P=.001) vaccination were associated with a reduced risk of MACE vs no vaccination. Further analysis found an increased risk of MACE associated with male sex (aHR, 1.45 [95% CI, 1.41-1.51]; P <.001), increasing age, and comorbidities, particularly previous MACE (aHR, 8.16 [95% CI, 7.79-8.55]; P <.001).

“To our surprise, even partial vaccination was associated with lower risk of adverse cardiovascular events,” said study investigator Joy Jiang, an MD, PhD candidate in the Nadkarni Lab. “Given the magnitude of SARS-CoV-2 infection worldwide, we hope our findings could help improve vaccination rates, especially in individuals with coexisting conditions.”

Reference: Jiang J, Chan L, Kauffman J, et al. Impact of vaccination on major adverse cardiovascular events in patients with COVID-19 infection. J Am Coll Cardiol. Published online February 20, 2023. doi:10.1016/j.jacc.2022.12.006