The coronavirus can affect the body in many ways. Researchers have now found that COVID accelerates the ageing of blood vessels by around five years, particularly in women. Even mild infections increased hardening of the arteries, with vaccinated people showing less damage. This vascular ageing can increase the long-term risk of heart attacks and strokes. The study was published in the European Heart Journal.
The Virus can Directly Affect the Blood Vessels
Blood vessels gradually stiffen with age, but the new study suggests that COVID could accelerate this process. The researchers believe this is important because people with stiffer blood vessels have a higher risk of cardiovascular diseases such as stroke and heart attack. The study was led by Professor Rosa Maria Bruno from the Université Paris Cité in France. She said: “Since the pandemic, we have learned that many people who have had COVID have symptoms that can last for months or even years. However, we are still exploring what happens in the body to cause these symptoms. We know that the virus can directly affect the blood vessels. We believe that this can lead to so-called premature vascular aging, which means that the blood vessels are older than the chronological age and you are more susceptible to heart disease. If this is the case, we need to find out early who is at risk to prevent heart attacks and strokes.”
The study involved 2,390 people from 16 different countries (Austria, Australia, Brazil, Canada, Cyprus, France, Greece, Italy, Mexico, Norway, Turkey, the UK and the USA) who were recruited between September 2020 and February 2022. They were categorized according to whether they had never had COVID, had recently developed COVID but were not hospitalized, and whether they were treated for COVID in a regular ward or in an intensive care unit. The researchers assessed each person’s vascular age using a device that measures how fast a blood pressure wave travels between the carotid artery (in the neck) and the femoral arteries (in the legs). This value is called the carotid-femoral pulse wave velocity (PWV). The higher this value is, the stiffer the blood vessels and the higher the vascular age of a person. The measurements were taken six months after the Covid infection and again after 12 months.
How a COVID Infection can Lead to Accelerated Vascular Ageing
The researchers also collected demographic data such as gender, age and other factors that can influence cardiovascular health. Taking these factors into account, they found that all three groups of patients infected with COVID, including those with a mild course, had stiffer arteries compared to the uninfected individuals. The effect was stronger in women than in men and in those who suffered from the persistent symptoms of long COVID, such as shortness of breath and fatigue. The average increase in PWV was 0.55 meters per second in women with a mild course, 0.60 meters per second in women hospitalized with COVID and 1.09 meters per second in women treated in the intensive care unit.
Researchers say that an increase of about 0.5 meters per second is “clinically relevant” and corresponds to an aging of about five years, with a 3% increased risk of cardiovascular disease in a 60-year-old woman. People who were vaccinated against COVID generally had less stiff arteries than those who were not vaccinated. In the long term, the vascular aging associated with COVID infection appeared to stabilize or slightly improve. “There are several possible explanations for the vascular effects of COVID. The virus acts on certain receptors in the body, called angiotensin-converting enzyme 2 receptors, which are located on the inner wall of blood vessels. The virus uses these receptors to penetrate the cells and infect them. This can lead to vascular dysfunction and accelerated vascular ageing. Our body’s inflammatory and immune reactions, which protect us from infections, could also play a role,” says Bruno.
Why Women are More Affected
According to the researchers, one of the reasons for the difference between women and men could be differences in the function of the immune system. Women develop a faster and stronger immune response, which can protect them from infections. However, the same response can also increase the damage to blood vessels after the initial infection. Vascular aging is easy to measure and can be treated with widely available treatments such as lifestyle changes, blood pressure-lowering and cholesterol-lowering medications. For people with accelerated vascular ageing, it is therefore important to do everything possible to reduce the risk of heart attacks and strokes. Professor Bruno and her colleagues will continue to monitor the participants over the coming years to see if the accelerated vascular ageing they have identified leads to an increased risk of heart attacks and strokes in the future.
In an accompanying editorial, Dr. Behnood Bikdeli of Harvard Medical School, Boston, USA, and colleagues wrote: “Although the acute threat of the COVID-19 pandemic has subsided, a new challenge has emerged in its wake: post-acute COVID-19 syndrome. Defined by the World Health Organization as symptoms that appear three months after infection and last for at least two months, studies suggest that up to 40% of original COVID-19 survivors develop this syndrome. This large, multicenter, prospective cohort study included 2390 participants from 34 centers and investigated whether arterial stiffness, as measured by PWV, persisted in individuals with recent COVID-19 infection. Gender-specific analyses revealed striking differences: women in all COVID-19 positive groups had a significantly increased PWV, with the highest increase (+1.09 m/s) observed in those who required intensive treatment. The CARTESIAN study proves that COVID-19 has aged our arteries, especially in adult women. The question is whether we can find modifiable targets to prevent this in future waves of infection and mitigate the negative consequences for people with COVID-19-related vascular aging.”