Cardiovascular, renal and pulmonary risks of Long COVID: a retrospective cohort study stratified by age and sex

BackgroundA substantial proportion of patients with acute COVID-19 develop post-acute sequelae of SARS-CoV-2 infection (Long COVID). The risk of adverse cardiovascular and related outcomes in Long COVID remain elusive. We hypothesized that individuals with Long COVID are at elevated risk for adverse cardiovascular, renal and pulmonary (CRP) outcomes compared to those who recovered from COVID-19 without developing Long COVID. MethodsWe performed a retrospective cohort study using the global TriNetX electronic health record network (> 150 million patients). Adults with documented COVID-19 were classified by the presence/absence of Long COVID. We analyzed absolute risks (AR) and relative risks (RR) for 15 CRP outcomes, stratified by age (18-50, 51-64, [≥]65 years). After excluding those with the preexisting outcomes of interest, propensity score matching was applied to adjust for age, sex, and common confounders. ResultsAmong 2,613,432 adults with COVID-19, 315,612 matched individuals were included in the study. Long COVID was associated with increased AR for most CRP outcomes across adult ages regardless of sex. RR were disproportionately higher in younger adults, especially in females for cardiovascular and renal outcomes and in males for selected pulmonary outcomes. In a secondary analysis among individuals with Long COVID, prior COVID-19 vaccination was not associated with a significantly lower risk of CRP outcomes. ConclusionsLong COVID is associated with increased risk of adverse CRP outcomes, with relatively higher risks observed in younger adults. These findings support the need for continuing surveillance and risk-reduction strategies for cardiovascular and related disorders in Long COVID.