Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study

• Published in: Nature communications 2024-03, Vol.15 (1), p.2173-14, Article 2173
• Main Authors: Cezard, Genevieve I., Denholm, Rachel E., Knight, Rochelle, Wei, Yinghui, Teece, Lucy, Toms, Renin, Forbes, Harriet J., Walker, Alex J., Fisher, Louis, Massey, Jon, Hopcroft, Lisa E. M., Horne, Elsie M. F., Taylor, Kurt, Palmer, Tom, Arab, Marwa Al, Cuitun Coronado, Jose Ignacio, Ip, Samantha H. Y., Davy, Simon, Dillingham, Iain, Bacon, Sebastian, Mehrkar, Amir, Morton, Caroline E., Greaves, Felix, Hyams, Catherine, Davey Smith, George, Macleod, John, Chaturvedi, Nishi, Goldacre, Ben, Whiteley, William N., Wood, Angela M., Sterne, Jonathan A. C., Walker, Venexia
• Format: Article
• Language: English
• Subjects: 631/326/590; 631/326/596/4130; 692/308/174; 692/4019; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cohort Studies; COVID-19; COVID-19 - epidemiology; COVID-19 - prevention & control; COVID-19 Testing; COVID-19 Vaccines; Electronic health records; Electronic medical records; Health risks; Humanities and Social Sciences; Humans; Immunization; Infections; multidisciplinary; Risk; SARS-CoV-2; Science; Science (multidisciplinary); Severe acute respiratory syndrome coronavirus 2; Vaccination; Viral diseases
• ISSN: 2041-1723; 2041-1723
• DOI: 10.1038/s41467-024-46497-0

Infection with SARS-CoV-2 is associated with an increased risk of arterial and venous thrombotic events, but the implications of vaccination for this increased risk are uncertain. With the approval of NHS England, we quantified associations between COVID-19 diagnosis and cardiovascular diseases in different vaccination and variant eras using linked electronic health records for ~40% of the English population. We defined a ‘pre-vaccination’ cohort (18,210,937 people) in the wild-type/Alpha variant eras (January 2020-June 2021), and ‘vaccinated’ and ‘unvaccinated’ cohorts (13,572,399 and 3,161,485 people respectively) in the Delta variant era (June-December 2021). We showed that the incidence of each arterial thrombotic, venous thrombotic and other cardiovascular outcomes was substantially elevated during weeks 1-4 after COVID-19, compared with before or without COVID-19, but less markedly elevated in time periods beyond week 4. Hazard ratios were higher after hospitalised than non-hospitalised COVID-19 and higher in the pre-vaccination and unvaccinated cohorts than the vaccinated cohort. COVID-19 vaccination reduces the risk of cardiovascular events after COVID-19 infection. People who had COVID-19 before or without being vaccinated are at higher risk of cardiovascular events for at least two years. SARS-CoV-2 infection is associated with an increased risk of arterial and venous thrombotic events. Here, the authors investigate the degree to which this association is modified by virus variant and vaccination using electronic health record data for ~18 million adults in England.