A new study has found that COVID-19 may accelerate plaque buildup in the arteries (atherosclerosis) and raise the risk of heart attack and stroke.
“This study builds on prior research linking COVID-19 to systemic inflammation and long-term cardiovascular complications,” says study senior author Junbo Ge, MD, a professor and the director of the cardiology department at Zhongshan Hospital at Fudan University in Shanghai, China.
“COVID-19 is not just a respiratory illness: It has lasting cardiovascular consequences,” Dr. Ge says. “Even mild infections may accelerate atherosclerosis and increase heart attack risk.”
COVID-19 Poses Long-Term Health Risks
Many Americans no longer view COVID-19 as a serious health threat. A poll from Gallup last year found that only 20 percent of U.S. adults were very or somewhat worried that they would contract COVID-19.
Concerns may have faded as these infections are generally milder than they were in the early years of the pandemic, and hospitalization rates have declined.
Still, COVID-19 can pose long-term health risks. While typical respiratory symptoms may pass relatively quickly, other health effects can spring up later, including problems with the gut, kidneys, brain, nervous system, and heart.
How COVID-19 Affects the Arteries
To see how the coronavirus that causes COVID-19, SARS-CoV-2, might affect coronary arteries that supply blood to the heart, Ge and his collaborators reviewed scans of the heart and blood vessels in about 800 older adults, taken between September 2018 and October 2023.
Participants, who were 64 years old on average, had at least two examinations performed about three years apart. A total of 690 adults with an associated 2,108 coronary plaques had confirmed COVID-19 over this time period, and 113 adults with 480 coronary plaques did not.
Ge and his team compared how plaque volumes changed between initial scans and follow-up imaging. The findings showed that plaque volumes grew faster in participants who had COVID-19.
In participants with COVID-19, the incidence of lesions (abnormal growths in blood vessels) developing into high-risk plaques that are likely to break away and cause a clot was just over 20 percent, compared with almost 16 percent in participants who didn’t have COVID-19.
“Inflammation following COVID-19 can lead to ongoing plaque growth, particularly in high-risk, noncalcified plaques,” says Ge.
The investigative team also found a 27 percent incident rate for coronary inflammation in the COVID group, versus just under 20 percent in the non-COVID group.
In addition, participants who’d had COVID-19 experienced a greater chance of having target lesion failure, in which a lesion in a blood vessel targeted with treatment is unsuccessful. The rate was 10.4 percent in the COVID group, versus 3.1 percent in the non-COVID group. This indicates increased heart attack and stroke risk, the authors wrote.
“While systemic inflammation was expected to influence atherosclerosis, the magnitude of plaque progression underscores the profound impact of COVID-19,” says Ge. “The study shows that even nonhospitalized COVID-19 patients face heightened risks of plaque progression and cardiovascular events.”
Taking Action to Protect the Heart
Patricia Nguyen, MD, an associate professor of cardiovascular medicine at Stanford Health Care in California, notes that these new findings align with her own previous research, which found a link between respiratory viruses, inflammation, and a higher risk of heart disease complications.
“The results are intriguing and correspond in some ways to research we’ve done looking at plaque on a cellular level to see why patients who have viral infections like flu and SARS have an increased risk of heart attack,” says Dr. Nguyen.
She stresses, however, that this study is limited because it’s retrospective — looking at already existing imaging and data, rather than directly following a group of participants. Furthermore, patients were all Asian and selected from a single health center, reducing any generalization of results to other populations.
Also, the analysis did not take lifestyle factors into account. “There is no information about diet and exercise, for example,” says Nguyen, pointing out that a lack of physical activity and poor eating habits could be contributing factors to negative heart health outcomes in some of these participants.
Ge urges people who get COVID-19 to talk to their healthcare providers and prioritize their heart health post-recovery. Steps to take could include:
Tom Gavin joined Everyday Health as copy chief in 2022 after a lengthy stint as a freelance copy editor. He has a bachelor's degree in psychology from College of the Holy Cross.
Prior to working for Everyday Health, he wrote, edited, copyedited, and fact-checked for books, magazines, and digital content covering a range of topics, including women's health, lifestyle, recipes, restaurant reviews, travel, and more. His clients have included Frommer's, Time-Life, and Google, among others.
He lives in Brooklyn, New York, where he likes to spend his time making music, fixing too-old electronics, and having fun with his family and the dog who has taken up residence in their home.
Don Rauf has been a freelance health writer for over 12 years and his writing has been featured in HealthDay, CBS News, WebMD, U.S. News & World Report, Mental Floss, United Press International (UPI), Health, and MedicineNet. He was previously a reporter for DailyRx.com where he covered stories related to cardiology, diabetes, lung cancer, prostate cancer, erectile dysfunction, menopause, and allergies. He has interviewed doctors and pharmaceutical representatives in the U.S. and abroad.
He is a prolific writer and has written more than 50 books, including Lost America: Vanished Civilizations, Abandoned Towns, and Roadside Attractions. Rauf lives in Seattle, Washington.
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Resources
Dai N et al. SARS-CoV-2 Infection Association with Atherosclerotic Plaque Progression at Coronary CT Angiography and Adverse Cardiovascular Events. Radiology. February 4, 2025.
After Four Years, 59% in U.S. Say COVID-19 Pandemic Is Over. Gallup. March 15, 2024.
Merschel M. Beyond Breathing: How COVID-19 Affects Your Heart, Brain and Other Organs. American Heart Association. January 16, 2024.
Taglieri N et al. Target Lesion Failure With Current Drug-Eluting Stents: Evidence From a Comprehensive Network Meta-Analysis. JACC: Cardiovascular Interventions. December 28, 2020.
Chase A. Heart Artery Plaque Immune Cells Cross-React With Virus and Vascular Proteins – A Potential Cause of Heart Attack. Stanford Medicine. May 13, 2022.
