{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:09:10Z","timestamp":1788952150087,"version":"build-2803163510"},"reference-count":46,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T00:00:00Z","timestamp":1788048000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100025520","name":"Medical Research Future Fund","doi-asserted-by":"publisher","award":["2005874"],"award-info":[{"award-number":["2005874"]}],"id":[{"id":"10.13039\/501100025520","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Melbourne Research Scholarship"},{"name":"Rowden White Scholarship"},{"name":"Baker Bright Spark Top-Up Scholarship"},{"name":"National Heart Foundation Future Leader Fellowship"},{"name":"Sohn Hearts and Minds Research Fellowship"},{"name":"Investigator grant","award":["2008129"],"award-info":[{"award-number":["2008129"]}]},{"DOI":"10.13039\/501100000925","name":"NHMRC","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Whether COVID-19 vaccination is associated with lower long-term cardiovascular risk after SARS-CoV-2 infection and how much infection prevention mediates this association remain unclear. To evaluate associations of vaccination, including its timing relative to SARS-CoV-2 infection, with post-COVID-19 cardiovascular disease (CVD), and quantify the contribution of infection prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This statewide population-based cohort study used linked administrative health data for 2 391 456 adults in Victoria, Australia (2019\u201325). Associations of pre- or post-infection vaccination with major adverse cardiovascular events (MACE; primary outcome), stroke, heart failure, acute myocardial infarction, acute coronary syndrome, atrial fibrillation, and venous thromboembolism were evaluated using time-varying Cox proportional hazards regression, causal mediation analysis, and target trial emulation. Vaccination was associated with lower hazards of MACE and all secondary outcomes. Estimated absolute risk reductions for MACE were 0.21% with pre-infection vaccination and 0.24% with post-infection vaccination. Three or more vaccine doses were associated with progressively lower hazards across cardiovascular outcomes. Mediation analysis suggested that \u223c68% of the estimated association between vaccination and lower post-COVID cardiovascular risk was not explained by prevention of SARS-CoV-2 infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Vaccination before or after SARS-CoV-2 infection was associated with lower hazards of post-COVID-19 cardiovascular outcomes, with stronger observed associations at higher dose numbers. Most of the estimated association was not explained by infection prevention alone. These findings support COVID-19 vaccination as an important component of strategies to reduce the burden of post-COVID-19 CVD while highlighting the need for further studies to clarify the mechanisms underlying these associations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcag139","type":"journal-article","created":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T13:16:32Z","timestamp":1788095792000},"source":"Crossref","is-referenced-by-count":0,"title":["COVID-19 vaccination and risk of post-COVID-19 cardiovascular disease: a population-based cohort and target trial emulation study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8309-5986","authenticated-orcid":false,"given":"Binyam Tariku","family":"Seboka","sequence":"first","affiliation":[{"name":"Baker Department of Cardiometabolic Health, The University of Melbourne , Grattan Street, Parkville, Melbourne, Victoria 3010 ,","place":["Australia"]},{"name":"Imaging Research Laboratory, Baker Heart and Diabetes Institute , 75 Commercial Road, Melbourne, Victoria 3004 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dianna J","family":"Magliano","sequence":"additional","affiliation":[{"name":"Diabetes and Population Health, Baker Heart and Diabetes Institute , 75 Commercial Road, Melbourne, Victoria 3004 ,","place":["Australia"]},{"name":"School of Public Health and Preventive Medicine, Monash University , 553 St Kilda Road, Melbourne, Victoria 3004 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas H","family":"Marwick","sequence":"additional","affiliation":[{"name":"Baker Department of Cardiometabolic Health, The University of Melbourne , Grattan Street, Parkville, Melbourne, Victoria 3010 ,","place":["Australia"]},{"name":"Imaging Research Laboratory, Baker Heart and Diabetes Institute , 75 Commercial Road, Melbourne, Victoria 3004 ,","place":["Australia"]},{"name":"Menzies Institute for Medical Research, University of Tasmania , Medical Science Precint, 17 Liverpool Street, Hobart, Tasmania 7000 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1368-5160","authenticated-orcid":false,"given":"Quan","family":"Huynh","sequence":"additional","affiliation":[{"name":"Baker Department of Cardiometabolic Health, The University of Melbourne , Grattan Street, Parkville, Melbourne, Victoria 3010 ,","place":["Australia"]},{"name":"Imaging Research Laboratory, Baker Heart and Diabetes Institute , 75 Commercial Road, Melbourne, Victoria 3004 ,","place":["Australia"]},{"name":"Menzies Institute for Medical Research, University of Tasmania , Medical Science Precint, 17 Liverpool Street, Hobart, Tasmania 7000 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,30]]},"reference":[{"key":"2026090905070112300_qcag139-B1","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s12916-025-03908-3","article-title":"Prevalence of cardiovascular symptoms in post-acute COVID-19 syndrome: a meta-analysis","volume":"23","author":"Huang","year":"2025","journal-title":"BMC Med"},{"key":"2026090905070112300_qcag139-B2","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1093\/eurjpc\/zwae070","article-title":"Cardiovascular disease as part of long COVID: a systematic review","volume":"32","author":"Tsampasian","year":"2025","journal-title":"Eur J Prev Cardiol"},{"key":"2026090905070112300_qcag139-B3","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1007\/s11886-022-01786-2","article-title":"Long-COVID syndrome and the cardiovascular system: a review of neurocardiologic effects on multiple systems","volume":"24","author":"DePace","year":"2022","journal-title":"Curr Cardiol Rep"},{"key":"2026090905070112300_qcag139-B4","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1093\/eurheartj\/ehac031","article-title":"Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus","volume":"43","author":"Raman","year":"2022","journal-title":"Eur Heart J"},{"key":"2026090905070112300_qcag139-B5","first-page":"726","article-title":"Beyond acute COVID-19: a review of long-term cardiovascular outcomes","volume":"39","author":"Parhizgar","year":"2023","journal-title":"Can J Cardiol"},{"key":"2026090905070112300_qcag139-B6","article-title":"The effect of SARS-CoV-2 infection on cardiac function in post-COVID-19 survivors: a systematic review and meta-analysis","volume":"95","author":"Rahmati","year":"2023","journal-title":"J Med Virol"},{"key":"2026090905070112300_qcag139-B7","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1038\/s41591-022-01689-3","article-title":"Long-term cardiovascular outcomes of COVID-19","volume":"28","author":"Xie","year":"2022","journal-title":"Nat Med"},{"key":"2026090905070112300_qcag139-B8","article-title":"Cardiovascular outcomes in long COVID-19: a systematic review and meta-analysis","volume":"12","author":"Zhang","year":"2025","journal-title":"Front Cardiovasc Med"},{"key":"2026090905070112300_qcag139-B9","doi-asserted-by":"crossref","DOI":"10.1080\/21645515.2022.2027160","article-title":"The efficacy and effectiveness of the COVID-19 vaccines in reducing infection, severity, hospitalization, and mortality: a systematic review","volume":"18","author":"Mohammed","year":"2022","journal-title":"Hum Vaccin Immunother"},{"key":"2026090905070112300_qcag139-B10","doi-asserted-by":"crossref","first-page":"e236","DOI":"10.1016\/S2666-5247(22)00390-1","article-title":"Efficacy of SARS-CoV-2 vaccines and the dose-response relationship with three major antibodies: a systematic review and meta-analysis of randomised controlled trials","volume":"4","author":"Yang","year":"2023","journal-title":"Lancet Microbe"},{"key":"2026090905070112300_qcag139-B11","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1016\/S1473-3099(22)00320-6","article-title":"Global impact of the first year of COVID-19 vaccination: a mathematical modelling study","volume":"22","author":"Watson","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"2026090905070112300_qcag139-B12","doi-asserted-by":"crossref","DOI":"10.1136\/bmjmed-2022-000385","article-title":"Effect of COVID-19 vaccination on long COVID: systematic review","volume":"2","author":"Byambasuren","year":"2023","journal-title":"BMJ Med"},{"key":"2026090905070112300_qcag139-B13","doi-asserted-by":"crossref","first-page":"10326","DOI":"10.1038\/s41467-025-65302-0","article-title":"A systematic review and meta-analysis of the impact of vaccination on prevention of long COVID","volume":"16","author":"Green","year":"2025","journal-title":"Nat Commun"},{"key":"2026090905070112300_qcag139-B14","doi-asserted-by":"crossref","first-page":"652","DOI":"10.3390\/vaccines10050652","article-title":"The impact of COVID vaccination on symptoms of long COVID: an international survey of people with lived experience of long COVID","volume":"10","author":"Strain","year":"2022","journal-title":"Vaccines (Basel)"},{"key":"2026090905070112300_qcag139-B15","article-title":"Effectiveness of COVID-19 vaccination against COVID-19 specific and all-cause mortality in older Australians: a population based study","volume":"40","author":"Liu","year":"2023","journal-title":"Lancet Reg Health West Pac"},{"key":"2026090905070112300_qcag139-B16","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1016\/S2213-2600(24)00179-6","article-title":"Estimated number of lives directly saved by COVID-19 vaccination programmes in the WHO European Region from December, 2020, to March, 2023: a retrospective surveillance study","volume":"12","author":"Mesl\u00e9","year":"2024","journal-title":"Lancet Respir Med"},{"key":"2026090905070112300_qcag139-B17","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s10238-024-01367-3","article-title":"Cardioprotective effects of vaccination in hospitalized patients with COVID-19","volume":"24","author":"Madrid","year":"2024","journal-title":"Clin Exp Med"},{"key":"2026090905070112300_qcag139-B18","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1016\/j.vaccine.2023.01.052","article-title":"Impact of COVID-19 vaccination in post-COVID cardiac complications","volume":"41","author":"Parodi","year":"2023","journal-title":"Vaccine"},{"key":"2026090905070112300_qcag139-B19","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2024.102962","article-title":"Real-world effectiveness and causal mediation study of BNT162b2 on long COVID risks in children and adolescents","volume":"79","author":"Wu","year":"2025","journal-title":"eClinicalMedicine"},{"key":"2026090905070112300_qcag139-B20","doi-asserted-by":"crossref","first-page":"27530","DOI":"10.1038\/s41598-025-13043-x","article-title":"Dynamic effects of COVID-19 vaccination on major acute cardiovascular events and mortality following SARS-CoV-2 infection in a target trial emulation study","volume":"15","author":"Meister","year":"2025","journal-title":"Sci Rep"},{"key":"2026090905070112300_qcag139-B21","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1038\/s41467-024-46497-0","article-title":"Impact of vaccination on the association of COVID-19 with cardiovascular diseases: an OpenSAFELY cohort study","volume":"15","author":"Cezard","year":"2024","journal-title":"Nat Commun"},{"key":"2026090905070112300_qcag139-B22","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.125.044546","article-title":"COVID-19 vaccination and cardiovascular outcomes in older adults with coronary artery disease and heart failure: insights from a large propensity-matched cohort study","volume":"14","author":"Akbar","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"2026090905070112300_qcag139-B23","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1136\/heartjnl-2023-323483","article-title":"The role of COVID-19 vaccines in preventing post-COVID-19 thromboembolic and cardiovascular complications","volume":"110","author":"Mercad\u00e9-Besora","year":"2024","journal-title":"Heart"},{"key":"2026090905070112300_qcag139-B24","doi-asserted-by":"crossref","first-page":"10115","DOI":"10.1038\/s41467-025-66270-1","article-title":"COVID-19 and cardiovascular disease in a total population-study of long-term effects, social factors and COVID-19-vaccination","volume":"16","author":"Spetz","year":"2025","journal-title":"Nat Commun"},{"key":"2026090905070112300_qcag139-B25","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1007\/s11886-023-01950-2","article-title":"COVID vaccination as a strategy for cardiovascular disease prevention","volume":"25","author":"Fundora","year":"2023","journal-title":"Curr Cardiol Rep"},{"key":"2026090905070112300_qcag139-B26","article-title":"Associations of COVID-19 vaccination with risks for post-infectious cardiovascular complications: an international cohort study in cancer patients with SARS-CoV-2 infection","volume":"44","author":"Lin","year":"2025","journal-title":"Lancet Reg Health Am"},{"key":"2026090905070112300_qcag139-B27","doi-asserted-by":"crossref","first-page":"A42","DOI":"10.1093\/eurheartjsupp\/suac123","article-title":"The impact of COVID-19 and COVID vaccination on cardiovascular outcomes","volume":"25","author":"Akhtar","year":"2023","journal-title":"Eur Heart J Suppl"},{"key":"2026090905070112300_qcag139-B28","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1038\/s41467-024-45953-1","article-title":"Persistence in risk and effect of COVID-19 vaccination on long-term health consequences after SARS-CoV-2 infection","volume":"15","author":"Lam","year":"2024","journal-title":"Nat Commun"},{"key":"2026090905070112300_qcag139-B29","doi-asserted-by":"crossref","first-page":"14","DOI":"10.4103\/ijpvm.ijpvm_260_24","article-title":"COVID-19 vaccination and cardiovascular events: a systematic review and Bayesian multivariate meta-analysis of preventive benefits and risks","volume":"16","author":"Karimi","year":"2025","journal-title":"Int J Prev Med"},{"key":"2026090905070112300_qcag139-B30","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/eurheartj\/ehae639","article-title":"Cardiovascular events following coronavirus disease 2019 vaccination in adults: a nationwide Swedish study","volume":"46","author":"Xu","year":"2025","journal-title":"Eur Heart J"},{"key":"2026090905070112300_qcag139-B31","doi-asserted-by":"crossref","first-page":"5500","DOI":"10.1016\/j.cell.2024.07.054","article-title":"Mechanisms of long COVID and the path toward therapeutics","volume":"187","author":"Peluso","year":"2024","journal-title":"Cell"},{"key":"2026090905070112300_qcag139-B32","author":"Australian Technical Advisory Group on Immunisation (ATAGI). ATAGI Statement on the administration of COVID-19 vaccines in 2024"},{"key":"2026090905070112300_qcag139-B33","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1016\/S0140-6736(18)30668-8","article-title":"Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study","volume":"391","author":"Gilbert","year":"2018","journal-title":"Lancet"},{"key":"2026090905070112300_qcag139-B34","author":"Australian Bureau of Statistics"},{"key":"2026090905070112300_qcag139-B35","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1007\/s11121-011-0270-1","article-title":"The causal mediation formula\u2014a guide to the assessment of pathways and mechanisms","volume":"13","author":"Pearl","year":"2012","journal-title":"Prev Sci"},{"key":"2026090905070112300_qcag139-B36","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1186\/s12874-021-01426-3","article-title":"Mediation analysis methods used in observational research: a scoping review and recommendations","volume":"21","author":"Rijnhart","year":"2021","journal-title":"BMC Med Res Methodol"},{"key":"2026090905070112300_qcag139-B37","doi-asserted-by":"crossref","first-page":"103188","DOI":"10.1016\/j.pmedr.2025.103188","article-title":"Association of COVID vaccinations and treatments with long COVID beyond 6 months: a case-control study on the adult population in a large integrated healthcare system in the United States from 2020 to 2023","volume":"57","author":"Liu","year":"2025","journal-title":"Prev Med Rep"},{"key":"2026090905070112300_qcag139-B38","doi-asserted-by":"crossref","first-page":"e941","DOI":"10.1093\/infdis\/jiaf133","article-title":"The effect of COVID-19 vaccination on the risk of persistent post\u2013COVID-19 condition: cohort study","volume":"231","author":"Hedberg","year":"2025","journal-title":"J Infect Dis"},{"key":"2026090905070112300_qcag139-B39","doi-asserted-by":"crossref","DOI":"10.1016\/j.jinf.2024.106358","article-title":"The effect of pre-COVID and post-COVID vaccination on long COVID: a systematic review and meta-analysis","volume":"89","author":"Chow","year":"2024","journal-title":"J Infect"},{"key":"2026090905070112300_qcag139-B40","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1093\/ehjqcco\/qcae016","article-title":"Vaccines and myocardial injury in patients hospitalized for COVID-19 infection: the CardioCOVID-Gemelli study","volume":"11","author":"Montone","year":"2025","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2026090905070112300_qcag139-B41","doi-asserted-by":"crossref","first-page":"e168","DOI":"10.1017\/ash.2023.447","article-title":"The effectiveness of COVID-19 vaccine in the prevention of post-COVID conditions: a systematic literature review and meta-analysis of the latest research","volume":"3","author":"Marra","year":"2023","journal-title":"Antimicrob Steward Healthc Epidemiol"},{"key":"2026090905070112300_qcag139-B42","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1001\/jamainternmed.2026.1929","article-title":"2024\u20132025 COVID-19 vaccine and major adverse cardiovascular events among US Veterans","volume":"186","author":"Cai","year":"2026","journal-title":"JAMA Intern Med"},{"key":"2026090905070112300_qcag139-B43","doi-asserted-by":"crossref","first-page":"6085","DOI":"10.1038\/s41467-024-49634-x","article-title":"Cohort study of cardiovascular safety of different COVID-19 vaccination doses among 46 million adults in England","volume":"15","author":"Ip","year":"2024","journal-title":"Nat Commun"},{"key":"2026090905070112300_qcag139-B44","doi-asserted-by":"crossref","first-page":"20235","DOI":"10.1038\/s41598-023-47690-9","article-title":"Influenza vaccination and major cardiovascular risk: a systematic review and meta-analysis of clinical trials studies","volume":"13","author":"Omidi","year":"2023","journal-title":"Sci Rep"},{"key":"2026090905070112300_qcag139-B45","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.8873","article-title":"Association of influenza vaccination with cardiovascular risk: a meta-analysis","volume":"5","author":"Behrouzi","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026090905070112300_qcag139-B46","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ijid.2020.07.038","article-title":"The protective effect of pneumococcal vaccination on cardiovascular disease in adults: a systematic review and meta-analysis","volume":"99","author":"Marra","year":"2020","journal-title":"Int J Infect Dis"}],"container-title":["European Heart Journal - Quality of Care and Clinical Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjqcco\/advance-article-pdf\/doi\/10.1093\/ehjqcco\/qcag139\/70871068\/qcag139.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/advance-article-pdf\/doi\/10.1093\/ehjqcco\/qcag139\/70871068\/qcag139.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:12:47Z","timestamp":1788948767000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjqcco\/advance-article\/doi\/10.1093\/ehjqcco\/qcag139\/8776131"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,30]]},"references-count":46,"URL":"https:\/\/doi.org\/10.1093\/ehjqcco\/qcag139","relation":{},"ISSN":["2058-5225","2058-1742"],"issn-type":[{"value":"2058-5225","type":"print"},{"value":"2058-1742","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,30]]},"article-number":"qcag139"}}