{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T15:01:04Z","timestamp":1790780464674,"version":"4.1.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>There is growing evidence that patients with SARS-CoV-2 (The severe acute respiratory syndrome coronavirus 2) may have a variety of cardiovascular complications in the post-acute phase of COVID-19, but these manifestations have not yet been comprehensively characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic review and meta-analysis of primary research papers which evaluated individuals at least four weeks after confirmed COVID-19 diagnosis and reported on cardiovascular disease prevalence. Systematic search conducted without language restrictions from December 1, 2019 to June 31, 2022 on PubMed, EMBASE, Web of Science, Cochrane library, ProQuest Coronavirus Research Database, COVID-19 Living Overview of the Evidence (L-OVE) subset of Episteminokos and the World Health Organization (WHO) Covid-19 databases. Study was reported according to MOOSE-lists and the PRISMA guidelines. The risk of bias was identified using the Newcastle-Ottawa Scale (NOS) for observational studies. Random-effects meta-analyses examined the pooled risk difference in the prevalence of each symptom or symptom combination in cases with confirmed SARS-coV-2 infection compared with controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eight cohort studies were eligible, including nearly 10 million people. Long COVID-19 was associated with a higher risk of thromboembolic disorders [HR 3.12 (1.60, 6.08)], coronary heart disease [HR 1.61 (1.13, 2.31)], stroke [HR 1.71 (1.07,2.72)], arrhythmia [HR 1.60 (1.13, 2.26)], cardiomyopathy [HR 1.71 (1.12, 2.61)], myocarditis [HR 6.11 (4.17,8.94)], hypertension [HR 1.70 (1.56, 1.85)], heart failure [HR 1.72 (1.15,2.59)] and cardiogenic shock [HR 2.09 (1.53,2.86)] compared to non-COVID-19 controls. Pooled risk differences in long COVID cases compared to controls were significantly higher for cardiomyopathy [0.15% (0.06, 0.23)], deep vein thrombosis [0.45% (0.06, 0.83)] and hypertension (0.32%, (0.06, 0.58) but not for thromboembolic disorders, coronary disease, stroke, arrhythmia, cardiomyopathy, myocarditis, hypertension, heart failure or cardiogenic shock.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The risk of cardiovascular disease increased significantly four weeks or more after recovering from acute COVID-19. Care for survivors after an acute attack of COVID-19 should include paying close attention to cardiovascular health and disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>PROSPERO [CRD42022353965].<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2025.1450470","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T01:52:39Z","timestamp":1738115559000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":31,"title":["Cardiovascular outcomes in long COVID-19: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"12","author":[{"given":"Ting","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhimao","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qimin","family":"Mei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph Harold","family":"Walline","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaocai","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yecheng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huadong","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1016\/S1473-3099(20)30120-1","article-title":"An interactive web-based dashboard to track COVID-19 in real time","volume":"20","author":"Dong","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e34625","DOI":"10.2196\/34625","article-title":"Authorship correction: international changes in COVID-19 clinical trajectories across 315 hospitals and 6 countries: retrospective cohort study","volume":"23","author":"Weber","year":"2021","journal-title":"J Med Internet Res"},{"key":"B3","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1038\/d41586-020-02796-2","article-title":"Long COVID: let patients help define long-lasting COVID symptoms","year":"2020","journal-title":"Nature"},{"key":"B4","article-title":"Why we need to keep using the patient made term \u201clong COVID\u201d","year":"","journal-title":"BMJ"},{"key":"B5","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.ijcard.2021.06.056","article-title":"Cardiac involvement in consecutive unselected hospitalized COVID-19 population: in-hospital evaluation and one-year follow-up","volume":"339","author":"Maestrini","year":"2021","journal-title":"Int J Cardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.ijcard.2022.04.070","article-title":"Echocardiographic assessment of COVID19 sequelae in survivors with elevated cardiac biomarkers","volume":"360","author":"R\u00f3denas-Alesina","year":"2022","journal-title":"Int J Cardiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.ijcard.2021.11.051","article-title":"Endothelial dysfunction in COVID-19: a potential predictor of long-COVID?","volume":"349","author":"Seitz","year":"2022","journal-title":"Int J Cardiol"},{"key":"B8","volume-title":"COVID-19 Rapid Guideline: Managing the Long-Term Effects of COVID-19","year":"2020"},{"key":"B9","doi-asserted-by":"publisher","first-page":"101012","DOI":"10.1016\/j.ijcha.2022.101012","article-title":"Cardiovascular complications in the post-acute COVID-19 syndrome (PACS)","volume":"40","author":"Elseidy","year":"2022","journal-title":"Int J Cardiol Heart Vasc"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2705","DOI":"10.1093\/cvr\/cvab298","article-title":"Cardiovascular disease and COVID-19: a consensus paper from the ESC working group on coronary pathophysiology & microcirculation, ESC working group on thrombosis and the association for acute cardiovascular care (ACVC), in collaboration with the European heart rhythm association (EHRA)","volume":"117","author":"Cenko","year":"2021","journal-title":"Cardiovasc Res"},{"key":"B11","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.jinf.2021.11.011","article-title":"Persistent symptoms following SARS-CoV-2 infection amongst children and young people: a meta-analysis of controlled and uncontrolled studies","volume":"84","author":"Behnood","year":"2022","journal-title":"J Infect"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e059385","DOI":"10.1136\/bmjopen-2021-059385","article-title":"Deriving and validating a risk prediction model for long COVID-19: protocol for an observational cohort study using linked Scottish data","volume":"12","author":"Daines","year":"2022","journal-title":"BMJ Open"},{"key":"B13","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1038\/s41591-021-01283-z","article-title":"Post-acute COVID-19 syndrome","volume":"27","author":"Nalbandian","year":"2021","journal-title":"Nat Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group","volume":"283","author":"Stroup","year":"2000","journal-title":"JAMA"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"The BMJ."},{"key":"B16","article-title":"Ottawa Hospital Research Institute","year":""},{"key":"B17","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur J Epidemiol"},{"key":"B18","first-page":"177","article-title":"Meta-analysis in clinical trials","volume-title":"Control Clin Trials","author":"DerSimonian","year":"1986"},{"key":"B19","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/1745-6215-8-16","article-title":"Practical methods for incorporating summary time-to-event data into meta-analysis","volume":"8","author":"Tierney","year":"2007","journal-title":"Trials"},{"key":"B20","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1016\/j.jclinepi.2014.03.003","article-title":"In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias","volume":"67","author":"Hunter","year":"2014","journal-title":"J Clin Epidemiol"},{"key":"B21","volume-title":"R: The R Project for Statistical Computing","year":""},{"key":"B22","volume-title":"R: A Language and Environment for Statistical Computing","year":"2014"},{"key":"B23","doi-asserted-by":"publisher","first-page":"n693","DOI":"10.1136\/bmj.n693","article-title":"Post-COVID syndrome in individuals admitted to hospital with COVID-19: retrospective cohort study","volume":"372","author":"Ayoubkhani","year":"2021","journal-title":"Br Med J"},{"key":"B24","doi-asserted-by":"publisher","first-page":"142","DOI":"10.12688\/wellcomeopenres.17735.1","article-title":"Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19: a descriptive cohort study within the OpenSAFELY platform","volume":"7","author":"Tazare","year":"2022","journal-title":"Wellcome Open Res"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e068414","DOI":"10.1136\/bmj-2021-068414","article-title":"Risk of persistent and new clinical sequelae among adults aged 65 years and older during the post-acute phase of SARS-CoV-2 infection: retrospective cohort study","volume":"376","author":"Cohen","year":"2022","journal-title":"Br Med J"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1706","DOI":"10.1038\/s41591-022-01909-w","article-title":"Symptoms and risk factors for long COVID in non-hospitalized adults","volume":"28","author":"Subramanian","year":"2022","journal-title":"Nat Med"},{"key":"B27","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1186\/s12916-022-02292-6","article-title":"Long COVID 12 months after discharge: persistent symptoms in patients hospitalised due to COVID-19 and patients hospitalised due to other causes\u2014a multicentre cohort study","volume":"20","author":"Rivera-Izquierdo","year":"2022","journal-title":"BMC Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n1098","article-title":"Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study","volume":"373","author":"Daugherty","year":"2021","journal-title":"The BMJ"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e1004052","DOI":"10.1371\/journal.pmed.1004052","article-title":"Cardiometabolic outcomes up to 12 months after COVID-19 infection. A matched cohort study in the UK","volume":"19","author":"Rezel-Potts","year":"2022","journal-title":"PLoS Med"},{"key":"B30","doi-asserted-by":"publisher","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":"B31","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1016\/S0140-6736(21)00896-5","article-title":"Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study","volume":"398","author":"Katsoularis","year":"2021","journal-title":"Lancet"},{"key":"B32","doi-asserted-by":"publisher","first-page":"m4677","DOI":"10.1136\/bmj.m4677","article-title":"Comparative evaluation of clinical manifestations and risk of death in patients admitted to hospital with COVID-19 and seasonal influenza: cohort study","volume":"371","author":"Xie","year":"2020","journal-title":"Br Med J"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1038\/s41591-020-0968-3","article-title":"Extrapulmonary manifestations of COVID-19","volume":"26","author":"Gupta","year":"2020","journal-title":"Nat Med"},{"key":"B34","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1126\/science.abg7113","article-title":"The road to addressing long COVID","volume":"373","author":"Alwan","year":"2021","journal-title":"Science"},{"key":"B35","doi-asserted-by":"publisher","first-page":"106975","DOI":"10.1016\/j.vph.2022.106975","article-title":"Endothelial dysfunction in acute and long standing COVID\u221219: a prospective cohort study","volume":"144","author":"Oikonomou","year":"2022","journal-title":"Vasc Pharmacol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"3827","DOI":"10.1093\/eurheartj\/ehaa664","article-title":"Pathological features of COVID-19-associated myocardial injury: a multicentre cardiovascular pathology study","volume":"41","author":"Basso","year":"2020","journal-title":"Eur Heart J"},{"key":"B37","doi-asserted-by":"publisher","first-page":"148980","DOI":"10.1172\/jci.insight.148980","article-title":"Cardiovascular complications of COVID-19","volume":"6","author":"Farshidfar","year":"2021","journal-title":"JCI Insight"},{"key":"B38","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1038\/s41586-021-03570-8","article-title":"COVID-19 tissue atlases reveal SARS-CoV-2 pathology and cellular targets","volume":"595","author":"Delorey","year":"2021","journal-title":"Nature"},{"key":"B39","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1038\/d41586-021-01392-2","article-title":"Count the cost of disability caused by COVID-19","volume":"593","author":"Briggs","year":"2021","journal-title":"Nature"},{"key":"B40","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1038\/s41569-020-0413-9","article-title":"COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives","volume":"17","author":"Nishiga","year":"2020","journal-title":"Nat Rev Cardiol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1161\/CIRCRESAHA.121.317997","article-title":"COVID-19 and cardiovascular disease","volume":"128","author":"Chung","year":"2021","journal-title":"Circ Res"},{"key":"B42","doi-asserted-by":"publisher","first-page":"3950","DOI":"10.1172\/JCI140183","article-title":"COVID-19, microangiopathy, hemostatic activation, and complement","volume":"130","author":"Song","year":"2020","journal-title":"J Clin Invest"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.1016\/S0140-6736(20)30937-5","article-title":"Endothelial cell infection and endotheliitis in COVID-19","volume":"395","author":"Varga","year":"2020","journal-title":"Lancet"},{"key":"B44","article-title":"Report: long-term immunological health consequences of COVID-19","year":"2020","journal-title":"British Society for Immunology"},{"key":"B45","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1080\/14779072.2020.1797491","article-title":"Epidemiology, prognosis, and clinical manifestation of cardiovascular disease in COVID-19","volume":"18","author":"Capone","year":"2020","journal-title":"Expert Rev Cardiovasc Ther"},{"key":"B46","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1093\/cid\/ciac630","article-title":"Reduced incidence of long coronavirus disease referrals to the Cambridge university teaching hospital long coronavirus disease clinic","volume":"76","author":"Krishna","year":"2023","journal-title":"Clin Infect Dis"},{"key":"B47","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/S1473-3099(21)00460-6","article-title":"Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID symptom study app: a prospective, community-based, nested, case-control study","volume":"22","author":"Antonelli","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"B48","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1038\/s41541-022-00526-5","article-title":"Association between BNT162b2 vaccination and reported incidence of post-COVID-19 symptoms: cross-sectional study 2020\u201321, Israel","volume":"7","author":"Kuodi","year":"2022","journal-title":"NPJ Vaccines"},{"key":"B49","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.bbi.2022.04.013","article-title":"Six-month sequelae of post-vaccination SARS-CoV-2 infection: a retrospective cohort study of 10,024 breakthrough infections","volume":"103","author":"Taquet","year":"2022","journal-title":"Brain Behav Immun"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1450470\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T01:52:45Z","timestamp":1738115565000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1450470\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":49,"alternative-id":["10.3389\/fcvm.2025.1450470"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1450470","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,29]]},"article-number":"1450470"}}