Pre-Infection COVID-19 Vaccination and Long-Term Cardiovascular Outcomes in Adults Without Preexisting Cardiovascular Disease: A Retrospective Cohort Study.

BACKGROUND

Long-term cardiovascular complications after COVID-19 are increasingly recognized, yet the protective effect of pre-infection vaccination in individuals without prior cardiovascular disease (CVD) remains unclear. This study examined the association between COVID-19 vaccination and major cardiovascular and related outcomes up to 3 years post-infection in adults without preexisting CVD.

METHODS

In this retrospective cohort analysis using the TriNetX US Collaborative Network, adults (≥ 18 years) diagnosed with COVID-19 from March 1, 2020, to December 31, 2023, without prior CVD were identified. Patients who received ≥ 1 vaccine dose before diagnosis were 1:1 propensity score-matched (caliper 0.1) to unvaccinated patients on 90 covariates, including demographics, comorbidities, medications, and laboratory values. Outcomes were assessed at one and 3 years. Risk ratios (RRs) with 95% confidence intervals (CIs) and p-values were calculated.

RESULTS

After 1:1 propensity score matching, 55,752 patients were included in each cohort for the 1-year analysis and 55,622 patients per cohort for the 3-year analysis. Vaccination was associated with lower risk of the primary composite outcome at 1 year (RR, 0.21; 95% CI, 0.17-0.27; p < 0.001). Significant reductions were observed at 1 year for cerebrovascular disease (RR, 0.35; 95% CI, 0.27-0.46; p < 0.001), circulatory system diseases (RR, 0.52; 95% CI, 0.50-0.55; p < 0.001), and all-cause mortality (RR, 0.20; 95% CI, 0.15-0.26; p < 0.001). Protective effects persisted at 3 years for cerebrovascular disease (RR, 0.71; 95% CI, 0.61-0.82; p < 0.001) and circulatory system diseases (RR, 0.82; 95% CI, 0.80-0.85; p < 0.001).

CONCLUSIONS

Pre-infection COVID-19 vaccination was associated with sustained reductions in major cardiovascular events, mortality, and healthcare utilization up to 3 years post-infection in adults without prior CVD.