A pilot observational study by the State-run Sri Jayadeva Institute of Cardiovascular Sciences and Research (SJICSR) has not found any association between premature cardiovascular disease and a prior history of COVID-19 infection, or COVID vaccination.
Amid mounting public anxiety over the rising trend of sudden cardiovascular events (heart attack, sudden cardiac death) post-COVID-19 pandemic, the Karnataka government had in February this year set up an expert committee headed by Jayadeva Director K. S. Ravindranath to evaluate the temporal and potential causal links with prior SARS-CoV-2 infection and/or COVID-19 vaccination.
The cross-sectional study involving 251 patients, including 32 females, aged below 45 years, was aimed at presenting evidence-based insights, identifying risk factors, and proposing recommendations for surveillance and prevention. The committee submitted its report to Harsh Gupta, Principal Secretary, Health and Family Welfare on July 4.
Under-recognised mechanisms
“Although conventional risk factors, such as hypertension, diabetes, dyslipidemia, and smoking, remain prevalent in a majority of the 251 patients, a significant minority of patients presented with none of these, suggesting the possible involvement of novel or under-recognized mechanisms,” Dr Ravindranath told The Hindu.
According to the report, while 87 of the patients were diabetic, 102 were hypertensive, 35 were having cholesterol disorder, 40 had family history of heart diseases, 111 were smokers, and 77 patients did not have any of the conventional risk factors. As many as 19 out of 251 patients had a history of previous COVID-19 infection. Of the 19, seven each had diabetes and hypertension, two had a family history, eight had no risk factors.
Almost all (249) of the 251 patients had been vaccinated against COVID. While 53 received only one dose, 180 received two doses, and 17 received all three doses of a vaccine. As many as 144 had been vaccinated with Covishield, 64 with Covaxin, and 52 were unaware of which vaccine they had received.
Comparative data
To compare the risk factor profile of similar premature coronary artery disease patients prior to the pandemic, the team used data from the institute’s Premature Coronary Artery Disease (PCAD) among the young registry maintained at the institute between April 1, 2019 and May 31, 2019. As the PCAD registry was maintained for patients aged under 40 years, a subset of patients from the present study aged below 40 years were grouped and compared with the 2019 age and sex-matched population.
Analysing all national and international peer reviewed scientific literature, journal articles, clinical studies and clinical registries to study the possible association of sudden cardiovascular events with past history of COVID-19 infection and vaccination, the Jayadeva committee noted that most studies and reports published globally have also not found any causal association between COVID vaccination and sudden cardiovascular events. “On the contrary, COVID vaccination has been shown to be protective against cardiac events in the long term,” the report stated.
No single cause
“Our study has not found any single cause behind the observed rise in sudden cardiac deaths. Rather, it appears to be a multi-factorial issue, with behavioural, genetic, and environmental risks. While in the immediate post-COVID phase, there is an increase in the incidence of sudden cardiovascular events due to a pro-inflammatory state, the same cannot be held to be true in the long term (>1 year). It has been three years since the end of the pandemic,” Dr Ravindranath said.
He said current data does not support the belief that ‘long COVID’ is responsible for the rise in sudden cardiovascular events among the young. “Rather, a rise in the prevalence of the common risk factors that lead to cardiovascular disease (hypertension, diabetes, smoking , dyslipidemia) is the best explanation for the rise in sudden cardiovascular events. In light of these findings, a multi-faceted public health strategy is essential,” he asserted.
Recommendations
Pointing out that the strategy should include establishing a robust surveillance system for sudden cardiac deaths, particularly among young adults, the Jayadeva director said implementing autopsy-based registries and integrating early cardiovascular screening at the school level is vital.
“Importantly, large-scale, prospective, multicentric studies are needed to better delineate the long-term cardiovascular effects of both COVID-19 infection and vaccination,” he explained.
Recommendations
Establish a cardiac surveillance programme and national registry for sudden cardiac deaths among young adults
Autopsy-based reporting and registry for unexplained deaths in young adults
Routine heart screening at school level (class 10 students or aged 15 years)
A detailed clinical examination for screening out congenital heart disease or structural abnormalities, inherited rhythm disorders, obesity, hypertension, lipid disorders and insulin resistance
Public health campaigns regarding cardiovascular diseases, their causes, risk factors, early detection, and preventive diet, and lifestyle changes
Promote physical activity, smoking cessation, reducing screen time, reducing sugar and salt intake, adequate sleep and tackling stress
Research funding for large-scale prospective case control clinical studies by a nodal agency, such as the ICMR, to conduct a multi-disciplinary collaborative study to probe the long-term effects of COVID-19 infection and vaccination
Published – July 05, 2025 04:33 pm IST
