Background
We have previously shown in cross-sectional studies that COVID-19 infection was associated with arterial stiffness and increased oxidized LDL (oxLDL). In this study, we assess changes in these cardiovascular parameters after COVID infection in a group of individuals who have documented pre-COVID assessments. Having pre-COVID assessments has been a limitation of current studies.
Methods
This prospective cohort study used FDA-approved EndoPAT2000 to measure the Augmentation Index (AI; arterial stiffness) and Reactive Hyperemic Index (RHI; endothelial function) in a group of individuals with available pre-pandemic measurements and a documented COVID-19 infection. A detailed medical and COVID-19 history were collected, and inflammatory and metabolic markers were measured. Linear mixed models with random intercept were used to estimate the effects of COVID-19 infection on markers of endothelial function, inflammation, gut permeability, and monocyte activation.
Results
Among the 78 participants (53% non-white race, 40% female), median age was 47 years and BMI 28 kg/m2. The median duration between pre-pandemic and post-COVID infection was 3 years, and between COVID infection and post-COVID assessment 451 days. At the pre-pandemic visit, 34% of participants had RHI ⩽1.67 and the median AI was 2.0. At follow-up, the proportion of participants with abnormal RHI did not change, but the proportion of participants with elevated arterial stiffness (AI≥2.0) increased by 15.3% (P<.0001), and significant increases in ICAM (P=0.02), sCD14 (P=0.01), sCD163 (p=0.001), and OxLDL (P= 0.03) were observed. Non-HDL cholesterol improved, without change in HbA1C or weight. After adjustment, female sex had more than six times [aOR: 6.2 (95% CIs: 1.5, 25.7); P=0.01] higher likelihood of having higher AI compared to male sex. Changes in arterial stiffness were not correlated with metabolic (weight, hbA1c, lipids) or inflammatory markers.
Conclusions
COVID infection is associated with arterial stiffness; female sex seems mostly affected. Long term cardiovascular effects of arterial stiffness are very concerning in this population and should be investigated.