Cardiovascular, Renal, and Pulmonary Risks of Long COVID: A Retrospective Cohort Study Stratified by Age and Sex, 2026, Pradeep et al.

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Cardiovascular, Renal, and Pulmonary Risks of Long COVID: A Retrospective Cohort Study Stratified by Age and Sex

Pradeep, Akash; Ramalho, Izola; Carvour, Martha L.; Sivamurugan, Srija M.; Singh, Upinder; Comellas, Alejandro P.; Dayal, Sanjana

Abstract​

Background​

A substantial proportion of patients with acute COVID‐19 develop postacute sequelae of SARS‐CoV‐2 infection (Long COVID).
The risk of adverse cardiovascular and related outcomes in Long COVID remains elusive.
We hypothesized that individuals with Long COVID are at elevated risk for adverse cardiovascular, renal, and pulmonary (CRP) outcomes compared with those who recovered from COVID‐19 without developing Long COVID.

Methods​

We performed a retrospective cohort study using the global TriNetX network (>150 million patients).
Adults with documented COVID‐19 were classified by the presence/absence of clinically recognized Long COVID.
We analyzed absolute risks and relative risks for 15 CRP outcomes, stratified by age (18–50, 51–64, ≥65 years).
After excluding patients with preexisting outcomes of interest, propensity score matching was applied for age, sex, and common confounders.

Results​

Among 2 613 432 adults identified with COVID‐19 within TriNetX network, 315 612 matched individuals were included in the study.
Long COVID was associated with higher risk of most CRP outcomes across all ages regardless of sex.
Relative risks were disproportionately higher in younger adults, especially in young women for cardiovascular and renal outcomes and in young men for pulmonary outcomes.
Findings remained directionally consistent across sensitivity analyses.
Prior SARS‐CoV‐2 vaccination was not consistently associated with reduced CRP risk.

Conclusions​

Clinically recognized Long COVID was associated with increased risk of CRP outcomes, with relatively higher relative risks observed in younger adults.
These findings support the need for continuing surveillance and risk‐reduction strategies for cardiovascular and related disorders in Long COVID.


Clinical Perspective​

What Is New?​

• Clinically recognized Long COVID is associated with increased cardiovascular, renal, and pulmonary risks across adult age groups, with relatively larger risks observed in younger adults.
• Sex‐specific differences are observed across multiple organ systems, indicating heterogeneity in postacute COVID‐19 risk profiles.

What Are the Clinical Implications?​

• These findings support consideration of individualized cardiovascular, renal, and pulmonary risk assessment in patients with clinically recognized Long COVID and highlight the need for sex‐specific approaches to long‐term follow‐up and care.

Web | DOI | Journal of the American Heart Association | Open Access
 
…a cohort of individuals with clinically recognized Long COVID, defined as having a recorded diagnosis of post‐COVID condition (ICD‐10‐CM U09), and a control cohort comprising individuals with confirmed COVID‐19 who never received a U09 diagnosis.
 
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