Long COVID and risk of incident cardiovascular disease: a prospective cohort study using the … (MIRACLE-S) cohort, 2026, Lindberg et al.

[Chandelier]

Long COVID and risk of incident cardiovascular disease: a prospective cohort study using the Multimorbidity Integrated Registry Across Care Levels in Stockholm (MIRACLE-S) cohort

Spoiler: Authors

Lindberg, Pia; Wiqvist, Samuel; Juszczyk, Maria; Lee, Seika; Kisiel, Marta A.; Wachtler, Caroline; Ståhlberg, Marcus; Wheelock, Åsa M.; Fedorowski, Artur; Carlsson, Axel C.

Summary​

Background​

Long COVID has emerged as a global health challenge, with increasing evidence of cardiovascular sequelae. Most previous studies have focused on hospitalised cohorts, whereas cardiovascular risk in community-managed long COVID cases remains less explored. We aimed to investigate the incidence of major cardiovascular events in individuals with long COVID compared to those without long COVID in a large population-based setting.

Methods​

Multimorbidity Integrated Registry Across Care Levels in Stockholm (MIRACLE-S) is a population-based cohort that covers all providers of healthcare for around 2.5 million residents in Stockholm County. Individuals aged 18–65 years with a physician-assigned long COVID diagnosis (ICD-10: U09.9) between October 2020 and January 2025 were identified. Exclusion criteria were hospitalisation for acute COVID-19 or pre-existing cardiovascular disease. Cox proportional hazards models estimated the effect of long COVID on a composite cardiovascular outcome (myocardial infarction, heart failure, cardiac arrhythmias, stroke, peripheral arterial disease), adjusting for demographic, lifestyle, and mental health factors.

Findings​

Among 1,217,693 individuals, 8999 (0.7%) had long COVID diagnosis (66% women). Cumulative incidence of any cardiovascular event was higher in long COVID group (women 18.2%, men 20.6%) compared with control group (women 8.4%, men 11.1%). In a fully adjusted model, long COVID was associated with the composite cardiovascular outcome (women HR 2.06, 95% CI 1.92–2.22; men HR 1.33, 1.20–1.48), cardiac arrhythmia (women HR 3.11, 2.85–3.39; men HR 1.61, 1.41–1.85), and coronary artery disease (women HR 1.25, 1.04–1.52; men HR 1.26, 1.05–1.51). Heart failure incidence was elevated in women only (HR 1.25, 1.00–1.55), as also was peripheral artery disease (HR 1.25, 1.05–1.50). Long COVID was not associated with stroke in either sex.

Interpretation​

Long COVID is associated with increased risk of incident cardiovascular disease, particularly cardiac arrhythmias, heart failure, and coronary artery disease. These findings underscore the need for systematic follow-up and integration of long COVID into cardiovascular risk assessment.

Web | DOI | PMC | PDF | eClinicalMedicine | Open Access

 

[rvallee]

These findings underscore the need for systematic follow-up and integration of long COVID into cardiovascular risk assessment

I keep banging my head seeing how common these takes have become and how they completely ignore the reality of health care availability. There simply is no capacity to do this, at all. It's like everyone is operating with an ideal version of health care in mind, as detached from reality as imagining finances that require an average income of $500K with not a single person making below half of that.

Follow-ups are becoming rarer. In many health care systems, pretty much all basic health care has ended, everything is either emergency care of "one issue at a time and don't waste our time about it". There are no basic checkups anymore, virtually no preventative medicine. Many health care systems, like my own, no longer even have the concept of GP, we almost never see the same person. Health care doing what they describe here is frankly at a "everyone gets a free pony and a lamborghini" level of not gonna happen.

Most of this is a demographic shift. With an aging population, where there used to be enough capacity to handle basic health care, we have shifted to a world in which there are more people aged 65+ than 5-. This will massively worsen, to the point where within a few years AI medicine will go from being a transformative shift to a basic necessity, nothing will work without it. No health care system has the capacity to do any of this right now, I don't understand the value of pretending otherwise.

But even beyond the demographic shift, a system built on the traditional model would need 10-20x more physicians and support workers to achieve such a level of service, which is economically unfeasible. Health care is generally around 10% of GDP already, so even a 5x increase is ludicrous, and it still would only provide basic health care.