COVID-19 mRNA vaccination does not amplify risk of cardiovascular hospitalisation

Patients with pre-existing cardiovascular (CV) disease did not have an increased likelihood of hospitalisation after receiving an mRNA vaccination against COVID-19. However, SARS-CoV-2 infected patients with pre-existing CV disease were at substantially increased risk for CV hospitalisation compared with non-infected controls.

Does vaccination with an mRNA COVID-19 vaccine introduce a particular risk of worsening for patients with pre-existing cardiovascular (CV) diseases? That was the central question assessed by Dr Anthony Simone (Kaiser Permanente Los Angeles Medical Center, CA, USA) and his fellow researchers [1]. They evaluated CV hospitalisations of adult patients with a history of a CV condition within 30 days after their vaccination compared with the expected incidence of CV hospitalisation (control) using data obtained from the same population during the same 30-day calendar period 2 years prior (a baseline period before the COVID-19 pandemic).

Out of a cohort of 229,829 patients with CV conditions, 165,711 who had received at least 1 dose of an mRNA-based vaccination were included. 160,482 of the included patients were vaccinated at least twice (38.7% mRNA-1273 and 31.2% BNT162b2). Prior diagnoses included atrial fibrillation, myocarditis, coronary artery disease, and heart failure. The baseline findings comprised a median age of 72 years, 43% women, 52% White, 25.4% Hispanic, 10.4% Asian, and 10.2% Black.

In total, admissions for CV conditions were registered for 844 patients during the 30 days following the first dose of an mRNA COVID-19 vaccine compared with 1,012 CV hospitalisations in the historical control group (odds ratio [OR] 0.86; 95% CI 0.76–0.91). After the second dose, 812 patients were hospitalised due to CV conditions compared with 960 in the control (OR 0.85; 95% CI 0.77–0.93). Of note, there were no hospital admissions in the group of patients with prior myocarditis. Looking at the hospitalisation rate of patients with CV disease after testing positive for SARS-CoV-2, the investigators found that out of 24,282 persons, 836 had to be admitted within 1 month after confirmation of the infection. Compared with controls, this translated into a nearly 5 times higher likelihood for patients with CV disease history to be hospitalised when infected with SARS-CoV-2 (OR 4.7; 95% CI 4.0–5.6).

The authors concluded that the difference in hospitalisation risk for vaccination compared with SARS-CoV-2 infection is large and suggests that the benefit of vaccination far outweighs the risks.

1. 
   
   1. Simone A, et al. Exacerbation of pre-existing cardiovascular disease following COVID-19 mRNA vaccination. EP.APS.P47, AHA Scientific Sessions 2022, 05–07 November, Chicago, USA.

 

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Posted on 11 January 2023