Population-based cohort study demonstrates lower risk of post-COVID-19 cardiovascular disease in adults, highlighting protection beyond infection prevention alone.
Key Points
To evaluate associations of pre- or post-infection COVID-19 vaccination with long-term cardiovascular disease and quantify the proportion of risk reduction mediated by infection prevention.
Conducted a statewide population-based cohort and target trial emulation study using linked administrative health data for 2,391,456 adults in Victoria, Australia between 2019 and 2025.
Evaluated associations of vaccination before or after SARS-CoV-2 infection with major adverse cardiovascular events (primary outcome), stroke, heart failure, acute myocardial infarction, acute coronary syndrome, atrial fibrillation, and venous thromboembolism using time-varying Cox proportional hazards regression and causal mediation analysis.
Vaccination was associated with lower hazards of major adverse cardiovascular events and all secondary outcomes, with estimated absolute risk reductions for MACE of 0.21% for pre-infection vaccination and 0.24% for post-infection vaccination.
Receipt of three or more vaccine doses was associated with progressively lower hazards across all evaluated cardiovascular outcomes.
Causal mediation analysis showed that approximately 68% of the estimated association between vaccination and lower post-COVID cardiovascular risk was not explained by the prevention of SARS-CoV-2 infection.