Bruno, RM ORCID: https://orcid.org/0000-0002-6107-3356, Badhwar, S, Abid, L ORCID: https://orcid.org/0000-0001-7793-5240, Agharazii, M ORCID: https://orcid.org/0000-0002-7628-5757, Anastasio, F ORCID: https://orcid.org/0000-0002-9033-0382, Bellien, J ORCID: https://orcid.org/0000-0002-0383-2342, Burghuber, O ORCID: https://orcid.org/0000-0002-8419-621X, Faconti, L ORCID: https://orcid.org/0000-0002-1066-6899, Filipovsky, J ORCID: https://orcid.org/0000-0002-1535-1263, Ghiadoni, L ORCID: https://orcid.org/0000-0002-7399-2720, Giannattasio, C ORCID: https://orcid.org/0000-0001-9116-3494, Hametner, B ORCID: https://orcid.org/0000-0003-2048-1019, Hughes, AD ORCID: https://orcid.org/0000-0001-5432-5271, Jeroncic, A ORCID: https://orcid.org/0000-0003-1621-1956, Ikonomidis, I ORCID: https://orcid.org/0000-0001-8241-7886, Lonnebakken, MT ORCID: https://orcid.org/0000-0002-5600-8859, Maloberti, A ORCID: https://orcid.org/0000-0002-2612-6264, Mayer, CC ORCID: https://orcid.org/0000-0002-5612-5481, Muiesan, ML ORCID: https://orcid.org/0000-0002-4007-9441, Paini, A, Panayiotou, A ORCID: https://orcid.org/0000-0002-6085-568X, Park, C ORCID: https://orcid.org/0000-0001-8302-7484, Rajkumar, C, Becerra, CR ORCID: https://orcid.org/0000-0002-4246-3922, Spronck, B ORCID: https://orcid.org/0000-0003-1076-1922, Terentes-Printzios, D ORCID: https://orcid.org/0000-0003-4039-8263, Tuncok, Y ORCID: https://orcid.org/0000-0002-4049-336X, Weber, T, Boutouyrie, P ORCID: https://orcid.org/0000-0002-4375-3569, Almhofer, H, Danninga, K, Algner, M, Wernhart, M, Azizzadeh, M, Breyer, MK, Bortolotto, L, Vilela-Martin, JF, Toshiro Passos Okawa, R, Lyrio Bermudes Okawa, J, Sebba Barroso, WK, Gomes Ciolac, E, do Amaral, VT, Fernandez, B, Goupil, R, Fortier, C, Photiou, G, Mayer, O, Seidlerová, J, Pazdiora, P, Hirmerová, J, Šustková, L, Bílková, S, Gelžinský, J, Kordíková, V, Mareš, Š, Cífková, R, Wohlfahrt, P, Kavalírová, J, Bruno, RM, Khettab, H, Justin, J, Moriconi, D, Fabbri, S, Hulot, JS, Fayol, A, Courbebaisse, M, Parfait, B, Lebeaux, D, Friedlander, G, Joannides, R, Iacob, M, Leroi, AM, Benetos, A, Georgiopoulos, I, Christopoulou, G, Tsioufis, K, Gardikioti, V, Vlachopoulos, C, Lambadiari, V, Kountouri, A, Katogiannis, K, Podrug, M, Pavičić-Ivelja, M, Koren, P, Salvetti, M, Cacciatore, M, Pucci, G, Scarnecchia, E, Alessandro, M, Algeri, M, Moreo, A, Tognola, C, Grillo, A, Fabris, B, Bernardi, S, Rovina, M, Di Pierro, G, Armenia, S, Bianchini, E and Hanson, Erik ORCID: https://orcid.org/0000-0002-7744-5652 (2025) Accelerated vascular ageing after COVID-19 infection: the CARTESIAN study. European Heart Journal, 46 (39). pp. 3905-3918. ISSN 0195-668X

Abstract

Background and Increasing evidence suggests that COVID-19 survivors experience long-term cardiovascular complications possibly through Aims development of vascular damage. The study aimed to investigate whether accelerated vascular ageing occurs after COVID-19 infection, and if so, identify its determinants. Methods This prospective, multicentric, cohort study, included 34 centres in 16 countries worldwide, in 4 groups of participants—COVID-19-negative controls (ⅰ) and three groups of individuals with recent (6 ± 3 months) exposure to SARS-CoV-2: not hospitalized (ⅱ), hospitalized in general wards (ⅲ), and hospitalized in intensive care units (ⅳ). The main outcome was carotid-femoral pulse wave velocity (PWV), an established biomarker of large artery stiffness. Results 2390 individuals (age 50 ± 15 years, 49.2% women) were recruited. After adjustment for confounders, all COVID-19-positive groups showed higher PWV (+0.41, +0.37, and +0.40 m/s for groups 2–4, P < .001, P = .001 and P = .003) vs. controls [PWV 7.53 (7.09; 7.97) m/s adjusted mean (95% CI)]. In sex-stratified analyses, PWV differences were significant in women [PWV (+0.55, +0.60, and +1.09 m/s for groups 2–4, P < .001 for all)], but not in men. Among COVID-19 positive women, persistent symptoms were associated with higher PWV, regardless of disease severity and cardiovascular confounders [adjusted PWV 7.52 (95% CI 7.09; 7.96) vs. 7.13 (95% CI 6.67; 7.59) m/s, P < .001]. A stable or improved PWV after 12 months was found in the COVID+ groups, whereas a progression was observed in the COVID− group. Conclusions COVID-19 is associated with early vascular ageing in the long term, especially in women.

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