Cardiometabolic Consequences of Long COVID

Beyond its acute effects, it is now compellingly clear that infection with SARS-CoV-2 leads to serious long-term health consequences—referred to as long COVID. Of particular concern is the increased risk of cardiometabolic disease, including kidney diseases, diabetes, and cardiovascular disease (Figure 1).

Cardiometabolic consequences of long COVID

Citation: Kidney News 14, 6

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Cardiometabolic consequences of long COVID

Citation: Kidney News 14, 6

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• Download figure as PowerPoint slide

Cardiometabolic consequences of long COVID

Citation: Kidney News 14, 6

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• Download figure as PowerPoint slide

In the first large-scale, high-dimensional characterization of the post-acute sequelae of COVID-19, we showed that people who survive the acute phase of COVID-19 have increased risk of post-acute sequelae involving pulmonary and a wide array of extrapulmonary disorders (1).

Further work from our team revealed that people who survive the acute phase of COVID-19 have an increased risk of developing kidney events in the post-acute phase of the disease, including acute kidney injury, decline in estimated glomerular filtration rate (eGFR), chronic kidney disease, and end stage kidney disease (2). In other work involving a comprehensive assessment of post-acute sequelae in the cardiovascular system at 1 year, we showed that people with COVID-19 were at an increased risk for developing cerebrovascular disease, dysrhythmias, inflammatory heart disease, ischemic heart disease, thrombotic disorders, and major adverse cardiac events (a composite risk of all-cause mortality, stroke, and myocardial infarction) (3). Most recently, we showed that after 1 year of follow-up, people with COVID-19 had a significantly higher risk of diabetes than non-infected controls (4). In all these analyses, the risk of post-acute sequelae was evident even in people whose acute COVID-19 was mild and did not necessitate hospitalization; these people represent the majority of those with COVID-19. There was also a graded increase in risk according to the severity of the acute infection, which progressively increased from non-hospitalized to hospitalized to admitted to intensive care (1–4).

The burden of cardiometabolic conditions is significant. We estimate that the absolute burden of these conditions ranges from 1% to 4% of people with COVID-19. Given the large number of people impacted with COVID-19, these single-digit percentages will translate into millions of affected people in the United States and many more around the world. This will likely have far- and wide-reaching ramifications on almost every aspect of our lives. It will drive an increase in burden of non-communicable diseases, impact health care costs, lead to a decline in life expectancy, and adversely affect labor participation and economic productivity and may have global-security implications.

Long after the pandemic abates, millions of people will still bear its scars in the form of cardiometabolic disease (and other facets of long COVID). People with cardiometabolic disease due to COVID-19 will need post-COVID-19 care. Governments and health systems around the world must be prepared to meet the challenges posed by the long-term consequences of the COVID-19 pandemic. This will entail, among other things, building health system capacity and care pathways to equitably address the care needs of people with long COVID and its myriad manifestations.