COVID-19 infection can increase arterial stiffness and accelerate vascular aging, particularly in women, according to the large multicenter CARTESIAN study, published Aug. 17 in EHJ.

Rosa Maria Bruno, MD, PhD, et al., examined the long-term effects of COVID-19 on biomarkers of vascular aging in 2,390 participants (mean age 50 years; 49% women) from 34 centers in 16 countries. Carotid-femoral pulse wave velocity (PWV), a biomarker of large artery stiffness, served as the primary outcome.

Participants were divided into four groups: 1) COVID-19 negative controls (n = 391), and COVID-19 positive individuals who: 2) were not hospitalized (n = 828), 3) hospitalized in general wards (n = 729) or 4) hospitalized in intensive care units (ICUs) (n = 146).

Results showed that all COVID-19 positive groups exhibited significantly higher PWV at a mean six-month follow-up post infection vs. controls (adjusted absolute difference in PWV: +0.41, +0.37 and +0.40 m/s for groups 2 to 4 vs. 7.53 for controls).

Notably, the sex-stratified analyses revealed that women across all COVID-19 positive groups had significantly elevated PWV (+0.55, +0.60 and +1.09 m/s for groups 2 to 4, p<0.001 for all), but not in men. Interestingly, the authors note that the PWV elevation in group 4 (>1 m/s) corresponds to an increase of 7.5 years of vascular and a 5.5% risk of cardiovascular events.

Regarding symptoms, 42% of COVID-19-positive participants had persistent symptoms at six months. Among COVID-19-positive women with persistent symptoms, PWV was significantly higher regardless of disease severity and cardiovascular confounders (adjusted PWV: 7.52 vs. 7.13 m/s, p<0.001).

After 12 months, data for 1,024 participants revealed stable or improved PWV in the COVID-19 positive groups, whereas PWV progressed in the COVID-19 negative group.

In an accompanying editorial comment, Syed Bukhari, MD, et al., write that "for clinicians, routine cardiovascular risk stratification in patients with post-acute COVID-19 syndrome – especially females – should be emphasized." And for researchers, they write that "the findings demand mechanistic studies into sex differences in post-viral endothelial function and immune response."