The role of COVID-19 vaccines in preventing post-COVID-19 thromboembolic and cardiovascular complications

被引:29
作者
Mercade-Besora, Nuria [1 ,2 ,3 ]
Li, Xintong [1 ]
Kolde, Raivo [4 ]
Trinh, Nhung T. H. [5 ]
Sanchez-Santos, Maria T. [1 ]
Man, Wai Yi [1 ]
Roel, Elena [3 ]
Reyes, Carlen [3 ]
Delmestri, Antonella [1 ]
Nordeng, Hedvig M. E. [6 ,7 ]
Uuskula, Anneli [8 ]
Duarte-Salles, Talita [3 ,9 ]
Prats, Clara [2 ]
Prieto-Alhambra, Daniel [1 ,9 ]
Jodicke, Annika M. [1 ]
Catala, Marti [1 ]
机构
[1] Univ Oxford, Botnar Res Ctr, Pharmaco and Device Epidemiol Grp, Hlth Data Sci,NDORMS, Oxford, England
[2] Univ Politecn Cataluna, Dept Phys, Barcelona, Spain
[3] Fundacio Inst Univ recerca Atencio Primaria Salut, IDIAP Jordi Gol, Barcelona, Catalunya, Spain
[4] Univ Tartu, Inst Comp Sci, Tartu, Estonia
[5] Univ Oslo, Fac Math & Nat Sci, Dept Pharm, Pharmacoepidemiol & Drug Safety Res Grp, Oslo, Norway
[6] Univ Oslo, Sch Pharm, Oslo, Norway
[7] Norwegian Inst Publ Hlth, Div Mental Hlth, Oslo, Norway
[8] Univ Tartu, Dept Family Med & Publ Hlth, Tartu, Estonia
[9] Erasmus MC, Erasmus Univ Rotterdam, Dept Med Informat, Rotterdam, Zuid Holland, Netherlands
关键词
COVID-19; Epidemiology; PUBLIC HEALTH; Electronic Health Records; COMMON DATA MODEL;
D O I
10.1136/heartjnl-2023-323483
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective To study the association between COVID-19 vaccination and the risk of post-COVID-19 cardiac and thromboembolic complications.Methods We conducted a staggered cohort study based on national vaccination campaigns using electronic health records from the UK, Spain and Estonia. Vaccine rollout was grouped into four stages with predefined enrolment periods. Each stage included all individuals eligible for vaccination, with no previous SARS-CoV-2 infection or COVID-19 vaccine at the start date. Vaccination status was used as a time-varying exposure. Outcomes included heart failure (HF), venous thromboembolism (VTE) and arterial thrombosis/thromboembolism (ATE) recorded in four time windows after SARS-CoV-2 infection: 0-30, 31-90, 91-180 and 181-365 days. Propensity score overlap weighting and empirical calibration were used to minimise observed and unobserved confounding, respectively. Fine-Gray models estimated subdistribution hazard ratios (sHR). Random effect meta-analyses were conducted across staggered cohorts and databases.Methods We conducted a staggered cohort study based on national vaccination campaigns using electronic health records from the UK, Spain and Estonia. Vaccine rollout was grouped into four stages with predefined enrolment periods. Each stage included all individuals eligible for vaccination, with no previous SARS-CoV-2 infection or COVID-19 vaccine at the start date. Vaccination status was used as a time-varying exposure. Outcomes included heart failure (HF), venous thromboembolism (VTE) and arterial thrombosis/thromboembolism (ATE) recorded in four time windows after SARS-CoV-2 infection: 0-30, 31-90, 91-180 and 181-365 days. Propensity score overlap weighting and empirical calibration were used to minimise observed and unobserved confounding, respectively. Fine-Gray models estimated subdistribution hazard ratios (sHR). Random effect meta-analyses were conducted across staggered cohorts and databases.Results The study included 10.17 million vaccinated and 10.39 million unvaccinated people. Vaccination was associated with reduced risks of acute (30-day) and post-acute COVID-19 VTE, ATE and HF: for example, meta-analytic sHR of 0.22 (95% CI 0.17 to 0.29), 0.53 (0.44 to 0.63) and 0.45 (0.38 to 0.53), respectively, for 0-30 days after SARS-CoV-2 infection, while in the 91-180 days sHR were 0.53 (0.40 to 0.70), 0.72 (0.58 to 0.88) and 0.61 (0.51 to 0.73), respectively.Conclusions COVID-19 vaccination reduced the risk of post-COVID-19 cardiac and thromboembolic outcomes. These effects were more pronounced for acute COVID-19 outcomes, consistent with known reductions in disease severity following breakthrough versus unvaccinated SARS-CoV-2 infection.
引用
收藏
页码:635 / 643
页数:9
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