Does Having COVID-19 Increase Your Risk for a Heart Attack and Stroke?

As we continue to learn about the lasting effects of COVID-19, it’s becoming clear how far-reaching this illness can be. 

New evidence shows that people who got sick with COVID early in the pandemic — before vaccines were available — had an increased risk of heart attack, stroke, and death in the 3 years after their infection. This was true even for people with no other risk factors for cardiovascular disease. 

So, here’s a look at why this link may exist, what we know about the long-term effects of COVID on the heart and blood vessels, and what this means for you and your loved ones now.

The link between COVID, heart attacks, and stroke

It’s been clear since the early months of the pandemic that the COVID virus could damage the heart and vascular system (the body’s network of blood vessels).

Research showed that in the 12 months after a COVID infection, there was an increased risk for stroke, heart attack, and heart failure, as well as many other heart conditions. 

Also, symptoms like chest pain and shortness of breath were common after COVID infection, in some cases lasting several months, called long COVID. 

So, experts were aware of a possible link between COVID infection and a risk of cardiovascular disease. 

But new research sheds more light on this. A study in the journal Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB) explores the extent of this link. 

The study looked at UK Biobank data of more than 10,000 adults who tested positive for COVID-19 before the end of 2020, which was before vaccination became available. 

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Researchers also looked at data from more than 200,000 adults who hadn’t been infected with COVID during the same period. They collected data on both groups until October 2022. 

They compared the health data and found the following: 

• COVID increased the risk of heart attack, stroke, or death from any cause. People who’d been sick with the original strain of COVID were more than twice as likely to have a heart attack, stroke, or death from any cause when compared with those who hadn’t had COVID. 

• Severe COVID increased this risk further. For people hospitalized with more severe illness, the risk was nearly four times greater.

• COVID increased this risk more than well-known cardiovascular risk factors. People with COVID and no underlying risk factors had greater risk than people with risk factors but not COVID. Risk factors include Type 2 diabetes and pre-existing cardiovascular disease.

In other words, the researchers suggest that getting COVID in 2020 could increase your risk for cardiovascular disease and death as much as — or even more than — well-known risk factors. 

It’s not clear what this means for people who became infected with later strains of the COVID virus. It’s also not clear whether vaccination changes things. 

How COVID affects the heart and blood vessels

COVID can affect the heart in a few different ways. And there’s much that scientists don’t yet fully understand. 

The current thinking from experts is that heart complications from COVID most likely arise from a combination of: 

• Direct injury to heart muscle cells

• High levels of inflammation in the body

• An overactive immune response to the virus 

• Damage to the inner lining of blood vessels (the endothelium)

• Dangerous clots (both large and small) in the arteries and veins

Put more simply, a series of reactions to a COVID infection leads to damaged heart cells and blood vessels — and lots of inflammation. In addition, blood becomes sticky and can trigger the body to create blood clots. Blood clots can then travel to the heart or brain, triggering a heart attack or stroke. 

These same processes may also be the reason why some people develop long COVID.

COVID and blood type

Over the past few years, researchers have wondered whether a person’s blood type could affect their risk of getting COVID. Some evidence suggests that having Type O blood may protect against COVID infection. And Type A blood may increase the risk of getting it.

The latest research from the UK Biobank data (mentioned above) found a similar effect. People with blood Types A, B, or AB had a 65% higher risk of cardiovascular events after hospitalization with COVID compared to those with Type O blood.

This could point to genetic reasons for why some people are more likely to have worse outcomes from COVID — and why others don’t. But more research is needed to understand if and how this works.

What this means for you

If you had COVID in 2020, you may be wondering what all this new evidence means for you and your heart health. 

Over 20 million people in the U.S. (and over 80 million people worldwide) had COVID in 2020. So the study’s findings are important on a global scale. 

The research suggests that even if you had a mild or moderate case of COVID back in 2020, it could still pose a long-term risk to your heart health. The risk is even greater if you had severe COVID that required hospitalization.

So, if you had COVID in 2020, here’s what to know: 

• You need to pay attention to your cardiovascular health and your lifestyle. 

• Discuss your medical history and your other risk factors with your primary care provider.

• Whether or not you have symptoms, ask about preventive measures to reduce your risk of heart disease and strokes (more on this below).

What we don’t know

It’s important to note that this research analyzed data in the past. This means that although it shows a link between COVID and heart attacks, stroke, and deaths from any cause, it isn’t enough to prove a cause-and-effect relationship between them. Only forward-looking research can do that. 

Moreover, this research is based on data collected from predominantly white people in the U.K. It’s not clear whether the results apply to people from other countries and from other racial and ethnic backgrounds. 

What about if you had COVID in 2021 and later?

The study didn’t include people who got later strains of COVID or those who were vaccinated. So, it’s not exactly clear how this research applies to them.

But previous research has shown that COVID vaccines reduce the risk of severe infection. They have also been shown to reduce the risk of cardiovascular events in people with breakthrough infections. So, it’s possible that with vaccination — and less deadly strains of COVID — the link between COVID, heart attacks, and strokes has become weaker. 

Here’s what to know if you had COVID in 2021 or later. Up until now, the guidance from the American College of Cardiology has been as follows: 

• If you had mild COVID and have no lasting heart or breathing symptoms, then you don’t need further testing.

• If you have ongoing heart or breathing symptoms at any time after a COVID infection, then you probably need testing, in the form of a heart workup. Basic heart tests include blood tests and an EKG. Depending on your symptoms you may also need an echocardiogram, a cardiac MRI, or a Holter monitor.

• Wait until all COVID symptoms are gone before restarting exercise. 

• Athletes who had heart or lung COVID symptoms should get heart testing before resuming exercise. 

Heart or breathing symptoms may include the following and more: 

• Shortness of breath

• Chest pain

• Chest tightness

• Palpitations

• Dizziness

• Blackouts 

If you have any questions about your heart health after a COVID infection, be sure to check in with your healthcare team.

How to prevent heart attack and stroke

Given the increased long-term cardiovascular risks associated with COVID, taking steps to protect heart health is more important than ever. This is especially true for those who had severe infections. 

The good news is that the changes you make to lower your risk of heart disease and stroke can also lower your risk of other conditions. In fact, with these changes you’ll notice improvements in every aspect of your health.

Preventing heart attacks and strokes starts with healthy lifestyle habits. Some people might also need medication. Here are some things to focus on:

• Follow a heart-healthy diet. A heart-healthy diet is one that’s rich in fruits, vegetables, whole grains, and lean proteins. Limit processed foods, salt, added sugars, fried foods, and foods high in saturated fats. These changes can help reduce the risk of heart disease.

• Make time for regular exercise. Physical activity strengthens the heart and improves circulation. It also improves your metabolism and your blood glucose levels. Expert associations recommend at least 150 minutes of moderate-intensity aerobic activity each week. Examples include fast walking, cycling, or swimming. They also recommend muscle-strengthening activities, twice a week.

• Quit smoking. Smoking damages the heart and blood vessels, leading to an increased risk of heart attack and stroke. Quitting smoking is one of the most effective ways to improve heart health.

• Maintain a healthy weight. This helps lower your risk of heart disease and strokes by lowering blood pressure, cholesterol, and blood glucose. Even a small amount of weight loss (5%) can make a significant difference to your health. 

• Take steps to limit and manage stress. Chronic stress can raise blood pressure and increase the risk of heart problems and strokes. Regular exercise can help lower stress. So can lower-energy activities like meditation, yoga, or time outdoors. 

• Manage and monitor your other health conditions. High blood pressure, high cholesterol, and diabetes are all risk factors for heart disease and strokes. Managing these conditions with the help of your primary care team can lower your risk of a heart attack or stroke.

• Attend regular check-ups. Schedule regular checkups with your primary care provider to monitor your cardiovascular health. Even if you feel healthy, it’s good to check regularly for health conditions. High cholesterol, high blood pressure, and Type 2 diabetes usually don’t cause symptoms, so the only way to know about them is to check. Detecting these early can prevent more serious complications down the road.

• Ask about preventative medications. There are plenty of medications that help prevent serious outcomes like heart attacks and strokes in people who’re at high risk. Examples include blood thinners like aspirin, cholesterol-lowering medications, and blood pressure medications. 

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Written by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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