Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study

Genevieve i. Cezard; Rachel e. Denholm; Rochelle Knight; Yinghui Wei; Lucy Teece; Renin Toms; Harriet j. Forbes; Alex j. Walker; Louis Fisher; Jon Massey; Lisa e. m. Hopcroft; Elsie m. f. Horne; Kurt Taylor; Tom Palmer; Marwa al Arab; Jose ignacio Cuitun coronado; Samantha h. y. Ip; Simon Davy; Iain Dillingham; Sebastian Bacon; Amir Mehrkar; Caroline e. Morton; Felix Greaves; Catherine Hyams; George Davey smith; John Macleod; Nishi Chaturvedi; Ben Goldacre; William n. Whiteley; Angela m. Wood; Jonathan a. c. Sterne; Venexia Walker

Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study

Genevieve i. Cezard, Rachel e. Denholm, Rochelle Knight, Yinghui Wei, Lucy Teece, Renin Toms, Harriet j. Forbes, Alex j. Walker, Louis Fisher, Jon Massey, Lisa e. m. Hopcroft, Elsie m. f. Horne, Kurt Taylor, Tom Palmer, Marwa al Arab, Jose ignacio Cuitun coronado, Samantha h. y. Ip, Simon Davy, Iain Dillingham, Sebastian BaconAmir Mehrkar, Caroline e. Morton, Felix Greaves, Catherine Hyams, George Davey smith, John Macleod, Nishi Chaturvedi, Ben Goldacre, William n. Whiteley, Angela m. Wood, Jonathan a. c. Sterne, Venexia Walker

School of Engineering, Computing and Mathematics

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Abstract

Infection with SARS-CoV-2 is associated with an increased risk of arterial and venous thrombotic events, but the implications of vaccination for this increased risk are uncertain. With the approval of NHS England, we quantified associations between COVID-19 diagnosis and cardiovascular diseases in different vaccination and variant eras using linked electronic health records for ~40% of the English population. We defined a ‘pre-vaccination’ cohort (18,210,937 people) in the wild-type/Alpha variant eras (January 2020-June 2021), and ‘vaccinated’ and ‘unvaccinated’ cohorts (13,572,399 and 3,161,485 people respectively) in the Delta variant era (June-December 2021). We showed that the incidence of each arterial thrombotic, venous thrombotic and other cardiovascular outcomes was substantially elevated during weeks 1-4 after COVID-19, compared with before or without COVID-19, but less markedly elevated in time periods beyond week 4.
Hazard ratios were higher after hospitalised than non-hospitalised COVID-19 and higher in the pre-vaccination and unvaccinated cohorts than the vaccinated cohort. COVID-19 vaccination reduces the risk of cardiovascular events after COVID-19 infection. People who had COVID-19 before or without being vaccinated are at higher risk of cardiovascular events for at least two years.

Original language	English
Article number	2173
Journal	Nature Communications
Volume	15
Issue number	1
Publication status	Published - 11 Mar 2024

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s41467-024-46497-0Final published version, 1.05 MBLicence: CC BY

https://www.nature.com/articles/s41467-024-46497-0

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Cezard, G. I., Denholm, R. E., Knight, R., Wei, Y., Teece, L., Toms, R., Forbes, H. J., Walker, A. J., Fisher, L., Massey, J., Hopcroft, L. E. M., Horne, E. M. F., Taylor, K., Palmer, T., Arab, M. A., Cuitun coronado, J. I., Ip, S. H. Y., Davy, S., Dillingham, I., ... Walker, V. (2024). Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study. Nature Communications, 15(1), Article 2173. https://www.nature.com/articles/s41467-024-46497-0

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title = "Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study",

abstract = "Infection with SARS-CoV-2 is associated with an increased risk of arterial and venous thrombotic events, but the implications of vaccination for this increased risk are uncertain. With the approval of NHS England, we quantified associations between COVID-19 diagnosis and cardiovascular diseases in different vaccination and variant eras using linked electronic health records for ~40% of the English population. We defined a {\textquoteleft}pre-vaccination{\textquoteright} cohort (18,210,937 people) in the wild-type/Alpha variant eras (January 2020-June 2021), and {\textquoteleft}vaccinated{\textquoteright} and {\textquoteleft}unvaccinated{\textquoteright} cohorts (13,572,399 and 3,161,485 people respectively) in the Delta variant era (June-December 2021). We showed that the incidence of each arterial thrombotic, venous thrombotic and other cardiovascular outcomes was substantially elevated during weeks 1-4 after COVID-19, compared with before or without COVID-19, but less markedly elevated in time periods beyond week 4.Hazard ratios were higher after hospitalised than non-hospitalised COVID-19 and higher in the pre-vaccination and unvaccinated cohorts than the vaccinated cohort. COVID-19 vaccination reduces the risk of cardiovascular events after COVID-19 infection. People who had COVID-19 before or without being vaccinated are at higher risk of cardiovascular events for at least two years.",

author = "Cezard, {Genevieve i.} and Denholm, {Rachel e.} and Rochelle Knight and Yinghui Wei and Lucy Teece and Renin Toms and Forbes, {Harriet j.} and Walker, {Alex j.} and Louis Fisher and Jon Massey and Hopcroft, {Lisa e. m.} and Horne, {Elsie m. f.} and Kurt Taylor and Tom Palmer and Arab, {Marwa al} and {Cuitun coronado}, {Jose ignacio} and Ip, {Samantha h. y.} and Simon Davy and Iain Dillingham and Sebastian Bacon and Amir Mehrkar and Morton, {Caroline e.} and Felix Greaves and Catherine Hyams and {Davey smith}, George and John Macleod and Nishi Chaturvedi and Ben Goldacre and Whiteley, {William n.} and Wood, {Angela m.} and Sterne, {Jonathan a. c.} and Venexia Walker",

year = "2024",

month = mar,

day = "11",

language = "English",

volume = "15",

journal = "Nature Communications",

issn = "2041-1723",

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Cezard, GI, Denholm, RE, Knight, R, Wei, Y, Teece, L, Toms, R, Forbes, HJ, Walker, AJ, Fisher, L, Massey, J, Hopcroft, LEM, Horne, EMF, Taylor, K, Palmer, T, Arab, MA, Cuitun coronado, JI, Ip, SHY, Davy, S, Dillingham, I, Bacon, S, Mehrkar, A, Morton, CE, Greaves, F, Hyams, C, Davey smith, G, Macleod, J, Chaturvedi, N, Goldacre, B, Whiteley, WN, Wood, AM, Sterne, JAC & Walker, V 2024, 'Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study', Nature Communications, vol. 15, no. 1, 2173. <https://www.nature.com/articles/s41467-024-46497-0>

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T1 - Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study

AU - Cezard, Genevieve i.

AU - Denholm, Rachel e.

AU - Knight, Rochelle

AU - Wei, Yinghui

AU - Teece, Lucy

AU - Toms, Renin

AU - Forbes, Harriet j.

AU - Walker, Alex j.

AU - Fisher, Louis

AU - Massey, Jon

AU - Hopcroft, Lisa e. m.

AU - Horne, Elsie m. f.

AU - Taylor, Kurt

AU - Palmer, Tom

AU - Arab, Marwa al

AU - Cuitun coronado, Jose ignacio

AU - Ip, Samantha h. y.

AU - Davy, Simon

AU - Dillingham, Iain

AU - Bacon, Sebastian

AU - Mehrkar, Amir

AU - Morton, Caroline e.

AU - Greaves, Felix

AU - Hyams, Catherine

AU - Davey smith, George

AU - Macleod, John

AU - Chaturvedi, Nishi

AU - Goldacre, Ben

AU - Whiteley, William n.

AU - Wood, Angela m.

AU - Sterne, Jonathan a. c.

AU - Walker, Venexia

PY - 2024/3/11

Y1 - 2024/3/11

N2 - Infection with SARS-CoV-2 is associated with an increased risk of arterial and venous thrombotic events, but the implications of vaccination for this increased risk are uncertain. With the approval of NHS England, we quantified associations between COVID-19 diagnosis and cardiovascular diseases in different vaccination and variant eras using linked electronic health records for ~40% of the English population. We defined a ‘pre-vaccination’ cohort (18,210,937 people) in the wild-type/Alpha variant eras (January 2020-June 2021), and ‘vaccinated’ and ‘unvaccinated’ cohorts (13,572,399 and 3,161,485 people respectively) in the Delta variant era (June-December 2021). We showed that the incidence of each arterial thrombotic, venous thrombotic and other cardiovascular outcomes was substantially elevated during weeks 1-4 after COVID-19, compared with before or without COVID-19, but less markedly elevated in time periods beyond week 4.Hazard ratios were higher after hospitalised than non-hospitalised COVID-19 and higher in the pre-vaccination and unvaccinated cohorts than the vaccinated cohort. COVID-19 vaccination reduces the risk of cardiovascular events after COVID-19 infection. People who had COVID-19 before or without being vaccinated are at higher risk of cardiovascular events for at least two years.

AB - Infection with SARS-CoV-2 is associated with an increased risk of arterial and venous thrombotic events, but the implications of vaccination for this increased risk are uncertain. With the approval of NHS England, we quantified associations between COVID-19 diagnosis and cardiovascular diseases in different vaccination and variant eras using linked electronic health records for ~40% of the English population. We defined a ‘pre-vaccination’ cohort (18,210,937 people) in the wild-type/Alpha variant eras (January 2020-June 2021), and ‘vaccinated’ and ‘unvaccinated’ cohorts (13,572,399 and 3,161,485 people respectively) in the Delta variant era (June-December 2021). We showed that the incidence of each arterial thrombotic, venous thrombotic and other cardiovascular outcomes was substantially elevated during weeks 1-4 after COVID-19, compared with before or without COVID-19, but less markedly elevated in time periods beyond week 4.Hazard ratios were higher after hospitalised than non-hospitalised COVID-19 and higher in the pre-vaccination and unvaccinated cohorts than the vaccinated cohort. COVID-19 vaccination reduces the risk of cardiovascular events after COVID-19 infection. People who had COVID-19 before or without being vaccinated are at higher risk of cardiovascular events for at least two years.

UR - http://www.scopus.com/inward/record.url?scp=85187437313&partnerID=8YFLogxK

M3 - Article

SN - 2041-1723

VL - 15

JO - Nature Communications

JF - Nature Communications

IS - 1

M1 - 2173

ER -

Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study

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