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

Genevieve I Cezard; Rachel E Denholm; Rochelle O C Knight; Yinghui Wei; Lucy Teece; Renin M B S Toms; Harriet J Forbes; Alex J Walker; Louis Fisher; Jon Massey; Lisa EM Hopcroft; Elsie M F Horne; Kurt R Taylor; Tom M Palmer; Marwa M AL Arab; Jose Ignacio Cuitun Coronado; Samantha 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 Whiteley; Angela M. Wood; Jonathan A C Sterne; Venexia M Walker

doi:10.1038/s41467-024-46497-0

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

Genevieve I Cezard, Rachel E Denholm, Rochelle O C Knight, Yinghui Wei, Lucy Teece, Renin M B S Toms, Harriet J Forbes, Alex J Walker, Louis Fisher, Jon Massey, Lisa EM Hopcroft, Elsie M F Horne, Kurt R Taylor, Tom M Palmer, Marwa M AL Arab, Jose Ignacio Cuitun Coronado, Samantha 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 Whiteley, Angela M. Wood, Jonathan A C Sterne^*, Venexia M Walker

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

17 Citations (Scopus)

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
Number of pages	14
Journal	Nature Communications
Volume	15
Issue number	1
DOIs	https://doi.org/10.1038/s41467-024-46497-0
Publication status	Published - 11 Mar 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.

Research Groups and Themes

Bristol Population Health Science Institute

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Cezard, G. I., Denholm, R. E., Knight, R. O. C., Wei, Y., Teece, L., Toms, R. M. B. S., Forbes, H. J., Walker, A. J., Fisher, L., Massey, J., Hopcroft, L. EM., Horne, E. M. F., Taylor, K. R., Palmer, T. M., AL Arab, M. M., Ignacio Cuitun Coronado, J., Ip, S., Davy, S., Dillingham, I., ... Walker, V. M. (2024). Impact of vaccination on the association of COVID-19 with cardiovascular diseases: an OpenSAFELY cohort study. Nature Communications, 15(1), Article 2173 . https://doi.org/10.1038/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 andvenous thrombotic events, but the implications of vaccination for this increasedrisk are uncertain. With the approval of NHS England, we quantified associationsbetween COVID-19 diagnosis and cardiovascular diseases in different vaccination and variant eras using linked electronic health records for ~40% of theEnglish population. We defined a {\textquoteleft}pre-vaccination{\textquoteright} cohort (18,210,937 people) inthe 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 theDelta variant era (June-December 2021). We showed that the incidence of eacharterial thrombotic, venous thrombotic and other cardiovascular outcomes wassubstantially elevated during weeks 1-4 after COVID-19, compared with beforeor without COVID-19, but less markedly elevated in time periods beyond week 4.Hazard ratios were higher after hospitalised than non-hospitalised COVID-19and higher in the pre-vaccination and unvaccinated cohorts than the vaccinatedcohort. COVID-19 vaccination reduces the risk of cardiovascular events afterCOVID-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 Knight, {Rochelle O C} and Yinghui Wei and Lucy Teece and Toms, {Renin M B S} and Forbes, {Harriet J} and Walker, {Alex J} and Louis Fisher and Jon Massey and Hopcroft, {Lisa EM} and Horne, {Elsie M F} and Taylor, {Kurt R} and Palmer, {Tom M} and {AL Arab}, {Marwa M} and {Ignacio Cuitun Coronado}, Jose and Samantha Ip 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 William Whiteley and Wood, {Angela M.} and Sterne, {Jonathan A C} and Walker, {Venexia M}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = mar,

day = "11",

doi = "10.1038/s41467-024-46497-0",

language = "English",

volume = "15",

journal = "Nature Communications",

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Cezard, GI, Denholm, RE , Knight, ROC, Wei, Y, Teece, L, Toms, RMBS, Forbes, HJ, Walker, AJ, Fisher, L, Massey, J, Hopcroft, LEM, Horne, EMF, Taylor, KR, Palmer, TM , AL Arab, MM, Ignacio Cuitun Coronado, J, Ip, S, Davy, S, Dillingham, I, Bacon, S, Mehrkar, A, Morton, CE, Greaves, F, Hyams, C , Davey Smith, G, MacLeod, J, Chaturvedi, N, Goldacre , B, Whiteley, W, Wood, AM, Sterne, JAC & Walker, VM 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://doi.org/10.1038/s41467-024-46497-0

TY - JOUR

T1 - Impact of vaccination on the association of COVID-19 with cardiovascular diseases

T2 - an OpenSAFELY cohort study

AU - Cezard, Genevieve I

AU - Denholm, Rachel E

AU - Knight, Rochelle O C

AU - Wei, Yinghui

AU - Teece, Lucy

AU - Toms, Renin M B S

AU - Forbes, Harriet J

AU - Walker, Alex J

AU - Fisher, Louis

AU - Massey, Jon

AU - Hopcroft, Lisa EM

AU - Horne, Elsie M F

AU - Taylor, Kurt R

AU - Palmer, Tom M

AU - AL Arab, Marwa M

AU - Ignacio Cuitun Coronado, Jose

AU - Ip, Samantha

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

AU - Wood, Angela M.

AU - Sterne, Jonathan A C

AU - Walker, Venexia M

PY - 2024/3/11

Y1 - 2024/3/11

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

U2 - 10.1038/s41467-024-46497-0

DO - 10.1038/s41467-024-46497-0

M3 - Article (Academic Journal)

C2 - 38467603

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

Abstract

Bibliographical note

Research Groups and Themes

UN SDGs

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Cite this