Viral infections such as COVID, HIV, can raise heart disease risk, but vaccines may help

Infections, including influenza, COVID-19, HIV, hepatitis C and herpes zoster, can raise the risk of cardiovascular disease (CVD), and vaccines could help lower that risk, according to a study published in the Journal of the American Heart Association on October 29.

CVD is the leading cause of death worldwide, responsible for more than 20 million deaths in 2021. Over recent decades, the burden of CVD has grown sharply in low- and middle-income countries, which now account for over 80% of global CVD deaths.

Viral infections can cause sudden inflammation, increase harmful immune signals, damage blood vessel linings, make blood more likely to clot and sometimes cause plaques in arteries to break, according to the study. The COVID-19 pandemic highlighted this connection; COVID was linked to higher risks of stroke and acute myocardial infarction.

While many studies have explored the relationship between viral infections and CVD, results for some viruses remain unclear, and past reviews have often focused on specific viruses or mainly on stroke.

Few comprehensive analyses have examined the broader impact of viral infections on cardiovascular outcomes, including coronary heart disease (CHD), according to researchers. To address this gap, a team of researchers hailing from Los Angeles, Houston and South Africa conducted a systematic review and meta-analysis of epidemiologic studies assessing the link between viral infections and CVD risk.

PRISMA guidelines were followed, and the study protocol was registered in the International Prospective Register of Systematic Reviews. The team searched MEDLINE, Embase, Web of Science, African-Wide Information and Cochrane Library up to July 3, 2024 for studies linking viral infections to CVD.

Eligible studies included cohort, case–control, case–crossover and self-controlled case series reporting outcomes such as CVD, stroke, CHD and heart failure. Three investigators screened and extracted study data, including design, population, follow-up, exposures, outcomes and confounders. Pooled risk estimates were calculated using random-effects models with subgroup, sensitivity and publication bias analyses to ensure robustness.

Overall, this review screened 52,336 studies and included 155 that examined the link between viral infections and CVD. Most studies were cohort studies, and the majority focused on a single virus. Studies were conducted mainly in North America, Europe and East Asia, and about 71% adjusted for key factors such as age, sex and traditional cardiovascular risks.

It was found that HIV infection was consistently linked to higher risks of CVD, including CHD, stroke and heart failure. In cohort studies, those with HIV had a 65% higher risk of CVD than those without HIV. COVID infection also increased CVD risk, especially within the first few months after infection, with higher risks of heart attack and stroke. Additionally, influenza showed a strong short-term risk for acute myocardial infarction and stroke, particularly in the first week after infection.

Other viruses showed mixed results. The hepatitis C virus increased the risks of CVD, CHD and CVD death, whereas hepatitis B showed no clear association. Cytomegalovirus and herpes zoster were also linked to higher CHD risk, and herpes zoster also increased stroke risk.

High-risk human papillomavirus and chikungunya, dengue and hantavirus infections were associated with elevated CVD or acute cardiovascular events in certain studies. Overall, several viral infections were associated with increased cardiovascular risks, particularly in the short-term period following infection.

In review, this study is the first to look at many viral infections and their link to CVD across 155 studies. It shows strong evidence that influenza and COVID raise the risk of sudden heart issues, while long-lasting infections, including HIV, hepatitis C and herpes zoster, increase the risk of heart disease and stroke over time.

Strengths of the study include using a self-controlled case series and cohort designs, which help reduce bias and make the results more reliable. Limitations include differences between studies, possible errors in identifying infections, limited data from areas with high disease burden and a lack of research on some viruses.

The authors suggest expanding cohort studies in underrepresented regions, evaluating multiple viral infections together and promoting preventive strategies, including vaccination, statin therapy and integration of CVD screening into chronic infection care.