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Cardiac risk factors and prevention
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The role of COVID-19 vaccines in preventing post-COVID-19 thromboembolic and cardiovascular complications
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  • Published on: 4 June 2024
    Possible protection against late post-COVID thrombosis, also in case of vaccination 8-11 months after infection, in the first epidemic waves.
    • Simone V Benatti, Infectious Diseases Physician Clinic of Infectious Diseases, Dept. of Health Sciences, University of Milan, ASST Santi Paolo e Carlo, Milan
    • Other Contributors:
      • Serena Venturelli, Infectious Diseases Physician
      • Arianna Ghirardi, Statistician

    Dear Sir,

    we read with deep interest the paper by Marcadé-Besora[1] and collaborators, providing extremely reliable evidence in favour of a long-term protective effect of SARS-CoV-2 vaccination, against cardiovascular events (especially thrombosis-related ones), in patients recovering from an acute SARS-CoV-2 infection.

    Such protective affect remains significant up to one year after acute infection, and this not only indirectly confirms that the well-recognized thrombophylic disturbance associated to SARS-CoV-2 lasts actually longer than initially thought[2], but also suggests that this is - at least in part - preventable, through immune mechanisms.

    In the study, the follow-up ended on the first post-COVID outcome event, so occasional SARS-CoV-2 reinfections, occurring more often in the unvaccinated individuals, cannot be the reason for the observed differences between groups.

    The authors did not stratify results according to the number of vaccine doses received: we suggest this analysis to be done. In fact, viral neutralization efficacy conferred by COVID vaccines is not “all-nothing” and depends on time since last booster and on number of doses received[3]: should the cardiovascular protective effect observed by the authors follow the same pattern, this would add a strong evidence in favour of its linkage to vaccination, instead of other potentially associated confounders.

    In a different setting, and a much smaller scale, we also obs...

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    Conflict of Interest:
    None declared.
  • Published on: 15 April 2024
    Competing risk bias
    • Haluk Vahaboglu, Professor in Infectious Diseases Istanbul Aydin University

    The data was evaluated by the authors using Fine-Gray competing risk models, with C-19 linked deaths included as competing risks. In the text, they referred to this as "To account for the competing risk of death associated with COVID-19."
    When examining the cardiovascular and thromboembolic effects of COVID-19, it is not appropriate to consider COVID-19 associated mortality as a competing risk. Furthermore, these consequences are the primary factors contributing to mortality in cases of C-19 infection.

    Conflict of Interest:
    None declared.