A recent meta-analysis published in February 2025 provides new insights into the prevalence and severity of cardiovascular symptoms in PACS. The study analyzed data from nearly 3 million patients across 37 studies. It sheds light on the heightened risk of cardiovascular sequelae in individuals recovering from COVID-19.
Among the many reported symptoms of Long COVID, cardiovascular complications stand out as particularly significant due to their potential for chronic impact and increased morbidity. Understanding these risks is essential for clinicians and researchers working to develop effective treatment strategies for Long COVID patients.
The study identifies three primary cardiovascular symptoms associated with PACS: chest pain, palpitations (, and hypertension.
22% of patients recovering from COVID-19 report persistent chest pain. Compared to non-infected controls, individuals with a history of COVID-19 have a four times higher risk of developing this symptom.
18% of Long COVID patients experience heart palpitations (racing heart), with a 3.4 times higher chance of experiencing palpitations compared to the general population.
19% of individuals affected by Long COVID develop high blood pressure. The chance to experience high blood pressure is 1.7 times higher in Long COVID patients than in the general population. This suggests that COVID-19 may contribute to persistent alterations in vascular function
Overall, these findings indicate that nearly 15% of all individuals who recover from COVID-19 may experience cardiovascular complications. This highlights the need for systematic follow-up in Long COVID patients, particularly those with preexisting cardiovascular risk factors.
Why Does COVID-19 Impact the Cardiovascular System?
While the exact mechanisms underlying these cardiovascular complications remain under investigation, the meta-analysis outlines several plausible explanations:
- The SARS-CoV-2 virus binds to ACE2 receptors, leading to endothelial inflammation, oxidative stress, and impaired vascular function. Persistent endothelial injury may contribute to hypertension and vascular stiffness.
- Immune dysregulation(irregular reaction of the immune system) and persistent inflammatory markers could play a role in triggering long-term cardiovascular symptoms.
- Some studies suggest that COVID-19 may induce an autoimmune reaction, leading to the production of cardiac-specific antibodies that can damage heart tissue.
- SARS-CoV-2 has been associated with increased clot formation, which may contribute to microvascular damage and symptoms such as chest pain and palpitations.
Implications for Patient Care: A Need for Long-Term Monitoring
The study’s findings emphasize the importance of proactive cardiovascular monitoring for individuals recovering from COVID-19, particularly those presenting with persistent symptoms. Clinicians should consider the following steps in managing PACS patients:
- Routine screening for hypertension
- Cardiac evaluations for chest pain and palpitations, including comprehensive cardiac assessments, electrocardiograms (ECG), and echocardiography
- Individualized risk assessment according to preexisting conditions or risk factors
- Lifestyle and pharmacological interventions to help mitigate cardiovascular risks
Despite the growing body of evidence on PACS-related cardiovascular symptoms, many questions remain unanswered. Extended follow-up studies are needed to determine the long-term trajectory of cardiovascular complications in COVID-19 survivors.
Moreover, research exploring the precise physiological pathways of the cardiovascular effects of Long COVID and standardized treatment guidelines are needed.
Overall, the meta-analysis reinforces the significant burden of cardiovascular symptoms in individuals recovering from COVID-19, with nearly 15% of them experiencing long-term cardiovascular issues. By prioritizing regular monitoring, early intervention, and continued research, we can better support those affected and improve long-term health outcomes.
It is imperative to develop comprehensive care strategies to address the diverse and persistent symptoms of Long COVID patients. Cardiovascular health should be a key component of these efforts, ensuring that patients receive the necessary support to recover.
