Long COVID and risk of incident cardiovascular disease : a prospective cohort study using the Multimorbidity Integrated Registry Across Care Levels in Stockholm (MIRACLE-S) cohort
Lindberg, Pia ; Wiqvist, Samuel ; Juszczyk, Maria ; Lee, Seika ; Kisiel, Marta A ; Wachtler, Caroline ; Ståhlberg, Marcus ; Wheelock, Åsa M ; Fedorowski, Artur LU
and Carlsson, Axel C
(2026)
In EClinicalMedicine
94.
p.1-10
- Abstract
BACKGROUND: Long COVID has emerged as a global health challenge, with increasing evidence of cardiovascular sequelae. Most previous studies have focused on hospitalised cohorts, whereas cardiovascular risk in community-managed long COVID cases remains less explored. We aimed to investigate the incidence of major cardiovascular events in individuals with long COVID compared to those without long COVID in a large population-based setting.
METHODS: Multimorbidity Integrated Registry Across Care Levels in Stockholm (MIRACLE-S) is a population-based cohort that covers all providers of healthcare for around 2.5 million residents in Stockholm County. Individuals aged 18-65 years with a physician-assigned long COVID diagnosis (ICD-10:... (More)
BACKGROUND: Long COVID has emerged as a global health challenge, with increasing evidence of cardiovascular sequelae. Most previous studies have focused on hospitalised cohorts, whereas cardiovascular risk in community-managed long COVID cases remains less explored. We aimed to investigate the incidence of major cardiovascular events in individuals with long COVID compared to those without long COVID in a large population-based setting.
METHODS: Multimorbidity Integrated Registry Across Care Levels in Stockholm (MIRACLE-S) is a population-based cohort that covers all providers of healthcare for around 2.5 million residents in Stockholm County. Individuals aged 18-65 years with a physician-assigned long COVID diagnosis (ICD-10: U09.9) between October 2020 and January 2025 were identified. Exclusion criteria were hospitalisation for acute COVID-19 or pre-existing cardiovascular disease. Cox proportional hazards models estimated the effect of long COVID on a composite cardiovascular outcome (myocardial infarction, heart failure, cardiac arrhythmias, stroke, peripheral arterial disease), adjusting for demographic, lifestyle, and mental health factors.
FINDINGS: Among 1,217,693 individuals, 8999 (0.7%) had long COVID diagnosis (66% women). Cumulative incidence of any cardiovascular event was higher in long COVID group (women 18.2%, men 20.6%) compared with control group (women 8.4%, men 11.1%). In a fully adjusted model, long COVID was associated with the composite cardiovascular outcome (women HR 2.06, 95% CI 1.92-2.22; men HR 1.33, 1.20-1.48), cardiac arrhythmia (women HR 3.11, 2.85-3.39; men HR 1.61, 1.41-1.85), and coronary artery disease (women HR 1.25, 1.04-1.52; men HR 1.26, 1.05-1.51). Heart failure incidence was elevated in women only (HR 1.25, 1.00-1.55), as also was peripheral artery disease (HR 1.25, 1.05-1.50). Long COVID was not associated with stroke in either sex.
INTERPRETATION: Long COVID is associated with increased risk of incident cardiovascular disease, particularly cardiac arrhythmias, heart failure, and coronary artery disease. These findings underscore the need for systematic follow-up and integration of long COVID into cardiovascular risk assessment.
FUNDING: Region Stockholm and Heart Lung Foundation.
(Less)
- author
- Lindberg, Pia
; Wiqvist, Samuel
; Juszczyk, Maria
; Lee, Seika
; Kisiel, Marta A
; Wachtler, Caroline
; Ståhlberg, Marcus
; Wheelock, Åsa M
; Fedorowski, Artur
LU
and Carlsson, Axel C
- publishing date
- 2026-04
- type
- Contribution to journal
- publication status
- published
- in
- EClinicalMedicine
- volume
- 94
- article number
- 103846
- pages
- 1 - 10
- publisher
- Lancet Publishing Group
- external identifiers
-
- pmid:42077647
- ISSN
- 2589-5370
- DOI
- 10.1016/j.eclinm.2026.103846
- language
- English
- LU publication?
- no
- additional info
- © 2026 The Author(s).
- id
- dfa118fa-0696-46f1-af43-4ee059e16b9e
- date added to LUP
- 2026-05-25 17:48:25
- date last changed
- 2026-05-26 07:47:41
@article{dfa118fa-0696-46f1-af43-4ee059e16b9e,
abstract = {{<p>BACKGROUND: Long COVID has emerged as a global health challenge, with increasing evidence of cardiovascular sequelae. Most previous studies have focused on hospitalised cohorts, whereas cardiovascular risk in community-managed long COVID cases remains less explored. We aimed to investigate the incidence of major cardiovascular events in individuals with long COVID compared to those without long COVID in a large population-based setting.</p><p>METHODS: Multimorbidity Integrated Registry Across Care Levels in Stockholm (MIRACLE-S) is a population-based cohort that covers all providers of healthcare for around 2.5 million residents in Stockholm County. Individuals aged 18-65 years with a physician-assigned long COVID diagnosis (ICD-10: U09.9) between October 2020 and January 2025 were identified. Exclusion criteria were hospitalisation for acute COVID-19 or pre-existing cardiovascular disease. Cox proportional hazards models estimated the effect of long COVID on a composite cardiovascular outcome (myocardial infarction, heart failure, cardiac arrhythmias, stroke, peripheral arterial disease), adjusting for demographic, lifestyle, and mental health factors.</p><p>FINDINGS: Among 1,217,693 individuals, 8999 (0.7%) had long COVID diagnosis (66% women). Cumulative incidence of any cardiovascular event was higher in long COVID group (women 18.2%, men 20.6%) compared with control group (women 8.4%, men 11.1%). In a fully adjusted model, long COVID was associated with the composite cardiovascular outcome (women HR 2.06, 95% CI 1.92-2.22; men HR 1.33, 1.20-1.48), cardiac arrhythmia (women HR 3.11, 2.85-3.39; men HR 1.61, 1.41-1.85), and coronary artery disease (women HR 1.25, 1.04-1.52; men HR 1.26, 1.05-1.51). Heart failure incidence was elevated in women only (HR 1.25, 1.00-1.55), as also was peripheral artery disease (HR 1.25, 1.05-1.50). Long COVID was not associated with stroke in either sex.</p><p>INTERPRETATION: Long COVID is associated with increased risk of incident cardiovascular disease, particularly cardiac arrhythmias, heart failure, and coronary artery disease. These findings underscore the need for systematic follow-up and integration of long COVID into cardiovascular risk assessment.</p><p>FUNDING: Region Stockholm and Heart Lung Foundation.</p>}},
author = {{Lindberg, Pia and Wiqvist, Samuel and Juszczyk, Maria and Lee, Seika and Kisiel, Marta A and Wachtler, Caroline and Ståhlberg, Marcus and Wheelock, Åsa M and Fedorowski, Artur and Carlsson, Axel C}},
issn = {{2589-5370}},
language = {{eng}},
pages = {{1--10}},
publisher = {{Lancet Publishing Group}},
series = {{EClinicalMedicine}},
title = {{Long COVID and risk of incident cardiovascular disease : a prospective cohort study using the Multimorbidity Integrated Registry Across Care Levels in Stockholm (MIRACLE-S) cohort}},
url = {{http://dx.doi.org/10.1016/j.eclinm.2026.103846}},
doi = {{10.1016/j.eclinm.2026.103846}},
volume = {{94}},
year = {{2026}},
}