Introduction

• COVID-19, besides respiratory complications, has long-term cardiovascular consequences.

• The CARTESIAN study, the largest multinational investigation into this aspect, indicates that COVID survivors show accelerated vascular ageing, particularly women.

• Key finding: Arteries of survivors behave as if 5–10 years older.

Significance of Arterial Stiffening

• Arterial stiffness is measured by carotid-femoral pulse wave velocity (PWV).

• Consequences include:

  • Increased cardiac workload

  • Elevated blood pressure

  • Higher risk of heart attack, stroke, kidney disease, and dementia

• Stiffening is clinically silent until severe events occur.

• Global context: With ~700 million COVID survivors, even partial prevalence implies a substantial future healthcare burden.

The CARTESIAN Study

• Objective: Investigate whether COVID-19 leaves a long-term vascular imprint.

• Scope:

  • 2,390 participants, average age 50

  • Across 18 countries and 38 research centers

  • Groups: uninfected controls, non-hospitalised, hospitalised, ICU survivors

• Methodology:

  • PWV measured at 6 months and 12 months post-infection

  • Adjustments made for age, sex, blood pressure, diabetes, smoking

Key Findings

• Overall Impact:

  • Every COVID-positive group had stiffer arteries than controls

  • PWV difference: ~0.4 m/s → equivalent to 5 years older arteries

• Gender Differences:

  • Women showed more pronounced stiffening, independent of severity

  • ICU women: arteries aged by ~10 years

  • Persistent long COVID symptoms (fatigue, breathlessness) correlated with greater stiffening

• Immune Response Factor:

  • Women mount stronger immune responses

  • Lingering inflammation post-COVID may damage blood vessels

Vaccination and Recovery

• Vaccination Effect:

  • Lower arterial stiffness in vaccinated individuals, especially women

• Recovery Patterns:

  • PWV stabilised or slightly improved after one year

  • Complete return to baseline not observed

Diverging Clinical Opinions

• Skeptics:

  • Indian cardiologist Balbir Singh emphasizes lack of pre-COVID baseline data

  • Notes no observable spike in hypertensive or ICU survivor heart issues in practice

• Supporters:

  • US researchers (Cleveland Clinic, Brigham and Women’s Hospital, Mount Sinai) note:

    • History of COVID should guide cardiovascular prevention

    • Observed myocarditis, palpitations, autonomic dysfunction (POTS)

    • Mild COVID can still cause heart and vessel inflammation

Implications for India

• CARTESIAN’s European focus limits South Asian representation

• Initial observations:

  • Asians had less stiff arteries pre-COVID

  • COVID eliminated this “ethnic advantage”

• India faces high cardiovascular disease burden, highlighting urgent need for domestic research and surveillance

Conclusion

• COVID-19 may accelerate vascular ageing, with women disproportionately affected.

• Long-term cardiovascular monitoring and preventive strategies are crucial.

• Vaccination mitigates risks, but invisible vascular damage persists in many survivors.

• Policy implication: India needs home-grown data to plan post-pandemic healthcare strategies.

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