Cardiovascular, Renal, and Pulmonary Risks of Long COVID: A Retrospective Cohort Study Stratified by Age and Sex

BACKGROUND: A substantial proportion of patients with acute COVID-19 develop postacute sequelae of SARS-CoV-2 infection (Long COVID). The risk of adverse cardiovascular and related outcomes in Long COVID remains elusive. We hypothesized that individuals with Long COVID are at elevated risk for adverse cardiovascular, renal, and pulmonary (CRP) outcomes compared with those who recovered from COVID-19 without developing Long COVID. METHODS: We performed a retrospective cohort study using the global TriNetX network (>150 million patients). Adults with documented COVID-19 were classified by the presence/absence of clinically recognized Long COVID. We analyzed absolute risks and relative risks for 15 CRP outcomes, stratified by age (18-50, 51-64, ≥65 years). After excluding patients with preexisting outcomes of interest, propensity score matching was applied for age, sex, and common confounders. RESULTS: Among 2 613 432 adults identified with COVID-19 within TriNetX network, 315 612 matched individuals were included in the study. Long COVID was associated with higher risk of most CRP outcomes across all ages regardless of sex. Relative risks were disproportionately higher in younger adults, especially in young women for cardiovascular and renal outcomes and in young men for pulmonary outcomes. Findings remained directionally consistent across sensitivity analyses. Prior SARS-CoV-2 vaccination was not consistently associated with reduced CRP risk. CONCLUSIONS: Clinically recognized Long COVID was associated with increased risk of CRP outcomes, with relatively higher relative risks observed in younger adults. These findings support the need for continuing surveillance and risk-reduction strategies for cardiovascular and related disorders in Long COVID.