Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study

Genevieve I Cezard, Rachel E Denholm, Rochelle Knight, Yinghui Wei, Lucy Teece, Renin Toms, Harriet J Forbes, Alex J Walker, Louis Fisher, Jon Massey, Lisa E M Hopcroft, Elsie M F Horne, Kurt Taylor, Tom Palmer, Marwa Al Arab, Jose Ignacio Cuitun Coronado, Samantha H Y Ip, Simon Davy, Iain Dillingham, Sebastian BaconAmir Mehrkar, Caroline E Morton, Felix Greaves, Catherine Hyams, George Davey Smith, John Macleod, Nishi Chaturvedi, Ben Goldacre, William N Whiteley, Angela M Wood, Jonathan A C Sterne*, Venexia Walker, Longitudinal Health and Wellbeing and Data and Connectivity UK COVID-19 National Core Studies, CONVALESCENCE study and the OpenSAFELY collaborative, CONVALESCENCE Study, The OpenSAFELY Collaborative

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Infection with SARS-CoV-2 is associated with an increased risk of arterial and venous thrombotic events, but the implications of vaccination for this increased risk are uncertain. With the approval of NHS England, we quantified associations between COVID-19 diagnosis and cardiovascular diseases in different vaccination and variant eras using linked electronic health records for ~40% of the English population. We defined a 'pre-vaccination' cohort (18,210,937 people) in the wild-type/Alpha variant eras (January 2020-June 2021), and 'vaccinated' and 'unvaccinated' cohorts (13,572,399 and 3,161,485 people respectively) in the Delta variant era (June-December 2021). We showed that the incidence of each arterial thrombotic, venous thrombotic and other cardiovascular outcomes was substantially elevated during weeks 1-4 after COVID-19, compared with before or without COVID-19, but less markedly elevated in time periods beyond week 4. Hazard ratios were higher after hospitalised than non-hospitalised COVID-19 and higher in the pre-vaccination and unvaccinated cohorts than the vaccinated cohort. COVID-19 vaccination reduces the risk of cardiovascular events after COVID-19 infection. People who had COVID-19 before or without being vaccinated are at higher risk of cardiovascular events for at least two years.

Original languageEnglish
Pages (from-to)2173
JournalNature Communications
Issue number1
Early online date11 Mar 2024
Publication statusE-pub ahead of print - 11 Mar 2024

Keywords / Materials (for Non-textual outputs)

  • Humans
  • Cardiovascular Diseases/epidemiology
  • COVID-19/epidemiology
  • SARS-CoV-2
  • COVID-19 Testing
  • COVID-19 Vaccines
  • Cohort Studies
  • Vaccination


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