New Delhi: A large-scale study led by researchers at the University of Pennsylvania has found that children and adolescents who contracted SARS-CoV-2 are at a significantly increased risk of developing multiple cardiovascular conditions during the post-acute phase of infection.
While this risk has been extensively studied in adults, evidence in paediatric populations has remained limited—until now.
Published in Nature Communications, the study analysed electronic health records (EHRs) of 1.2 million individuals under age 21 from 19 major U.S. children's hospitals and healthcare institutions in the RECOVER consortium between March 2020 and September 2023.
Of the participants, 297,920 were SARS-CoV-2-positive and 915,402 served as matched controls without prior COVID-19 infection. All were followed up for at least six months, with outcomes tracked from 28 to 179 days after infection.
The researchers found that "children and adolescents with prior SARS-CoV-2 infection are at a statistically significant increased risk of various cardiovascular outcomes", including hypertension, ventricular arrhythmias, myocarditis, heart failure, cardiomyopathy, cardiac arrest, thromboembolism, chest pain, and palpitations, compared to uninfected controls.
These risks were evident across children both with and without congenital heart defects (CHDs), though those with CHD had a notably higher risk of developing atrial fibrillation.
Notably, the relative risk of myocarditis was nearly four times higher in infected children with CHD, and over three times higher in those without. The study also found that the risks were consistent across age, race, sex, obesity status, acute COVID-19 severity, and dominant virus variant.
Even children with no previous heart conditions were affected. Risk was particularly high for symptoms like chest pain and palpitations, which align with global findings on post-COVID complications in youth.
The authors also explored obesity’s role in cardiovascular risk. They observed a nuanced relationship where obesity was associated with increased risks for severe cardiovascular outcomes such as ventricular arrhythmias and cardiogenic shock, but with lower risks for cardiovascular-related symptoms like chest pain and palpitations.
“While these findings were not substantial, they highlight the complexity of obesity-related cardiovascular health in paediatric populations,” the team noted.
The study emphasizes that even children without a prior history of heart disease were vulnerable to these complications.
“Awareness of the heightened risk of cardiovascular disorders after SARS-CoV-2 infection can lead to timely referrals, diagnostic evaluations, and management to mitigate long-term cardiovascular complications in children and adolescents,” the researchers stated.
In light of these findings, the study urges clinicians, parents, and public health stakeholders to remain vigilant for cardiovascular symptoms in children recovering from COVID-19 and to consider targeted follow-up care.