Associations of COVID-19 vaccination with risks for post-infectious cardiovascular complications: an international cohort study in cancer patients with SARS-CoV-2 infection

Emily Pei-Ying Lin^{1

2

3

4

5}, Chih-Yuan Hsu^{1

2}, Sanjay Mishra^{6

7}, Elizabeth A Griffiths⁸, Brahm H Segal⁸, Clara Hwang⁹, Sunny R K Singh^{9

10}, Nino Balanchivadze^{9

11}, Chinmay Jani^{12

13}, Melissa G Mariano¹², Padmanabh S Bhatt¹², Kendra Vieira⁷, Peter Paul Yu¹⁴, Eric J Oligino¹⁴, Trisha Wise-Draper¹⁵, Elizabeth K Ferrara¹⁵, Rana R McKay¹⁶, Taylor K Nonato¹⁶, Chris Labaki¹⁷, Eddy Saad¹⁷, Renée-Maria Saliby¹⁷, Alicia K Morgans¹⁷, Anju Nohria¹⁸, Matthew Puc¹⁹, Melissa K Accordino²⁰, Brianne E Bodin²⁰, Rahul Nanchal²¹, Harpreet Singh²¹, Stephanie Berg^{17

22}, Blanche Mavromatis²³, Hannah D McManus²⁴, Susan Halabi²⁵, Toni K Choueiri¹⁷, Jeremy L Warner^{6

7}, Yu Shyr^{1

2

26}; COVID-19 and Cancer Consortium

Affiliations

¹ Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
² Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
³ Division of Thoracic Medicine, Department of Internal Medicine, School of Medicine & Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁴ Division of Thoracic Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
⁵ Center for Precision Health and Quantitative Sciences & Precision Medicine Research Center, Department of Medical Research, Taipei Medical University Hospital, Taipei, Taiwan.
⁶ Division of Hematology and Oncology, Department of Medicine, Brown University, Providence, RI 02912, USA.
⁷ Lifespan Cancer Institute at Rhode Island Hospital, Providence, RI 02912, USA.
⁸ Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
⁹ Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Health, Detroit, MI, 48202, USA.
¹⁰ University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
¹¹ Virginia Oncology Associates, Norfolk, VA 23502, USA.
¹² Mount Auburn Hospital, Cambridge, MA 02138, USA.
¹³ Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA.
¹⁴ Hartford HealthCare Cancer Institute, Hartford, CT 06102, USA.
¹⁵ University of Cincinnati Cancer Center, Cincinnati, OH 45267, USA.
¹⁶ Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA.
¹⁷ Lank Center for Genitourinary (GU) Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
¹⁸ Cardio-Oncology Program, Brigham and Women's Hospital, Boston, MA 02115, USA.
¹⁹ Virtua Health, Marlton, NJ 08053, USA.
²⁰ Herbert Irving Comprehensive Cancer Center at Columbia University, New York, NY 10032, USA.
²¹ Medical College of Wisconsin, Milwaukee, WI 53226, USA.
²² Loyola University Medical Center, Maywood, IL 60153, USA.
²³ UPMC Western Maryland, Cumberland, MD 2150, USA.
²⁴ Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA.
²⁵ Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA.
²⁶ Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan.

PMID: 40124588
PMCID: PMC11930098
DOI: 10.1016/j.lana.2025.101038

Associations of COVID-19 vaccination with risks for post-infectious cardiovascular complications: an international cohort study in cancer patients with SARS-CoV-2 infection

Emily Pei-Ying Lin et al. Lancet Reg Health Am. 2025.

. 2025 Mar 6:44:101038.

doi: 10.1016/j.lana.2025.101038. eCollection 2025 Apr.

Authors

Affiliations

¹ Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
² Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
³ Division of Thoracic Medicine, Department of Internal Medicine, School of Medicine & Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁴ Division of Thoracic Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
⁵ Center for Precision Health and Quantitative Sciences & Precision Medicine Research Center, Department of Medical Research, Taipei Medical University Hospital, Taipei, Taiwan.
⁶ Division of Hematology and Oncology, Department of Medicine, Brown University, Providence, RI 02912, USA.
⁷ Lifespan Cancer Institute at Rhode Island Hospital, Providence, RI 02912, USA.
⁸ Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
⁹ Division of Hematology/Oncology, Department of Internal Medicine, Henry Ford Health, Detroit, MI, 48202, USA.
¹⁰ University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
¹¹ Virginia Oncology Associates, Norfolk, VA 23502, USA.
¹² Mount Auburn Hospital, Cambridge, MA 02138, USA.
¹³ Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA.
¹⁴ Hartford HealthCare Cancer Institute, Hartford, CT 06102, USA.
¹⁵ University of Cincinnati Cancer Center, Cincinnati, OH 45267, USA.
¹⁶ Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA.
¹⁷ Lank Center for Genitourinary (GU) Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
¹⁸ Cardio-Oncology Program, Brigham and Women's Hospital, Boston, MA 02115, USA.
¹⁹ Virtua Health, Marlton, NJ 08053, USA.
²⁰ Herbert Irving Comprehensive Cancer Center at Columbia University, New York, NY 10032, USA.
²¹ Medical College of Wisconsin, Milwaukee, WI 53226, USA.
²² Loyola University Medical Center, Maywood, IL 60153, USA.
²³ UPMC Western Maryland, Cumberland, MD 2150, USA.
²⁴ Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA.
²⁵ Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA.
²⁶ Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan.

PMID: 40124588
PMCID: PMC11930098
DOI: 10.1016/j.lana.2025.101038

Abstract

Background: Whether COVID-19 vaccination is associated with risks for cardiovascular complications after SARS-CoV-2 infection in patients with cancer is unknown. The objective of this study was to investigate the associations between the two.

Methods: This registry (COVID-19 and Cancer Consortium)-based retrospective cohort study included patients with laboratory-confirmed SARS-CoV-2 infection from the United States, Canada, and Mexico between April 2021 and December 2022. Patients without COVID-19 vaccination were assigned to the unvaccinated group and patients with ≥2 doses of COVID-19 vaccination were assigned to the fully-vaccinated group. The primary outcome was a composite of post-infectious cardiac complications, including acute myocardial infarction, other ischemic heart disease, atrial fibrillation, ventricular fibrillation, other arrhythmias, cardiomyopathy, and congestive heart failure. The secondary outcome was a composite measure of post-infectious cardiovascular events, comprising of the cardiac complications along with pulmonary embolism, deep vein thrombosis, superficial vein thrombosis, other thrombosis, and cerebrovascular stroke. Multivariable logistic regression was used for data analysis.

Findings: A total of 2729 patients were included for analyses, with 1382 in the unvaccinated group and 1347 in the fully-vaccinated group. The median age of the study population was 65 (interquartile range (IQR), 55-74) years. Overall, 1534 (56.0%) were women; 1272 (47%) were never smokers; 1639 (60%) were not obese; 2043 (75%) had stable cancer, and 446 (16%) took anticoagulants at baseline. The primary and secondary analyses showed lower risks of cardiac complications and cardiovascular events in the fully-vaccinated group, with adjusted odds ratios (aOR) of 0.66 (95% confidence interval (CI), 0.48-0.89) and 0.76 (95% CI, 0.59-0.99), respectively. The protective trend with COVID-19 vaccination was observed across infections with different dominant SARS-CoV-2 strains and in patients with or without anticoagulant use.

Interpretation: COVID-19 vaccination was associated with a reduced risk of cardiac complications and cardiovascular events by 34% and 24%, respectively, after SARS-CoV-2 infection in patients with cancer.

Funding: National Institutes of Health USA; National Science and Technology Council of Taiwan.

Keywords: COVID-19; Cancer; Cardiovascular complication; Post-infectious; Vaccination.

PubMed Disclaimer

Conflict of interest statement

Dr. Shyr reports research supports from the National Institutes of Health USA (P30CA068485, P50CA236733, P50CA098131, P30CA068485 (supplement), U54CA163072, U54CA260560); Payment or honoraria from Roche, AstraZeneca, Eisai; Participation on a Data Safety Monitoring Board or Advisory Board of Novartis, Janssen (Johnson & Johnson), Roche, Pfizer, and AstraZeneca. Dr. Lin reports funding from Ministry of Science and Technology/National Science and Technology Council Taiwan, National Health Research Institute Taiwan, and Taipei Medical University and Hospital Taiwan (MOST 111-2628-B-038-020-MY3, NSTC 112-2314-B-038-037-MY3, NHRI-EX111-10937BC, NHRI-EX112-10937BC, TMU-110-5410-003-111, DP5-111-21314-07, TMU-111-1801-002-400, GT11002-5, GT11104-1). Dr. Berg reports receiving consulting fees from Pfizer, Exelixis, Natera, and Guardant. Dr. Choueiri reports institutional and/or personal, paid and/or unpaid support for research, advisory boards, consultancy, and/or honoraria past 5 years, ongoing or not, from: Alkermes, Arcus Bio, AstraZeneca, Aravive, Aveo, Bayer, Bristol Myers-Squibb, Bicycle Therapeutics, Calithera, Circle Pharma, Deciphera Pharmaceuticals, Eisai, EMD Serono, Exelixis, GlaxoSmithKline, Gilead, HiberCell, IQVA, Infinity, Institut Servier, Ipsen, Jansen, Kanaph, Lilly, Merck, Nikang, Neomorph, Nuscan/PrecedeBio, Novartis, Oncohost, Pfizer, Roche, Sanofi/Aventis, Scholar Rock, Surface Oncology, Takeda, Tempest, Up-To-Date, CME events (Peerview, OncLive, MJH, CCO and others); Institutional patents filed on molecular alterations and immunotherapy response/toxicity, and ctDNA; Stocks & Equity in: Tempest, Pionyr, Osel, Precede Bio, CureResponse, InnDura Therapeutics, Primium, Bicycle; being on committees of: NCCN, GU Steering Committee, ASCO (BOD 6-2024-, ESMO, ACCRU, KidneyCan; outside the submitted work. Additionally, Dr. Choueiri has mentored several non-US citizens on research projects with potential funding (in part) from non-US sources/Foreign Components. Dr. Choueiri’s institution (Dana-Farber Cancer Institute) may have received additional independent funding of drug companies or/and royalties potentially involved in research around the subject matter. Dr. Choueiri’s medical writing and editorial assistance support may have been funded by Communications companies in part. T. K. Choueiri is supported in part by the Dana-Farber/Harvard Cancer Center Kidney SPORE (2P50CA101942-16) and Program 5P30CA006516-56, the Kohlberg Chair at Harvard Medical School and the Trust Family, Michael Brigham, Pan Mass Challenge, Hinda and Arthur Marcus Fund and Loker Pinard Funds for Kidney Cancer Research at DFCI. Dr. Griffiths reports Grant Funding to Roswell Park Comprehensive Cancer Center from Astex/Taiho, Alexion/AstraZeneca Rare Disease Blueprint, BMS/Celgene, Celldex Therapeutics, Genenetch; personal Consulting fees from AbbVie, Alexion/AstraZeneca Rare Disease, Apellis, BMS/Celgene, CTI Biopharma, Genenetch, Novartis, Servier Pharmaceuticals and Takeda; honoraria from AAMDSIF, ASH, DOD, Dresner Foundation, Medicom Worldwide, Physician Educational Resource, Picnic Health, WebMD. Dr. Halabi reports Participation on a Data Safety Monitoring Board or Advisory Board of Aveo Oncology, BMS, BeiGene, CG Oncology, Janessen and Sanofi. Dr. Hwang reports Institutional funding (Henry Ford Cancer) used to support data abstraction; Research contracts to her institution from Astellas, Merck, Bayer, AstraZeneca, Seagen, Taiho Oncology, Hengrui Pharmaceutical, Scholar Rock, Exelixis, Fujifilm, Adcentrx; personal payment from Janssen (advisory board); OncLive, Merck, Exelixis, Participation on a Data of HCRN (GU18-343); Board member position on the Wayne County Medical Society Foundation; Stock or stock options in the Johnson and Johnson; and meals from Dendreon, Genentech. Dr. McKay reports Consulting fees from Ambrx, Arcus, AstraZeneca, Aveo, Bayer, Blue Earth Diagnostics, Bristol-Myers Squibb, Calithera, Caris, Daiichi Sankyo, Dendreon, Eisai, Exelixis, Johnson & Johnson, Lilly, Merck, Myovant, Neomorph, Nimbus, Novartis, Pfizer, Sanofi, SeaGen, Sorrento Therapeutics, Telix, Tempus. Institutional research funding from Artera AI, AstraZeneca, Bayer, Bristol-Myers Squibb, Exelixis, Oncternal, Tempus. Dr. McManus reports Consulting fees from Astellas, Bayer, Pfizer. Dr. Mishra reports funding through his institution from NIH/NCI, AACR; personal frees from Disney Corporation; and support for attending meetings from the Schmidt Foundation. Dr. Nohria reports Research support from Bristol Myers Squibb; and Consulting fees from AstraZeneca and from Takeda Oncology. Dr. Segal reports participation in the Scientific Advisory Board of NextCure. Dr. Warner reports funding to institution from NIH/NCI, Brown Physicians Inc and AACR; personal consulting from Westat, Landmark Medical Center; Support for attending meetings and/or travel from NIH/NCI; and unpaid leadership role in HemOnc.org LLC. All others (Accordino, Balanchivadze, Bhatt, Bodin, Ferrara, Hsu, Jani, Labaki, Mariano, Mavromatis, Morgans, Nanchal, Nonato, Oligino, Puc, Saad, Saliby, Singh N, Singh S., Vieira, Wise-Draper, and Yu) have nothing to report.

Figures

**Fig. 1**
Flowchart representing the number of patients included overall, and within each study group.

**Fig. 2**
The Effect size plots of (a) cardiac complications and (b) cardiovascular events in patients with cancer after SARS-CoV-2 infection. a: FV: received 2 or more doses of mRNA COVID-19 vaccines; NV: did not receive any COVID-19 vaccine. b: Others included: remission or no evidence of disease, active and responding to treatment, or active and stable disease. c: Had been taking a given medication prior to SARS-CoV-2 infection. d: Had received a given therapy within 3 months prior to SARS-CoV-2 infection. Anticoagulants included vitamin K antagonists, low-molecular weight heparin, unfractionated heparin, direct thrombin inhibitors, direct factor Xa inhibitors, and Fondaparinux.

See this image and copyright information in PMC

References

1. Patone M., Mei X., Handunnetthi L., et al. Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection. Nat Med. 2022;28(2):410–422. - PMC - PubMed
1. Xie Y., Xu W., Bowe B., Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583–590. - PMC - PubMed
1. Katsoularis I., Fonseca-Rodríguez O., Farrington P., et al. Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study. BMJ. 2022;377 doi: 10.1136/bmj-2021-069590. - DOI - PMC - PubMed
1. Block J., Boehmer T., Forrest C., et al. Cardiac complications after SARS-CoV-2 infection and mRNA COVID-19 vaccination - PCORnet, United States, january 2021-January 2022. MMWR Morb Mortal Wkly Rep. 2022;71(14):517–523. - PMC - PubMed
1. Chudzik M., Lewek J., Kapusta J., Banach M., Jankowski P., Bielecka-Dabrowa A. Predictors of long COVID in patients without comorbidities: data from the polish long-COVID cardiovascular (PoLoCOV-CVD) study. J Clin Med. 2022;11(17):4980. - PMC - PubMed

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Associations of COVID-19 vaccination with risks for post-infectious cardiovascular complications: an international cohort study in cancer patients with SARS-CoV-2 infection

Affiliations

Associations of COVID-19 vaccination with risks for post-infectious cardiovascular complications: an international cohort study in cancer patients with SARS-CoV-2 infection

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Miscellaneous