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Multicenter Study
. 2025 Oct 14;46(39):3905-3918.
doi: 10.1093/eurheartj/ehaf430.

Accelerated vascular ageing after COVID-19 infection: the CARTESIAN study

Rosa Maria Bruno  1   2 , Smriti Badhwar  1 , Leila Abid  3 , Mohsen Agharazii  4 , Fabio Anastasio  5 , Jeremy Bellien  6 , Otto Burghuber  7   8 , Luca Faconti  9 , Jan Filipovsky  10 , Lorenzo Ghiadoni  11 , Cristina Giannattasio  12   13 , Bernhard Hametner  14 , Alun D Hughes  15 , Ana Jeroncic  16 , Ignatios Ikonomidis  17 , Mai Tone Lonnebakken  18   19 , Alessandro Maloberti  12   13 , Christopher C Mayer  14 , Maria Lorenza Muiesan  20 , Anna Paini  20 , Andrie Panayiotou  21 , Chloe Park  15 , Chakravarthi Rajkumar  22 , Carlos Ramos Becerra  23 , Bart Spronck  24   25 , Dimitrios Terentes-Printzios  26 , Yesim Tuncok  27 , Thomas Weber  28 , Pierre Boutouyrie  1   2 ; CARTESIAN Investigators
Collaborators, Affiliations
Multicenter Study

Accelerated vascular ageing after COVID-19 infection: the CARTESIAN study

Rosa Maria Bruno et al. Eur Heart J. .

Erratum in

Abstract

Background and aims: Increasing evidence suggests that COVID-19 survivors experience long-term cardiovascular complications possibly through development of vascular damage. The study aimed to investigate whether accelerated vascular ageing occurs after COVID-19 infection, and if so, identify its determinants.

Methods: This prospective, multicentric, cohort study, included 34 centres in 16 countries worldwide, in 4 groups of participants-COVID-19-negative controls (ⅰ) and three groups of individuals with recent (6 ± 3 months) exposure to SARS-CoV-2: not hospitalized (ⅱ), hospitalized in general wards (ⅲ), and hospitalized in intensive care units (ⅳ). The main outcome was carotid-femoral pulse wave velocity (PWV), an established biomarker of large artery stiffness.

Results: 2390 individuals (age 50 ± 15 years, 49.2% women) were recruited. After adjustment for confounders, all COVID-19-positive groups showed higher PWV (+0.41, +0.37, and +0.40 m/s for groups 2-4, P < .001, P = .001 and P = .003) vs. controls [PWV 7.53 (7.09; 7.97) m/s adjusted mean (95% CI)]. In sex-stratified analyses, PWV differences were significant in women [PWV (+0.55, +0.60, and +1.09 m/s for groups 2-4, P < .001 for all)], but not in men. Among COVID-19 positive women, persistent symptoms were associated with higher PWV, regardless of disease severity and cardiovascular confounders [adjusted PWV 7.52 (95% CI 7.09; 7.96) vs. 7.13 (95% CI 6.67; 7.59) m/s, P < .001]. A stable or improved PWV after 12 months was found in the COVID+ groups, whereas a progression was observed in the COVID- group.

Conclusions: COVID-19 is associated with early vascular ageing in the long term, especially in women.

Keywords: Arterial stiffness; COVID-19; Long COVID; Sex differences; Vascular ageing.

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Figures

Structured Graphical Abstract
Structured Graphical Abstract
COVID-19 effects on ARTErial StIffness and vascular AgeiNg: the CARTESIAN study. CI, COnfidence Intervals; COVID, Corona VIrus Disease; EVA, early vascular ageing; ICU, Intensive Care Unit; PWV, pulse wave velocity; SARS-COV2, Severe acute respiratory syndromecoronavirus 2.
Figure 1
Figure 1
Study population flowchart of the CARTESIAN study. BP, blood pressure; PWV, pulse wave velocity
Figure 2
Figure 2
PWV differences between disease groups in the overall population (A), in women (B) and in men (C). Hierarchical linear models are adjusted for fixed factors: age, BMI, diabetes, anti-HT drugs, smoking, established CV disease; random factors: device type, country income level. ICU, intensive care unit; PWV, pulse wave velocity
Figure 3
Figure 3
Disease-specific determinants of PWV in men and women. Hierarchical linear models are adjusted for fixed factors: age, BMI, diabetes, anti-HT drugs, smoking, established CV disease; random factors: device type, country income level. PWV, pulse wave velocity
Figure 4
Figure 4
Individual and groups averaged PWV changes between Visit 1 and Visit 2. Unadjusted values. ICU, intensive care unit; PWV, pulse wave velocity
See this image and copyright information in PMC

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