COVID-19 infection appears to cause women’s blood vessels to age prematurely, potentially increasing their risk of heart disease, a new study says.

Women infected with COVID experienced about five additional years of blood vessel aging, even if they had a mild case, according to results published Aug. 17 in the European Heart Journal.

If a woman landed in the intensive care unit (ICU) with severe COVID, her blood vessels received up to 10 years of premature aging, results show.

“We know that COVID can directly affect blood vessels. We believe that this may result in what we call early vascular aging, meaning that your blood vessels are older than your chronological age and you are more susceptible to heart disease,” lead researcher Dr. Rosa Maria Bruno, a professor of clinical pharmacology at Université Paris Cité in France, said in a news release.

“If that is happening, we need to identify who is at risk at an early stage to prevent heart attacks and strokes,” Bruno added.

Men also experienced blood vessel aging as a result of COVID infection, but the effect was not statistically significant among the participants studied, researchers report.

For the study, researchers tested 2,400 people from 16 countries recruited between September 2020 and February 2022. 

The participants included people not infected by COVID, as well as COVID patients who didn’t require hospitalization, were treated in a hospital or had an infection severe enough to require time in an intensive care unit.

Researchers assessed each person’s vascular age with a device that measures how quickly a wave of blood pressure travels between the carotid artery in the neck and the femoral arteries of the legs.

This measurement is called carotid-femoral pulse wave velocity (PWV). The higher this number, the stiffer and older a person’s blood vessels have become, researchers said.

Measurements taken six months and a year after a person’s COVID infection showed that all three groups had stiffer arteries compared to those who were never infected:

• The average increase in PWV was 0.55 meters per second for women who had mild COVID and 0.6 meters per second for women hospitalized with COVID.

• For women treated in an ICU, the average increase in PWV was 1.09 meters per second.

Researchers said an increase of about 0.5 meters per second is “clinically relevant” and equivalent to aging of around five years. For example, it would increase risk of heart disease by about 3% in a 60-year-old woman.

People who had persistent symptoms of long COVID, such as shortness of breath or fatigue, were more likely to have prematurely aged arteries, researchers said.

In fact, this effect on the arteries might help explain some of the long COVID symptoms reported by as many as 40% of COVID patients, Dr. Behnood Bikdeli, a cardiologist at Harvard Medical School, noted in an accompanying editorial.

“Vascular injury — marked by endothelial dysfunction, inflammation and coagulation abnormalities — is a key mechanism driving these complications,” Bikdeli wrote.

On the other hand, people who had been vaccinated against COVID generally had arteries that were less stiff compared to the unvaccinated.

There are several potential explanations for why COVID might cause premature stiffening in the arteries, Bruno said.

“The COVID-19 virus acts on specific receptors in the body, called the angiotensin-converting enzyme 2 receptors, that are present on the lining of the blood vessels,” she said. “The virus uses these receptors to enter and infect cells. This may result in vascular dysfunction and accelerated vascular aging.”

Bruno said the body’s inflammation and immune responses, defenses against infection, may also be involved.

Immune response might also explain the difference between women and men, she said.

“Women mount a more rapid and robust immune response, which can protect them from infection,” Bruno said. “However, this same response can also increase damage to blood vessels after the initial infection.”

Doctors should perform vascular aging tests on COVID patients and treat those affected with drugs to lower their blood pressure and cholesterol, Bruno said. Lifestyle changes such as a healthy diet and regular exercise also can help protect their heart health.

“For people with accelerated vascular aging, it is important to do whatever possible to reduce the risk of heart attacks and strokes,” Bruno said.

The researchers plan to continue following participants to see whether their accelerated vascular aging actually leads to an increased risk of heart attack and stroke.