Emerging evidence suggests that survivors of COVID-19 may face long-term cardiovascular complications.¹ A new study has investigated whether the infection accelerates vascular ageing. The CARTESIAN study (Covid-19 effects on ARTErial StIffness and vascular AgeiNg) aimed to assess this by measuring arterial stiffness in individuals following SARS-CoV-2 infection.²

The CARTESIAN study was a prospective, multicentric cohort study conducted across 34 centres in 16 countries. It enrolled 2,390 individuals (mean age 50 years; 49.2% women) who were categorised into four groups: a COVID-19-negative control group, and three groups of individuals with recent (6 ± 3 months) SARS-CoV-2 exposure, categorised by severity: not hospitalised, hospitalised in general wards, and hospitalised in an intensive care unit (ICU).

The primary outcome was carotid-femoral pulse wave velocity (PWV), an established biomarker of large artery stiffness and vascular ageing, measured at baseline and again at a 12-month follow-up.

After adjusting for confounding factors, all three COVID-19 positive groups demonstrated a significantly higher PWV compared to the control group. The adjusted mean PWV for controls was 7.53 m/s. In comparison, the PWV was higher by +0.41 m/s in the non-hospitalised group (p<0.001), +0.37 m/s in the hospitalised group (p=0.001), and +0.40 m/s in the ICU group (p=0.003).

A key finding emerged from a sex-stratified analysis. The increase in PWV was significant only in women, who showed a higher PWV across all COVID-19 severity groups compared to female controls (+0.55 m/s, +0.60 m/s, and +1.09 m/s for non-hospitalised, hospitalised, and ICU groups, respectively; p<0.001 for all). No significant differences were observed in men.

Among women who had COVID-19, those with persistent symptoms had a higher PWV than those without (7.52 m/s vs 7.13 m/s; p<0.001). At the 12-month follow-up, PWV levels in the COVID-19 positive groups were stable or had improved, whereas the control group showed a progression in PWV.

The findings suggest a link between COVID-19 infection and accelerated vascular ageing, with a pronounced effect in women that correlates with disease severity and the presence of long COVID symptoms. The CARTESIAN investigators concluded that 'COVID-19 is associated with early vascular ageing in the long term, especially in women'.²

The authors noted that further studies are needed to confirm these findings, explore the effects of vaccination and newer SARS-CoV-2 variants, and determine if these preclinical changes translate to an increase in clinical cardiovascular events.

This study was funded by the Artery Society, the Canadian Institutes of Health Research, Fondation Université de Paris, AXA research fund, Fondation Hopitaux de Paris-Hopitaux de France, and others.

References

1. Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28:583–90. https://doi.org/10.1038/s41591-022-01689-3

2. Bruno RM, Badhwar S, Abid L, et al. Accelerated vascular ageing after COVID-19 infection: the CARTESIAN study. Eur Heart J. 2025;46(39):3905–3918. https://doi.org/10.1093/eurheartj/ehaf430

Disclaimer: The information presented in this article is for educational purposes only. Any quotes included reflect the opinions of the individual quoted, and do not necessarily reflect the views of the publisher. The publisher does not guarantee the accuracy or completeness of the content and accepts no responsibility for any errors, or any consequences arising from its use.