October 2025
Vascular ageing effects of COVID-19 more evident in women
Dr Sasha Ellery BM BCh
COVID-19 is associated with accelerated vascular ageing, particularly in women, according to findings from the international CARTESIAN study, published in the European Heart Journal. Survivors of COVID-19 showed increased arterial stiffness, a marker of early vascular ageing, six months after infection.
The prospective, multicentre study was conducted in 34 centres in 16 countries and involved 2390 individuals. Participants comprised COVID-19-negative controls and three groups of COVID-19- positive individuals: those not hospitalised, those hospitalised in general wards and those hospitalised in intensive care. Vascular ageing was assessed by carotid-femoral pulse wave velocity (PWV), a validated biomarker of arterial stiffness.
Compared with controls, all COVID-19-positive groups showed higher PWV values six months after infection, even after adjusting for confounders such as age, body mass index and smoking history. In sex-stratified analysis, however, the effect was confined to women. Female survivors of COVID-19 had significantly stiffer arteries than uninfected women, regardless of whether they had been hospitalised. In contrast, no significant differences were observed in men.
Professor Ravinay Bhindi, Interventional Cardiologist and Head of Cardiology at the Royal North Shore Hospital, Sydney, said the finding may reflect differences in immune system function.
‘Women mount stronger immune responses,’ he told Medicine Today, ‘which can protect them early but also increase susceptibility to prolonged autoimmune-related complications from COVID-19.’
The study also found that among women, persistent post-COVID-19 symptoms such as fatigue or breathlessness were linked to greater arterial stiffness regardless of disease severity or cardiovascular confounders. Vaccination appeared protective, with vaccinated women showing lower PWV than unvaccinated women.
‘Vaccination clearly reduces infection severity and lowers the risk of long-term cardiovascular damage – my work on the AUS-COVID study supports this,’ Professor Bhindi said.
Follow-up data at 12 months showed that arterial stiffness in survivors of COVID-19 remained stable or slightly improved, whereas uninfected controls showed the expected age-related progression. This suggested that COVID-19-related vascular ageing might partially recover over time.
In light of the findings from this study, Professor Bhindi recommended that GPs be alert to cardiovascular symptoms after COVID-19, especially in women, and consider earlier screening.
The study authors concluded that COVID-19 had lasting effects on vascular health and could contribute to future cardiovascular disease burden, particularly in women. They emphasised the importance of monitoring survivors for early vascular ageing and adjusting preventive strategies as needed.
‘We need to understand the biological drivers of these sex differences and track patients over the long term,’ Professor Bhindi said. ‘This would be the first step in creating and implementing more targeted interventions and tailored monitoring strategies.’