Long after your fever breaks and your cough fades, a COVID-19 infection may still be quietly attacking your blood vessels. Even a mild COVID-19 infection may prematurely age your arteries by five years, a new international study suggests, especially if you're a woman.

The research shows that people who have recovered from COVID-19 have stiffer blood vessels, a sign of vascular aging. Having stiffer blood vessels raises the risk of heart attacks, stroke and other cardiovascular diseases. According to the study, the stiffening was clinically significant even in those people who weren't hospitalized, and it was most pronounced in women.

Across the board, the measures showed that the arteries of people infected with COVID-19 had aged significantly.

“We know that COVID-19 can directly affect blood vessels. We believe that this may result in what we call vascular aging, meaning that your blood vessels are older than your chronological age and you are more susceptible to heart disease,” lead researcher Rosa Maria Bruno, a professor in Clinical Pharmacology at Université Paris Cité in France, said in a media 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.

The research team looked at the records of nearly 2,400 participants from 16 countries including Austria, Australia, Brazil, Canada, Cyprus, France, Greece, Italy, Mexico, Norway, Turkey, the United Kingdom and the U.S. between September 2020 and February 2022. Their average age was 50. People in the study were divided into groups based on their COVID-19 infection status:

  • Those who had never had COVID-19
  • Those who had had COVID-19 but were never hospitalized
  • Those hospitalized for COVID-19
  • Those treated for COVID-19 in an ICU

The vascular health of participants was evaluated using carotid-femoral pulse wave velocity (PWV), which shows how fast blood travels from the arteries in your neck to those in your legs. The faster the wave, the stiffer the arteries. Measurements were taken at six months and again at 12 months, post-infection.

Across the board, the pulse wave velocity of all the people infected with COVID-19 was higher than normal, indicating their arteries had aged significantly compared to the control group who'd never had COVID-19. The stiffening was especially marked in women. It also increased with the severity of illness.

“One of the reasons for the difference between women and men could be differences in the function of the immune system. Women mount a more rapid and robust immune response, which can protect them from infection. However, this same response can also increase damage to blood vessels after the initial infection.”

Men also showed increased arterial stiffness, but to a lesser degree; and in men, vaccination status did not significantly impact vascular age. Among women, however, vaccinated individuals had significantly less stiffening, suggesting some protective effect.

What's causing this kind of damage? COVID-19 is known to attack ACE2 receptors, which are proteins found on the lining of blood vessels. Once inside, the virus can trigger inflammation and immune system responses that damage the vascular system. The combination of viral invasion and immune overreaction, especially in women, may explain the accelerated aging that's reported in the study.

If you've had COVID-19, especially if you're a woman or have lingering symptoms, it's a good idea to proactively protect your heart.

Those participants experiencing long COVID-19 symptoms, such as persistent fatigue and breathlessness, were more likely to show higher PWV. Again, this was found to be especially true in women.

An editorial accompanying the study, by cardiologists from Johns Hopkins and Brigham and Women's Hospital/Harvard Medical School, agrees that the research makes the case that COVID-19 has aged our arteries. It points out that now the question is whether we can find modifiable targets to prevent further aging from future surges of infection and mitigate adverse outcomes in those afflicted with COVID-19-induced vascular aging.

What does all this mean for you? If you've had COVID-19, especially if you're a woman or have lingering symptoms, it's a good idea to proactively protect your heart. This includes eating a heart-healthy diet, being active, staying at a healthy weight, quitting smoking and staying away from second-hand smoke, controlling your cholesterol, blood glucose and blood pressure, drinking alcohol only in moderation and managing stress.

You might also want to speak with your doctor about early heart screenings. Your arteries might be older than you think.

The study and editorial are published in European Heart Journal.