Research Summary

Viral Infections Linked to Increased Cardiovascular Risk: Global Systematic Review Highlights Preventive Role of Vaccination

Edited by:
Kate Young

Key Highlights:

  • SARS-CoV-2, influenza, HIV, hepatitis C virus, and herpes zoster were associated with elevated risks of coronary heart disease and stroke.
  • The greatest short-term risks occurred within weeks following acute viral infection.
  • Chronic viral infections were linked to long-term cardiovascular disease (CVD) risk.

A large systematic review and meta-analysis published in the Journal of the American Heart Association, evaluated data from 155 epidemiologic studies across five major databases to examine the relationship between viral infections and cardiovascular disease (CVD). The analysis found that several acute and chronic viral infections significantly increase the risk of coronary heart disease (CHD) and stroke, underscoring the importance of preventive measures such as vaccination to reduce cardiovascular burden globally.

Researchers followed the PRISMA guidelines and registered the study protocol with PROSPERO (CRD42024564888). Databases searched included MEDLINE, Embase, Web of Science, African-Wide Information, and the Cochrane Library through July 2024. Studies assessing viral infection and subsequent CVD risk—including CHD, stroke, or heart failure—were included if they reported adjusted risk estimates from cohort, case–control, or self-controlled case series (SCCS) designs. Random-effects meta-analyses were conducted using inverse variance weighting, and heterogeneity was assessed via I² and τ² statistics.

Study Findings

Analysis of 155 studies revealed significant associations between multiple viral infections and cardiovascular outcomes.

  • HIV infection increased the risk of CHD (RR 1.60; 95% CI, 1.38–1.85), stroke (RR 1.45; 95% CI, 1.26–1.67), and heart failure (RR 1.89; 95% CI, 1.46–2.44).
  • SARS-CoV-2 was linked to elevated risks of CHD (RR 1.74; 95% CI, 1.44–2.11) and stroke (RR 1.69; 95% CI, 1.23–2.31), particularly within 14 weeks post-infection.
  • Influenza infection showed a fourfold higher risk of acute myocardial infarction (IRR 4.01; 95% CI, 2.66–6.05) and fivefold higher risk of stroke (IRR 5.01; 95% CI, 3.41–7.37) in the first month after diagnosis.
  • Hepatitis C virus increased CHD (RR 1.27; 95% CI, 1.13–1.42) and stroke (RR 1.23; 95% CI, 1.04–1.46) risks, while herpes zoster raised CHD risk by 12% (RR 1.12; 95% CI, 1.08–1.15) and stroke risk by 18% (RR 1.18; 95% CI, 1.09–1.27).
    Evidence for other viruses—such as cytomegalovirus, hepatitis A, herpes simplex virus 1, human papillomavirus, dengue, and chikungunya—was less conclusive but suggested potential cardiovascular links.

Clinical Implications

The authors noted that both acute and chronic viral infections may trigger cardiovascular events through inflammatory, endothelial, and procoagulant pathways. Preventive interventions, including vaccination against influenza, SARS-CoV-2, and herpes zoster, could substantially reduce global CVD incidence. Integrating cardiovascular risk assessment into infectious disease management—particularly for HIV and HCV populations—was emphasized as a key preventive strategy.

“Influenza, SARS-CoV-2, HIV, hepatitis C virus, and herpes zoster were associated with an increased risk of major cardiovascular events,” the researchers concluded. “Vaccines may play an important role in preventing the risk of cardiovascular disease.”

Reference
Kawai K, Muhere CF, Lemos EV, Francis JM. Viral infections and risk of cardiovascular disease: systematic review and meta-analysis. J Am Heart Assoc. 2025;14:e042670. doi:10.1161/JAHA.125.042670.