Prior COVID-19 vaccination and reduced risk of cerebrovascular diseases among COVID-19 survivors

Sheng-Yin Chen; Tina Yi Jin Hsieh; Yao-Min Hung; Jae Won Oh; Shen-Kai Chen; Shiow-Ing Wang; Renin Chang; James Cheng-Chung Wei

doi:10.1002/jmv.29648

Prior COVID-19 vaccination and reduced risk of cerebrovascular diseases among COVID-19 survivors

J Med Virol. 2024 May;96(5):e29648. doi: 10.1002/jmv.29648.

Authors

Sheng-Yin Chen^{1

2

3}, Tina Yi Jin Hsieh^{4

5}, Yao-Min Hung^{6

7

8}, Jae Won Oh^{3

9

10}, Shen-Kai Chen¹¹, Shiow-Ing Wang^{12

13

14}, Renin Chang^{15

16

17

18}, James Cheng-Chung Wei^{13

19

20

21

22}

Affiliations

¹ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
² Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
³ Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.
⁴ Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, MA.
⁵ Department of Bioinformatics, Harvard Medical School, Boston, MA.
⁶ Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital Taitung Branch, Taiwan.
⁷ Master Program in Biomedicine, College of Science and Engineering, National Taitung University, Taitung, Taiwan.
⁸ College of Health and Nursing, Meiho University, Pingtung, Taiwan.
⁹ Department of Neurology, Brigham and Women's Hospital, Boston, MA.
¹⁰ Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA.
¹¹ Department of Education, Kaohsiung Chang Gung Memorial Hospital, Boston, Massachusetts, USA.
¹² Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
¹³ Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.
¹⁴ Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan.
¹⁵ Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
¹⁶ Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
¹⁷ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
¹⁸ Department of Recreation and Sports Management, Tajen University, Pintung, Taiwan.
¹⁹ Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.
²⁰ Department of Nursing, Chung Shan Medical University, Taichung, Taiwan.
²¹ Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
²² Office of Research and Development, Asia University, Taichung, Taiwan.

PMID: 38727032
DOI: 10.1002/jmv.29648

Abstract

The effects of COVID-19 vaccination on short-term and long-term cerebrovascular risks among COVID-19 survivors remained unknown. We conducted a national multi-center retrospective cohort study with 151 597 vaccinated and 151 597 unvaccinated COVID-19 patients using the TriNetX database, from January 1, 2020 to December 31, 2023. Patients baseline characteristics were balanced with propensity score matching (PSM). The outcomes were incident cerebrovascular diseases occurred between 1st and 30th days (short-term) after COVID-19 diagnosis. Nine subgroup analyses were conducted to explore potential effect modifications. We performed six sensitivity analyses, including evaluation of outcomes between 1st to 180th days, accounting for competing risk, and incorporating different variant timeline to test the robustness of our results. Kaplan-Meier curves and Log-Rank tests were performed to evaluate survival difference. Cox proportional hazards regressions were adopted to estimate the PSM-adjusted hazard ratios (HR). The overall short-term cerebrovascular risks were lower in the vaccinated group compared to the unvaccinated group (HR: 0.66, 95% CI: 0.56-0.77), specifically cerebral infarction (HR: 0.62, 95% CI: 0.48-0.79), occlusion and stenosis of precerebral arteries (HR: 0.74, 95% CI: 0.53-0.98), other cerebrovascular diseases (HR: 0.57, 95% CI: 0.42-0.77), and sequelae of cerebrovascular disease (HR: 0.39, 95% CI:0.23-0.68). Similarly, the overall cerebrovascular risks were lower in those vaccinated among most subgroups. The long-term outcomes, though slightly attenuated, were consistent (HR: 0.80, 95% CI: 0.73-0.87). Full 2-dose vaccination was associated with a further reduced risk of cerebrovascular diseases (HR: 0.63, 95% CI: 0.50-0.80) compared to unvaccinated patients. Unvaccinated COVID-19 survivors have significantly higher cerebrovascular risks than their vaccinated counterparts. Thus, clinicians are recommended to monitor this population closely for stroke events during postinfection follow-up.

Keywords: COVID‐19 vaccination; cohort study; strokes.

Publication types

Research Support, Non-U.S. Gov't
Multicenter Study

MeSH terms

Adult
Aged
COVID-19 Vaccines* / administration & dosage
COVID-19 Vaccines* / adverse effects
COVID-19* / epidemiology
COVID-19* / prevention & control
Cerebrovascular Disorders* / epidemiology
Cerebrovascular Disorders* / etiology
Female
Humans
Male
Middle Aged
Proportional Hazards Models
Retrospective Studies
Risk Factors
SARS-CoV-2 / immunology
Survivors / statistics & numerical data
Vaccination* / statistics & numerical data

Substances

COVID-19 Vaccines

Grants and funding

Chung Shan Medical University Hospital