Early BP checks, diabetes, combined with healthy food habits and regular exercise, are key to slowing or reversing arterial stiffness.
Published Sep 01, 2025 | 8:00 AM ⚊ Updated Sep 01, 2025 | 8:00 AM
Representational image. Credit: iStock
Synopsis: The study quantified the vascular changes in women, reporting that “the average increase in PWV in women who had mild COVID was 0.55 meters per second, 0.60 in women hospitalised with COVID, and 1.09 for women treated in intensive care.” Women, particularly those experiencing lingering symptoms of long COVID such as fatigue and breathlessness, seem to be disproportionately affected.
A recent international study, known as the CARTESIAN study, has shed light on a lesser-known impact of COVID-19: its ability to accelerate the aging of blood vessels, particularly in women. The research, published in the European Heart Journal, examined the long-term effects of COVID-19 on vascular health using precise measurements like carotid-femoral pulse wave velocity (PWV).
The study shows that even mild COVID can make blood vessels age faster, which may increase the risk of heart problems. Normally, vessels stiffen with age, but COVID seems to speed up this process. Women, particularly those experiencing lingering symptoms of long COVID such as fatigue and breathlessness, seem to be disproportionately affected.
However, experts say that it is important to note that findings from international studies cannot always be directly applied to the Indian population. The exposure to infections, antibodies, and environmental conditions in India differs from many other countries, which can influence how COVID-19 affects vascular health.
Differences in immunity, lifestyle, and everyday practices mean that while the study provides valuable insights, the implications for India may not be identical, and local context needs to be considered when interpreting these results.
To uncover how COVID-19 affects blood vessels, the researchers looked at 2,390 people across 16 countries, with different experiences of the virus, from those who never had COVID to those who were hospitalised in intensive care. They measured vascular health using carotid-femoral pulse wave velocity (PWV), a test that shows how stiff the arteries are by tracking the speed of blood pressure waves between the neck and legs.
“The higher this measurement, the stiffer the blood vessels and the higher the vascular age of a person,” the study explained. Participants were checked six months after infection and again at 12 months, allowing researchers to see how the changes evolved over time.
After adjusting for factors like age, sex, and other cardiovascular risk determinants, the study found that “all three groups of patients who had been infected with COVID, including those with mild COVID, had stiffer arteries, compared to those who had not been infected.” The impact was stronger in women and in people who had long COVID symptoms like fatigue and shortness of breath.
The study quantified the vascular changes in women, reporting that “the average increase in PWV in women who had mild COVID was 0.55 meters per second, 0.60 in women hospitalised with COVID, and 1.09 for women treated in intensive care.”
Researchers noted that “an increase of around 0.5 meters per second is ‘clinically relevant’ and equivalent to ageing around five years, with a 3 percent increased risk of cardiovascular disease, in a 60-year-old woman.”
These findings highlight that women may face a disproportionately higher long-term cardiovascular risk after COVID, making awareness and early monitoring particularly important.
Vaccination seemed to help protect blood vessels. The study found that vaccinated people “generally had arteries that were less stiff than people who were unvaccinated.”
Over time, the vascular aging associated with COVID infection seemed to stabilise or improve slightly, providing hope for mitigating long-term cardiovascular consequences.
Authors also explained the possible mechanisms behind the accelerated vascular aging.
“The COVID-19 virus targets ACE2 receptors on blood vessel linings to enter cells, which can lead to stiffening and accelerated aging of the vessels. The body’s inflammation and immune responses may also play a role.”
The researchers plan to continue following the participants over the coming years to see whether this accelerated vascular aging leads to a higher risk of heart attacks and strokes, providing crucial long-term insights into post-COVID health.
Dr Vinod K, a Cardiac Anesthesiologist at Meitra Hospital, Calicut, said, applying international study findings directly to India is complex. “In India, to conduct such a study or apply the results, we need to carefully compare deaths before and after COVID and examine the data thoroughly,” he explained.
He pointed out that in India, post-mortems are generally only conducted in suspicious deaths, not in common cases. This limitation makes it challenging to replicate international research, which often relies on detailed post-mortem or hospital data.
Dr Vinod emphasised that “a very detailed comprehensive study must be taken in the Indian context,” and that such research requires experts, not just general doctors.
He stressed that results can vary depending on the questions being asked. For example, if the focus is on stroke, the study may show one outcome, while looking at other factors like diabetes or vascular thickening could produce a different result.
“The result of the study will vary as the question changes,” he noted.
Finally, he highlighted India’s unique environmental and immunity factors. Everyday exposure to pathogens, through food, water, and surroundings, means many people in India have stronger natural immunity compared to populations in other countries.
Because of these differences, Dr Vinod cautioned that applying findings from international studies on blood vessel aging directly to the Indian population may not provide an accurate picture, and careful local research is needed to understand the true impact.
Dr Jyotirmaya Dash, Senior Cardiologist, MGM Healthcare, Chennai, noted that COVID-19’s impact on the heart has been especially concerning among women and even in the younger population.
“We are seeing patients as young as 20–25 years developing heart attacks without warning, even after mild or moderate COVID,” he said.
This, he explained, is due to premature vascular ageing, where a 25-year-old may have blood vessels that look like those of a 40-year-old. Stiffer arteries lose elasticity, raising blood pressure and causing endothelial dysfunction, which in turn makes people more prone to coronary events and strokes.
Doctors can measure this stiffness through pulse-wave velocity tests, where “the faster the velocity, the stiffer the artery,” he said, adding that this accelerated vascular aging explains the rise in post-COVID complications.
He explained that women appear more affected than men during long COVID, with many showing greater vascular stiffness and higher rates of cardiac and vascular complications. The study suggested that women’s stronger immune response to COVID might paradoxically cause “more devastating outcomes in terms of vascular ageing.”
This immune overreaction can damage the endothelium – the inner lining of arteries – leading to dysfunction that triggers a cascade of health issues including metabolic syndrome, diabetes, erectile dysfunction, and heart attacks.
“This may be one reason why women are disproportionately affected,” he said, while cautioning that the exact cause is still uncertain.
Premature vascular aging after COVID doesn’t have to be permanent. While it “may not be 100 percent reversible,” many patients can recover significant vascular health with timely intervention, the cardiologist explained.
Early checks for blood pressure, diabetes, and cholesterol, combined with healthy food habits and regular exercise, are key to slowing or reversing arterial stiffness. On the other hand, neglecting these factors, uncontrolled sugar, high cholesterol, excess weight, and poor diet, can worsen vascular ageing.
He stressed that “lifestyle modification plays a major role,” pointing to reduced saturated fat, more fruits and vegetables, quitting smoking and alcohol, and daily walking as measures that can put vascular health into “reverse gear.”
Early assessment of vascular age and vessel elasticity, the doctor stressed, is vital in preventing long-term complications. He pointed out a disturbing post-COVID trend: unlike in the past when heart attacks often came with warning signs, many young people are now experiencing sudden deaths, collapsing in gyms, workplaces, or even at social events without prior symptoms.
To counter this, he urged shifting the mindset that cardiac checks are only needed after 40 or 50. Instead, people as young as 25 should begin screening for blood pressure, sugar, cholesterol, thyroid, and metabolic risks like obesity and diabetes.
He also emphasised the role of healthcare professionals and media in spreading awareness, since even healthy-looking young adults without habits like smoking or drinking are now at risk.
“We are losing young hearts,” he warned, calling for annual heart check-ups and vascular age assessments to prevent silent disasters later in life.
The doctor urged people of all ages, regardless of whether they had mild, moderate, or severe COVID, to undergo regular health checks. He recommended that everyone above 25 should make annual screenings a habit, not waiting for symptoms to appear.
Even simple tests like ECG, echocardiogram, treadmill testing, and basic blood work, including sugar, kidney and liver function, thyroid, and a full lipid profile, can provide a “mirror image” of heart and overall health. Advanced markers such as vascular stiffness assessments can further reveal whether one’s “heart age” matches their biological age.
“My personal advice is that even healthy people should get checked every year. Those with diabetes or blood pressure must consult their doctors regularly. By doing these small things at the right time, we can prevent needless suffering and reduce mortality in society,” he concluded.
(Edited by Amit Vasudev)
