Accelerated vascular ageing after COVID-19 infection: the CARTESIAN study

Rosa Maria Bruno; Smriti Badhwar; Leila Abid; Mohsen Agharazii; Fabio Anastasio; Jeremy Bellien; Otto Burghuber; Luca Faconti; Jan Filipovský; Lorenzo Ghiadoni; Cristina Giannattasio; Bernhard Hametner; Alun D. Hughes; Ana Jeroncic; Ignatios Ikonomidis; Mai Tone Lonnebakken; Alessandro Maloberti; Christopher C. Mayer; Maria Lorenza Muiesan; Anna Paini; Andrie Panayiotou; Chloe Park; Chakravarthi Rajkumar; Carlos Ramos Becerra; Bart Spronck; Dimitrios Terentes-Printzios; Yesim Tuncok; Thomas Weber; Pierre Boutouyrie; CARTESIAN Investigators; COVID-HOP study group

doi:10.1093/eurheartj/ehaf430

Accelerated vascular ageing after COVID-19 infection: the CARTESIAN study

Rosa Maria Bruno^*, Smriti Badhwar, Leila Abid, Mohsen Agharazii, Fabio Anastasio, Jeremy Bellien, Otto Burghuber, Luca Faconti, Jan Filipovský, Lorenzo Ghiadoni, Cristina Giannattasio, Bernhard Hametner, Alun D. Hughes, Ana Jeroncic, Ignatios Ikonomidis, Mai Tone Lonnebakken, Alessandro Maloberti, Christopher C. Mayer, Maria Lorenza Muiesan, Anna PainiAndrie Panayiotou, Chloe Park, Chakravarthi Rajkumar, Carlos Ramos Becerra, Bart Spronck, Dimitrios Terentes-Printzios, Yesim Tuncok, Thomas Weber, Pierre Boutouyrie, CARTESIAN Investigators, COVID-HOP study group

^*Corresponding author for this work

Macquarie Medical School

Research output: Contribution to journal › Article › peer-review

17 Citations (Scopus)

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Abstract

Background and Aims Increasing evidence suggests that COVID-19 survivors experience long-term cardiovascular complications possibly through Aims development of vascular damage. The study aimed to investigate whether accelerated vascular ageing occurs after COVID-19 infection, and if so, identify its determinants. Methods This prospective, multicentric, cohort study, included 34 centres in 16 countries worldwide, in 4 groups of participants—COVID-19-negative controls (ⅰ) and three groups of individuals with recent (6 ± 3 months) exposure to SARS-CoV-2: not hospitalized (ⅱ), hospitalized in general wards (ⅲ), and hospitalized in intensive care units (ⅳ). The main outcome was carotid-femoral pulse wave velocity (PWV), an established biomarker of large artery stiffness. Results 2390 individuals (age 50 ± 15 years, 49.2% women) were recruited. After adjustment for confounders, all COVID-19-positive groups showed higher PWV (+0.41, +0.37, and +0.40 m/s for groups 2–4, P < .001, P = .001 and P = .003) vs. controls [PWV 7.53 (7.09; 7.97) m/s adjusted mean (95% CI)]. In sex-stratified analyses, PWV differences were significant in women [PWV (+0.55, +0.60, and +1.09 m/s for groups 2–4, P < .001 for all)], but not in men. Among COVID-19 positive women, persistent symptoms were associated with higher PWV, regardless of disease severity and cardiovascular confounders [adjusted PWV 7.52 (95% CI 7.09; 7.96) vs. 7.13 (95% CI 6.67; 7.59) m/s, P < .001]. A stable or improved PWV after 12 months was found in the COVID+ groups, whereas a progression was observed in the COVID− group. Conclusions COVID-19 is associated with early vascular ageing in the long term, especially in women.

Original language	English
Pages (from-to)	3905-3918
Number of pages	14
Journal	European Heart Journal
Volume	46
Issue number	39
DOIs	https://doi.org/10.1093/eurheartj/ehaf430
Publication status	Published - 14 Oct 2025

Bibliographical note

Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

A correction exists for this article and can be found in European Heart Journal 46(45) 1 December 2025, p. 4984, at doi: 10.1093/eurheartj/ehaf709. The original has been updated.

Keywords

Arterial stiffness
COVID-19
Long COVID
Sex differences
Vascular ageing

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10.1093/eurheartj/ehaf430Licence: CC BY-NC

Publisher version (open access)Final published version, 4 MBLicence: CC BY-NC

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Bruno, R. M., Badhwar, S., Abid, L., Agharazii, M., Anastasio, F., Bellien, J., Burghuber, O., Faconti, L., Filipovský, J., Ghiadoni, L., Giannattasio, C., Hametner, B., Hughes, A. D., Jeroncic, A., Ikonomidis, I., Lonnebakken, M. T., Maloberti, A., Mayer, C. C., Muiesan, M. L., ... COVID-HOP study group (2025). Accelerated vascular ageing after COVID-19 infection: the CARTESIAN study. European Heart Journal, 46(39), 3905-3918. https://doi.org/10.1093/eurheartj/ehaf430

@article{a271fda7defd454ba39a67cb7aa698f1,

title = "Accelerated vascular ageing after COVID-19 infection: the CARTESIAN study",

abstract = "Background and Aims Increasing evidence suggests that COVID-19 survivors experience long-term cardiovascular complications possibly through Aims development of vascular damage. The study aimed to investigate whether accelerated vascular ageing occurs after COVID-19 infection, and if so, identify its determinants. Methods This prospective, multicentric, cohort study, included 34 centres in 16 countries worldwide, in 4 groups of participants—COVID-19-negative controls (ⅰ) and three groups of individuals with recent (6 ± 3 months) exposure to SARS-CoV-2: not hospitalized (ⅱ), hospitalized in general wards (ⅲ), and hospitalized in intensive care units (ⅳ). The main outcome was carotid-femoral pulse wave velocity (PWV), an established biomarker of large artery stiffness. Results 2390 individuals (age 50 ± 15 years, 49.2\% women) were recruited. After adjustment for confounders, all COVID-19-positive groups showed higher PWV (+0.41, +0.37, and +0.40 m/s for groups 2–4, P < .001, P = .001 and P = .003) vs. controls [PWV 7.53 (7.09; 7.97) m/s adjusted mean (95\% CI)]. In sex-stratified analyses, PWV differences were significant in women [PWV (+0.55, +0.60, and +1.09 m/s for groups 2–4, P < .001 for all)], but not in men. Among COVID-19 positive women, persistent symptoms were associated with higher PWV, regardless of disease severity and cardiovascular confounders [adjusted PWV 7.52 (95\% CI 7.09; 7.96) vs. 7.13 (95\% CI 6.67; 7.59) m/s, P < .001]. A stable or improved PWV after 12 months was found in the COVID+ groups, whereas a progression was observed in the COVID− group. Conclusions COVID-19 is associated with early vascular ageing in the long term, especially in women.",

keywords = "Arterial stiffness, COVID-19, Long COVID, Sex differences, Vascular ageing",

author = "Bruno, \{Rosa Maria\} and Smriti Badhwar and Leila Abid and Mohsen Agharazii and Fabio Anastasio and Jeremy Bellien and Otto Burghuber and Luca Faconti and Jan Filipovsk{\'y} and Lorenzo Ghiadoni and Cristina Giannattasio and Bernhard Hametner and Hughes, \{Alun D.\} and Ana Jeroncic and Ignatios Ikonomidis and Lonnebakken, \{Mai Tone\} and Alessandro Maloberti and Mayer, \{Christopher C.\} and Muiesan, \{Maria Lorenza\} and Anna Paini and Andrie Panayiotou and Chloe Park and Chakravarthi Rajkumar and Becerra, \{Carlos Ramos\} and Bart Spronck and Dimitrios Terentes-Printzios and Yesim Tuncok and Thomas Weber and Pierre Boutouyrie and \{CARTESIAN Investigators\} and Herta Almhofer and Kathen Danninga and Margot Algner and Martin Wernhart and Mohammad Azizzadeh and Breyer, \{Marie Kathrin\} and Luiz Bortolotto and Vilela-Martin, \{Jose Fernando\} and \{Toshiro Passos Okawa\}, Rog{\'e}rio and \{Lyrio Bermudes Okawa\}, Jaqueline and \{Sebba Barroso\}, \{Weimar Kunz\} and \{Gomes Ciolac\}, Emmanuel and \{do Amaral\}, \{Vanessa Teixeira\} and Bianca Fernandez and R{\'e}mi Goupil and Catherine Fortier and Galatia Photiou and Otto Mayer and Jitka Seidlerov{\'a} and Petr Pazdiora and Jana Hirmerov{\'a} and Lucie {\v S}ustkov{\'a} and Simona B{\'i}lkov{\'a} and J{\'u}lius Gel{\v z}insk{\'y} and Veronika Kord{\'i}kov{\'a} and {\v S}t{\v e}p{\'a}n Mare{\v s} and Renata C{\'i}fkov{\'a} and Peter Wohlfahrt and Jana Kaval{\'i}rov{\'a} and Hakim Khettab and Junior Justin and Diego Moriconi and Saverio Fabbri and Hulot, \{Jean Sebastien\} and Antoine Fayol and Marie Courbebaisse and Beatrice Parfait and David Lebeaux and G{\'e}rard Friedlander and \{COVID-HOP study group\} and Robinson Joannides and Michele Iacob and Leroi, \{Anne Marie\} and Athanase Benetos and Ioannis Georgiopoulos and Georgia Christopoulou and Konstantinos Tsioufis and Vasiliki Gardikioti and Charalambos Vlachopoulos and Vaia Lambadiari and Alkaternini Kountouri and Konstantinos Katogiannis and Mario Podrug and Mirela Pavi{\v c}i{\'c}-Ivelja and Pjero Koren and Massimo Salvetti and Marco Cacciatore and Giacomo Pucci and Elisa Scarnecchia and Michela Algeri and Antonella Moreo and Chiara Tognola and Andrea Grillo and Bruno Fabris and Stella Bernardi and Matteo Rovina and \{Di Pierro\}, Giuliano and Sabina Armenia and Elisabetta Bianchini and Luca Zanoli and Pietro Castellino and Arturo Montineri and Alice Sciuto and Davide Grassi and Jolita Badariene and Ligita Ryliskyte and Agne Laucyte-Cibulskiene and Ligita Jancoriene and Kristina Ryliskiene and Agne Juceviciene and Milda Kovaite and Laura Balkeviciene and Guillermos Alanis-S{\'a}nchez and Pedro Martinez-Ayala and Cardona-Mu{\~n}{\'o}z, \{Ernesto G.\} and David Cardona-Muller and Berge, \{Caroline Annette\} and Lucimere Bohn and Jos{\'e} Oliveira and Emilia Alves and Costa, \{Simao Pedro\} and Telmo Pereira and Armando Caseiro and F{\'a}bio Lira and \{Bernal L{\'o}pez\}, \{Maria Rosa\} and \{Ruiz Moreno\}, \{Mar{\'i}a Isabel\} and \{G{\'o}mez Huelgas\}, Ricardo and \{Lopez Sampalo\}, Almudena and \{Sanz Canovas\}, Jaime and \{Vargas Cancela\}, \{Victor Antonio\} and \{Cobos Palacios\}, Lidia and \{Mancebo Sevilla\}, \{Juan Jos{\'e}\} and Zeka, \{Arzu Nazlı\} and Ebru {\"O}zpelit and Canet İncir and Barı{\c s}, \{Mustafa M.\} and Ali Canturk and Cimilli, \{Hasan Can\} and Salem Abdessalem and Selma Charfeddine and Amine Bahloul and Rania Hammami and Mahdi Walha and Alexandra Jamieson and Chowienczyk, \{Philip J.\} and Bushra Farukh and Riaz Akhtar and Alena Shantsila and Gregory Lip and Gurovich, \{Alvaro N.\} and Manuel Gomez and Lee Stoner and Michelle Meyer and Erik Hanson and Gabriel Zieff and Lassalle, \{Patricia Pagan\} and Lauren Bates",

note = "Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher. A correction exists for this article and can be found in European Heart Journal 46(45) 1 December 2025, p. 4984, at doi: 10.1093/eurheartj/ehaf709. The original has been updated.",

year = "2025",

month = oct,

day = "14",

doi = "10.1093/eurheartj/ehaf430",

language = "English",

volume = "46",

pages = "3905--3918",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "39",

}

Bruno, RM, Badhwar, S, Abid, L, Agharazii, M, Anastasio, F, Bellien, J, Burghuber, O, Faconti, L, Filipovský, J, Ghiadoni, L, Giannattasio, C, Hametner, B, Hughes, AD, Jeroncic, A, Ikonomidis, I, Lonnebakken, MT, Maloberti, A, Mayer, CC, Muiesan, ML, Paini, A, Panayiotou, A, Park, C, Rajkumar, C, Becerra, CR, Spronck, B, Terentes-Printzios, D, Tuncok, Y, Weber, T, Boutouyrie, P, CARTESIAN Investigators & COVID-HOP study group 2025, 'Accelerated vascular ageing after COVID-19 infection: the CARTESIAN study', European Heart Journal, vol. 46, no. 39, pp. 3905-3918. https://doi.org/10.1093/eurheartj/ehaf430

TY - JOUR

T1 - Accelerated vascular ageing after COVID-19 infection

T2 - the CARTESIAN study

AU - Bruno, Rosa Maria

AU - Badhwar, Smriti

AU - Abid, Leila

AU - Agharazii, Mohsen

AU - Anastasio, Fabio

AU - Bellien, Jeremy

AU - Burghuber, Otto

AU - Faconti, Luca

AU - Filipovský, Jan

AU - Ghiadoni, Lorenzo

AU - Giannattasio, Cristina

AU - Hametner, Bernhard

AU - Hughes, Alun D.

AU - Jeroncic, Ana

AU - Ikonomidis, Ignatios

AU - Lonnebakken, Mai Tone

AU - Maloberti, Alessandro

AU - Mayer, Christopher C.

AU - Muiesan, Maria Lorenza

AU - Paini, Anna

AU - Panayiotou, Andrie

AU - Park, Chloe

AU - Rajkumar, Chakravarthi

AU - Becerra, Carlos Ramos

AU - Spronck, Bart

AU - Terentes-Printzios, Dimitrios

AU - Tuncok, Yesim

AU - Weber, Thomas

AU - Boutouyrie, Pierre

AU - CARTESIAN Investigators

AU - Almhofer, Herta

AU - Danninga, Kathen

AU - Algner, Margot

AU - Wernhart, Martin

AU - Azizzadeh, Mohammad

AU - Breyer, Marie Kathrin

AU - Bortolotto, Luiz

AU - Vilela-Martin, Jose Fernando

AU - Toshiro Passos Okawa, Rogério

AU - Lyrio Bermudes Okawa, Jaqueline

AU - Sebba Barroso, Weimar Kunz

AU - Gomes Ciolac, Emmanuel

AU - do Amaral, Vanessa Teixeira

AU - Fernandez, Bianca

AU - Goupil, Rémi

AU - Fortier, Catherine

AU - Photiou, Galatia

AU - Mayer, Otto

AU - Seidlerová, Jitka

AU - Pazdiora, Petr

AU - Hirmerová, Jana

AU - Šustková, Lucie

AU - Bílková, Simona

AU - Gelžinský, Július

AU - Kordíková, Veronika

AU - Mareš, Štěpán

AU - Cífková, Renata

AU - Wohlfahrt, Peter

AU - Kavalírová, Jana

AU - Khettab, Hakim

AU - Justin, Junior

AU - Moriconi, Diego

AU - Fabbri, Saverio

AU - Hulot, Jean Sebastien

AU - Fayol, Antoine

AU - Courbebaisse, Marie

AU - Parfait, Beatrice

AU - Lebeaux, David

AU - Friedlander, Gérard

AU - COVID-HOP study group

AU - Joannides, Robinson

AU - Iacob, Michele

AU - Leroi, Anne Marie

AU - Benetos, Athanase

AU - Georgiopoulos, Ioannis

AU - Christopoulou, Georgia

AU - Tsioufis, Konstantinos

AU - Gardikioti, Vasiliki

AU - Vlachopoulos, Charalambos

AU - Lambadiari, Vaia

AU - Kountouri, Alkaternini

AU - Katogiannis, Konstantinos

AU - Podrug, Mario

AU - Pavičić-Ivelja, Mirela

AU - Koren, Pjero

AU - Salvetti, Massimo

AU - Cacciatore, Marco

AU - Pucci, Giacomo

AU - Scarnecchia, Elisa

AU - Algeri, Michela

AU - Moreo, Antonella

AU - Tognola, Chiara

AU - Grillo, Andrea

AU - Fabris, Bruno

AU - Bernardi, Stella

AU - Rovina, Matteo

AU - Di Pierro, Giuliano

AU - Armenia, Sabina

AU - Bianchini, Elisabetta

AU - Zanoli, Luca

AU - Castellino, Pietro

AU - Montineri, Arturo

AU - Sciuto, Alice

AU - Grassi, Davide

AU - Badariene, Jolita

AU - Ryliskyte, Ligita

AU - Laucyte-Cibulskiene, Agne

AU - Jancoriene, Ligita

AU - Ryliskiene, Kristina

AU - Juceviciene, Agne

AU - Kovaite, Milda

AU - Balkeviciene, Laura

AU - Alanis-Sánchez, Guillermos

AU - Martinez-Ayala, Pedro

AU - Cardona-Muñóz, Ernesto G.

AU - Cardona-Muller, David

AU - Berge, Caroline Annette

AU - Bohn, Lucimere

AU - Oliveira, José

AU - Alves, Emilia

AU - Costa, Simao Pedro

AU - Pereira, Telmo

AU - Caseiro, Armando

AU - Lira, Fábio

AU - Bernal López, Maria Rosa

AU - Ruiz Moreno, María Isabel

AU - Gómez Huelgas, Ricardo

AU - Lopez Sampalo, Almudena

AU - Sanz Canovas, Jaime

AU - Vargas Cancela, Victor Antonio

AU - Cobos Palacios, Lidia

AU - Mancebo Sevilla, Juan José

AU - Zeka, Arzu Nazlı

AU - Özpelit, Ebru

AU - İncir, Canet

AU - Barış, Mustafa M.

AU - Canturk, Ali

AU - Cimilli, Hasan Can

AU - Abdessalem, Salem

AU - Charfeddine, Selma

AU - Bahloul, Amine

AU - Hammami, Rania

AU - Walha, Mahdi

AU - Jamieson, Alexandra

AU - Chowienczyk, Philip J.

AU - Farukh, Bushra

AU - Akhtar, Riaz

AU - Shantsila, Alena

AU - Lip, Gregory

AU - Gurovich, Alvaro N.

AU - Gomez, Manuel

AU - Stoner, Lee

AU - Meyer, Michelle

AU - Hanson, Erik

AU - Zieff, Gabriel

AU - Lassalle, Patricia Pagan

AU - Bates, Lauren

N1 - Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher. A correction exists for this article and can be found in European Heart Journal 46(45) 1 December 2025, p. 4984, at doi: 10.1093/eurheartj/ehaf709. The original has been updated.

PY - 2025/10/14

Y1 - 2025/10/14

N2 - Background and Aims Increasing evidence suggests that COVID-19 survivors experience long-term cardiovascular complications possibly through Aims development of vascular damage. The study aimed to investigate whether accelerated vascular ageing occurs after COVID-19 infection, and if so, identify its determinants. Methods This prospective, multicentric, cohort study, included 34 centres in 16 countries worldwide, in 4 groups of participants—COVID-19-negative controls (ⅰ) and three groups of individuals with recent (6 ± 3 months) exposure to SARS-CoV-2: not hospitalized (ⅱ), hospitalized in general wards (ⅲ), and hospitalized in intensive care units (ⅳ). The main outcome was carotid-femoral pulse wave velocity (PWV), an established biomarker of large artery stiffness. Results 2390 individuals (age 50 ± 15 years, 49.2% women) were recruited. After adjustment for confounders, all COVID-19-positive groups showed higher PWV (+0.41, +0.37, and +0.40 m/s for groups 2–4, P < .001, P = .001 and P = .003) vs. controls [PWV 7.53 (7.09; 7.97) m/s adjusted mean (95% CI)]. In sex-stratified analyses, PWV differences were significant in women [PWV (+0.55, +0.60, and +1.09 m/s for groups 2–4, P < .001 for all)], but not in men. Among COVID-19 positive women, persistent symptoms were associated with higher PWV, regardless of disease severity and cardiovascular confounders [adjusted PWV 7.52 (95% CI 7.09; 7.96) vs. 7.13 (95% CI 6.67; 7.59) m/s, P < .001]. A stable or improved PWV after 12 months was found in the COVID+ groups, whereas a progression was observed in the COVID− group. Conclusions COVID-19 is associated with early vascular ageing in the long term, especially in women.

AB - Background and Aims Increasing evidence suggests that COVID-19 survivors experience long-term cardiovascular complications possibly through Aims development of vascular damage. The study aimed to investigate whether accelerated vascular ageing occurs after COVID-19 infection, and if so, identify its determinants. Methods This prospective, multicentric, cohort study, included 34 centres in 16 countries worldwide, in 4 groups of participants—COVID-19-negative controls (ⅰ) and three groups of individuals with recent (6 ± 3 months) exposure to SARS-CoV-2: not hospitalized (ⅱ), hospitalized in general wards (ⅲ), and hospitalized in intensive care units (ⅳ). The main outcome was carotid-femoral pulse wave velocity (PWV), an established biomarker of large artery stiffness. Results 2390 individuals (age 50 ± 15 years, 49.2% women) were recruited. After adjustment for confounders, all COVID-19-positive groups showed higher PWV (+0.41, +0.37, and +0.40 m/s for groups 2–4, P < .001, P = .001 and P = .003) vs. controls [PWV 7.53 (7.09; 7.97) m/s adjusted mean (95% CI)]. In sex-stratified analyses, PWV differences were significant in women [PWV (+0.55, +0.60, and +1.09 m/s for groups 2–4, P < .001 for all)], but not in men. Among COVID-19 positive women, persistent symptoms were associated with higher PWV, regardless of disease severity and cardiovascular confounders [adjusted PWV 7.52 (95% CI 7.09; 7.96) vs. 7.13 (95% CI 6.67; 7.59) m/s, P < .001]. A stable or improved PWV after 12 months was found in the COVID+ groups, whereas a progression was observed in the COVID− group. Conclusions COVID-19 is associated with early vascular ageing in the long term, especially in women.

KW - Arterial stiffness

KW - COVID-19

KW - Long COVID

KW - Sex differences

KW - Vascular ageing

UR - https://www.scopus.com/pages/publications/105018789737

UR - https://doi.org/10.1093/eurheartj/ehaf709

U2 - 10.1093/eurheartj/ehaf430

DO - 10.1093/eurheartj/ehaf430

M3 - Article

C2 - 40819656

AN - SCOPUS:105018789737

SN - 0195-668X

VL - 46

SP - 3905

EP - 3918

JO - European Heart Journal

JF - European Heart Journal

IS - 39

ER -

Accelerated vascular ageing after COVID-19 infection: the CARTESIAN study

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