Vascular Aging and Long-Term Cardiovascular Impact of COVID-19: Gender Perspectives

Amidst the broad health implications of COVID-19, its influence on vascular health emerges as a pressing concern. The pandemic's potential to fast-track vascular aging, with signals that may differ by sex, though current evidence remains preliminary, demands attention from clinicians and researchers, while estimates vary widely and high-quality longitudinal data are still emerging.

ACE2 and related pathways are implicated among multiple mechanisms—including endothelial inflammation, RAAS imbalance, and immune activation—that can contribute to oxidative stress and vascular stiffness, markers associated with accelerated vascular aging.

These pathways implicated in disease severity also inform ongoing vascular risk.

The emerging data reveals that COVID-19's cardiovascular footprint may carry long-term consequences. Studies suggest increased risks of thrombosis, vascular calcification, and even cognitive decline tied to neurovascular disruptions. Clinicians can reference contemporary guidance (e.g., AHA/ACC statements and NICE long COVID guidelines) for structured evaluation and follow-up.

These changes underscore interactions between SARS-CoV-2 pathology and common cardiometabolic comorbidities such as hypertension, diabetes, and dyslipidemia.

For patients concerned about these potential outcomes, the experience can be distressing. Particularly for women, emerging research signals possible differences by sex; in one cohort study, investigators estimated an apparent ~5-year increase in vascular age among women post-infection; results may not generalize across populations.

Despite an improved understanding of these processes, significant challenges remain in managing these risks, especially in the context of emerging variants. The landscape of cardiovascular health management is evolving with each new discovery, offering both challenges and opportunities for refining clinical practice. Advances in diagnostic technology now allow for more precise monitoring, further supporting these efforts—for example, arterial stiffness indices (e.g., pulse wave velocity), endothelial function testing, and microvascular imaging that align with earlier discussions of oxidative stress and vascular stiffness.

These findings are reshaping how clinicians anticipate and address health challenges in the post-acute period, including PASC (long COVID). Engaging with patients to address these emerging risks involves not only direct treatment but also evolving conversations about lifestyle modifications and routine monitoring. These discussions can be guided by contemporary consensus statements (e.g., NICE long COVID guidance and AHA scientific statements) to align with best practices.

Next steps include sex-aware risk stratification, guideline-informed monitoring, and multidisciplinary long COVID clinics—for example, integrating arterial stiffness assessments into routine follow-up for high-risk patients.

Key Takeaways:

• COVID-19 may accelerate vascular aging via multiple mechanisms involving endothelial dysfunction and immune activation, with sex differences still under investigation.
• Selected studies report long-term cardiovascular effects including thrombosis and potential neurovascular-related cognitive issues; clinicians can consult major society guidance for structured evaluation.
• Diagnostic follow-up can incorporate arterial stiffness indices, endothelial function testing, and microvascular imaging to track risk aligned with discussed mechanisms.
• Care pathways should emphasize sex-aware strategies, guideline-informed monitoring, and multidisciplinary support for patients with PASC.