Gloved hand holding COVID-19 vaccine in syringe on a background of SARS-CoV-2 particles
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Previous infection with SARS-CoV-2 increases the risk of cardiometabolic diseases such as diabetes, but vaccination seems to reduce this risk, show research findings from Cedars Sinai Medical Center in Los Angeles.

Individuals who had COVID-19 early in the pandemic, particularly serious infections, were more likely to develop diabetes, high blood pressure and high cholesterol than those not infected. For example, a study published last year suggests those who had COVID-19 had 62% increased risk for developing new onset type 1 or type 2 diabetes compared with the general population.

What is unclear is whether the less virulent Omicron variants also increase the risk for diabetes and other cardiometabolic health issues and whether vaccination against COVID-19 influences this risk.

To investigate further, Alan Kwan, a cardiologist and cardiac imaging researcher at Cedars-Sinai, and colleagues analyzed data from 23,709 patients with one or more COVID-19 infections, who were treated within the Cedars-Sinai Health System from March 2020 to June 2022. The average age of the cohort was 48 years and it was 54% female and 46% male.

As reported in JAMA Network Open, the researchers assessed the risk for a new onset cardiometabolic (diabetes, high blood pressure or high cholesterol) vs non-cardiometabolic diagnosis (eg. urinary tract infection) occurring 90 days after vs before infection while correcting for possible confounding factors such as age and sex. Timing of the infection (before or after emergence of Omicron) and COVID-19 vaccination status were also taken into account.

The researchers found that the risk of diabetes after Omicron infection was significantly elevated (58% increase in relative risk), after taking all possible confounders into account. However, the risk of high blood press or high cholesterol was not significantly linked to COVID-19 infection in this time period after correcting for confounding factors.

“In this cohort study, COVID-19 infection was associated with increased risk of diabetes… Our results suggest that this risk persisted as the Omicron variant became predominant, and the association remained even after accounting for temporal confounders,” write the researchers.

“Mechanisms contributing to postinfection diabetes risk remain unclear, although persistent inflammation contributing to insulin resistance is a proposed pathway.”

People with a prior COVID-19 vaccination were less likely to develop diabetes in the 90 days after infection, compared with unvaccinated individuals, at 7% vs 78% increased risk, respectively, compared with uninfected individuals. However, this difference was not statistically significant (P=0.08).

“Additional studies are needed to understand cardiometabolic sequelae of COVID-19 and whether COVID-19 vaccination attenuates risk of cardiometabolic disease,” note the researchers.

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