RSV Carries Year-Long Cardiovascular Risk in Older Adults, Study Finds

A nationwide Danish cohort study reports cardiovascular events up to 1 year after infection, comparable to that observed with influenza. | Image credit: insta_photos - stock.adobe.com

A nationwide Danish cohort study reports cardiovascular events up to 1 year after infection, comparable to that observed with influenza.

Respiratory syncytial virus (RSV) in adults aged 45 years and older is associated with a sustained increase in cardiovascular risk that persists for up to 1 year following the initial infection, according to a nationwide Danish cohort study. The study, published in JAMA Network Open, found that the magnitude of excess risk was comparable to that observed after influenza infection and was highest among hospitalized patients, older adults, and those with preexisting cardiovascular disease or diabetes.1

Investigators used linked Danish national health registries to evaluate the absolute excess risk of cardiovascular events following laboratory-confirmed RSV infection. The study included 8,747 adults with RSV infection, matched 1:1 with 8,747 individuals without RSV infection on age, sex, and a comprehensive set of comorbidities, including preexisting cardiovascular disease, diabetes, chronic respiratory disease, cancer, and immunocompromised conditions. The cohort's mean age was 71.8 years, and 57.6% were female. Participants were followed for up to 365 days after the first positive RSV polymerase chain reaction test. Absolute risk differences were calculated at 30 days and 365 days using cumulative incidence methods that accounted for the competing risk of death.

Over 1 year of follow-up, RSV-infected patients experienced 665 cardiovascular events compared with just 257 events in the uninfected group, translating to nearly 5 additional cardiovascular problems for every 100 people infected with RSV. Risk was highest within the first 30 days after infection, with a 30-day risk difference of 3.82 percentage points.

Arrhythmias and heart failure accounted for the largest components of excess risk. At 365 days, RSV infection was associated with a 2.81 percentage-point higher risk of arrhythmias and a 1.33 percentage-point higher risk of heart failure compared with no infection. Ischemic heart disease, stroke, and venous thromboembolism also occurred more frequently among RSV-infected individuals, although with smaller absolute risk differences. Inflammatory heart disease did not differ significantly between groups.

Among patients hospitalized for RSV infection, the 365-day excess risk of any cardiovascular event was 6.61 percentage points, whereas no statistically significant excess risk was observed among individuals who were not hospitalized. Approximately 69% of RSV-infected participants in the study experienced hospitalization.

Age was a major determinant of cardiovascular burden. Adults aged 85 to 94 years experienced a 365-day excess risk of 7.93 percentage points, compared with 0.91 percentage points among those aged 45 to 54 years. Preexisting cardiovascular disease was associated with the greatest absolute burden, with an excess risk of 11.95 percentage points over 1 year. Diabetes was also associated with elevated risk, corresponding to 7.50 additional cardiovascular events per 100 individuals. Even among participants without major baseline comorbidities, RSV infection was associated with a 3.14 percentage-point excess risk.

To contextualize these findings, investigators compared RSV infection with other clinical triggers of cardiovascular events, including influenza. When matched to individuals with influenza infection, RSV showed no significant difference in cardiovascular risk at either 30 days or 365 days, indicating a comparable long-term cardiovascular burden. “Our finding of comparable 1-year cardiovascular event rates between RSV and influenza infection is consistent with observations from French emergency department patients,”2 the authors note.

Overall, this nationwide analysis identifies RSV infection as an important contributor to cardiovascular morbidity in older adults, particularly among hospitalized patients and those with advanced age or cardiometabolic comorbidities. While the mechanisms underlying this prolonged risk remain unclear, the findings support heightened clinical awareness of cardiovascular complications following RSV infection.

References

1. Hviid A, Fischer TK, Biering-Sørensen T, Bech Svalgaard I. Cardiovascular events 1 year after respiratory syncytial virus infection in adults. JAMA Netw Open. 2025;8(12):e2547618. doi:10.1001/jamanetworkopen.2025.47618
2. Alamé K, Le Hingrat Q, Catoire P, et al. Comparison of patients presenting to emergency departments infected with respiratory syncytial virus versus influenza virus: A retrospective cohort study. J Clin Virol. 2025;177:105775. doi:10.1016/j.jcv.2025.105775