Sex Modifies the Effect of COVID-19 on Arterial Elasticity

Viruses. 2024 Jul 6;16(7):1089. doi: 10.3390/v16071089.

Abstract

There is limited long-term evidence on the effects of COVID-19 on vascular injury between male and female sex. An adult cohort of COVID-19 survivors (COVID+) and confirmed SARS-CoV-2 antibody-negative participants (COVID-) were prospectively enrolled. COVID+ participants who have documented the presence of persistent symptoms four weeks following infection were considered to have post-acute sequelae of COVID-19 (PASC). Non-invasive, FDA-approved EndoPAT (Endo-PAT2000) was used for endothelial assessment. COVID-(n = 94) were 1:1 propensity score matched to COVID+ (n = 151) on baseline covariates including sex. Among COVID+, 66.2% (n = 100) had PASC. Higher levels of coagulation marker, D-dimer (p = 0.001), and gut permeability marker, zonulin (p = 0.001), were associated with female sex. Estimated differences in augmentation index (AI) between COVID- (0.9 ± 17.2) and COVID+ (8.4 ± 15.7; p = 0.001) and between female and male sex (12.9 ± 1.9; p < .0001) were observed. Among COVID+ with PASC, the average AI (10.5 ± 1.6) was 9.7 units higher than COVID- (p < .0001) and 6.2 units higher compared to COVID+ with no PASC (p = 0.03). COVID+ PASC+ female sex had the highest AI (14.3 ± 1.9). The effects of SARS-CoV-2 infection on vascular function varies across strata of sex and female sex in the post-acute phase of COVID-19 have the worse arterial elasticity (highest AI).

Keywords: COVID-19; PASC; arterial stiffness; effect modification; endothelial dysfunction; long COVID; sex differences.

MeSH terms

  • Adult
  • Aged
  • Arteries / physiopathology
  • COVID-19* / physiopathology
  • Elasticity
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Humans
  • Male
  • Middle Aged
  • Post-Acute COVID-19 Syndrome
  • Prospective Studies
  • SARS-CoV-2*
  • Sex Factors
  • Vascular Stiffness

Substances

  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D

Grants and funding

This project was supported by the Clinical and Translational Science Collaborative of Northern Ohio which is funded by the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health, UM1TR004528. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.