COVID-19 and Stroke Facts

Since the COVID-19 pandemic began, scientists have studied the disease’s short-term and long-term impacts. Research has looked into whether COVID-19 can cause other health complications like strokes.

Studies have found that there is a higher risk of stroke after infection with SARS-CoV-2, the virus that causes COVID-19. Here’s what to know.

COVID-19 and Stroke Risk

In the early days of COVID-19, data showed a significant increase in stroke risk associated with COVID-19. As time passed, the size of the risk dropped. COVID-19 does cause an increased risk of stroke — just not as much as what was once feared.

“Very early evidence coming out, we had seen an alarming rate of stroke associated with COVID,” says Nirav Bhatt, MD, assistant professor, neurology, University of Pittsburgh School of Medicine, and associate director, UPMC Stroke Institute, Presbyterian University Hospital.

“As we have developed more data, we learned that the risk of stroke associated with COVID infection was modestly higher than that in the non-COVID patients.”

A February 2022 study in the journal Nature showed people who recovered from COVID-19 had a 52% higher risk of stroke compared to a contemporary control group of people who did not have COVID-19.

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How COVID-19 Causes Stroke

COVID-19 can lead to stroke in different ways.

The first is through inflammation. As the body fights an infection, it can cause inflammation in multiple organ systems, including the blood.

“It creates more tendency of the blood to form clots,” Dr. Bhatt says. This can make the blood more likely to form clots, which can increase the risk of stroke.

Another potential stroke cause happens when SARS-CoV-2 attaches itself to cells in the blood vessels known as ACE2 receptors. That allows the virus to integrate into the blood vessel wall, which causes more inflammation and the potential for clots and stroke.

“The ACE2 receptor is a receptor in the blood vessels,” Dr. Bhatt says. “COVID gains entry into the blood vessels from the ACE2 receptor, and it causes changes within the blood vessel that allows clot formation within the blood vessels.”

Who’s at Risk of COVID-Related Stroke?

Many studies have shown that people who have coexisting vascular risk factors are at higher risk of a stroke after having COVID-19. Those risk factors include age, hypertension, diabetes, and heart disease, among others.

Older adults — ages 60 and above — are more at risk of stroke than younger age groups, Dr. Bhatt says.

One study presented at the American Stroke Association’s International Stroke Conference 2022 reported the risk was higher in people 65 to 74 years old than in people 85 and older.

Other medical conditions are also risk factors for COVID-related strokes. Medical conditions that could cause an increased risk of stroke after COVID-19 include:

  • Previous stroke.
  • Heart disease.
  • Diabetes.
  • High blood pressure.
  • High cholesterol.
  • Obesity.
  • Smoking.

Researchers are studying other potential links between COVID-19 and stroke. Some studies have shown social and demographic disparities in stroke incidence and outcomes related to COVID. But some of these disparities seem to result from preexisting vascular risk factors, and definitive evidence to substantiate these disparities is lacking.

“Some of the studies are limited in what populations they have been looking at,” Dr. Bhatt says. “And we have to take into consideration how much of this risk is actually being contributed just by COVID and not by the other risk factors.”

More research is necessary for any conclusive answers. That’s especially the case as COVID-19 and SARS-CoV-2 continue to evolve, Dr. Bhatt says.

“In the last two years, we’ve made such rapid advances and the information has changed so very rapidly,” he says. “And I believe with evolving COVID-related variants, we will have more and more variable information.”

Preventing COVID-Related Stroke

There are three key ways to lower your risk of COVID-related stroke.

1. Getting the COVID-19 vaccine lowers your risk of infection. It also can prevent severe illness, which in turn can reduce your risk of complications like stroke. An analysis published in the journal Neurology reported that vaccinated people were 200 times less likely to have a stroke than someone who got hospitalized with COVID-19 and had not gotten vaccinated. The vaccine does not increase your risk of stroke, according to the study.

2. Managing chronic health conditions, such as high blood pressure, is important because they increase your risk. Eating a healthy diet, getting regular exercise, taking prescribed medications, and avoiding smoking are all ways to lower your risk.

3. Seeking care when you need it is crucial. During the pandemic, many people delayed or avoided routine care because of fears of infection. Some people avoided going to the emergency department even when they had chest pain or signs of stroke. People with acute symptoms should seek immediate care, Dr. Bhatt says.

You can remember the warning signs of stroke with the acronym BE FAST:

  • Balance: Sudden loss of balance.
  • Eyes: Sudden double vision or loss of vision.
  • Face: One side of the face drooping.
  • Arms: Weakness or numbness in one arm.
  • Speech: Slurred speech.
  • Time: Be fast and call 911 right away!

“Bottom line, the three big things to prevent stroke from COVID are vaccination No. 1,” Dr. Bhatt says. “Then is cardiovascular prevention in terms of a healthy, balanced diet, no smoking, preventing diabetes, physical exercise, control your cholesterol, and so on.

“And then, finally, when you have a problem, seek timely care because stroke is a very time-sensitive condition. If you delay treatments, then we will not be able to prevent the disabilities and sometimes even devastating consequences for patients. We have all the resources to take care of patients in a timely manner if they seek care.”

At UPMC, we provide comprehensive stroke care. From diagnosis to treatment to prevention, our experts can help. To find stroke care at a UPMC location near you, visit our website.

American Heart Association, Stroke Risk Among Older Adults Highest in First 3 Days After COVID-19 Diagnosis. Link

Cedars Sinai, New Data Show COVID-19 Vaccine Does Not Raise Stroke Risk. Link

Saima May Sidik, Nature, Heart-Disease Risk Soars After COVID — Even With a Mild Case. Link

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