COVID-19 Infection Linked to Higher Heart Attack Risk Than Vaccination, New Study Finds

Since the COVID-19 pandemic, cardiologists, pharmacists, and health care professionals across the cardiovascular spectrum have struggled to determine whether the virus, or the vaccine against it, poses a threat to the heart. A new case-control study presented at the American Heart Association EPI|Lifestyle Scientific Sessions 2026 in Boston, Massachusetts, offers some of the clearest answers yet, drawing on the National Institutes of Health's All of Us Research Program.

Researchers from Georgia Southern University analyzed data from 2020 to 2022, constructing 2 parallel case-control studies, one examining acute myocardial infarction (MI) risk following COVID-19 infection and another following COVID-19 vaccination. Participants with prior heart disease or missing demographic data were excluded, leaving 70,282 participants in the infection study and 37,800 in the vaccination study.¹

The findings suggested that within a 90-day exposure window, COVID-19 infection was associated with nearly 5 times the odds of suffering an MI (adjusted OR, 4.81; 95% CI, 2.90-7.98). Conversely, any COVID-19 vaccine dose was not significantly associated with MI (adjusted OR, 1.11; 95% CI, 0.73-1.67), although a modest signal was observed with additional booster doses (adjusted OR, 1.60; 95% CI, 1.05-2.42).¹

Why COVID-19 Strains the Heart

The biological plausibility behind these findings is well established. SARS-CoV-2 can damage the myocardium through direct viral invasion or indirect mechanisms driven by systemic inflammation, immune-mediated injury, and dysregulation of the renin-angiotensin system. Myocardial injury affects roughly one-fourth of patients with COVID-19 and is associated with higher mortality rates and long-term sequelae.²

Imaging research has added a further dimension to the picture. Compared with uninfected patients, SARS-CoV-2–infected individuals showed faster coronary plaque growth, a higher incidence of high-risk plaque development (20.1% vs 15.8%), and more frequent coronary inflammation (27% vs 19.9%). These structural changes help explain why patients with SARS-CoV-2 infection appear to be at increased risk for MI, acute coronary syndrome, and stroke for up to a year following infection.³

Population-level data corroborate these findings. A large British Columbia cohort study found that SARS-CoV-2 infection was associated with a 34% higher risk of major adverse cardiovascular events, with the risk increasing substantially among those requiring hospitalization or intensive care unit admission, and accounted for approximately 7% of all incident cardiovascular events.⁴

Where Does Vaccination Fit In?

The Georgia Southern study’s vaccination findings align with a growing body of evidence suggesting vaccines do not meaningfully elevate MI risk—and may actively protect against it. A Bayesian meta-analysis found no increased risk of heart attack or stroke following COVID-19 vaccination overall, and a protective effect on both outcomes was observed after the third vaccine dose.²

Data from a nationwide Swedish cohort study published in the European Heart Journal similarly showed that risks for most serious cardiovascular outcomes were reduced after vaccination, particularly after the third dose, with HRs ranging from 0.69 to 0.81, whereas risks for myocarditis and pericarditis were transiently elevated 1 to 2 weeks after messenger RNA vaccination.⁵

The American College of Cardiology’s 2025 Concise Clinical Guidance reinforces this stance, noting that COVID-19 vaccination benefits include reduced risk of infection, severe disease, death, MI, COVID-19–induced myocarditis/pericarditis, stroke, atrial fibrillation, and long COVID symptoms.⁶

Implications for Pharmacy Practice

These data carry direct implications for pharmacists counseling patients, particularly those with existing cardiovascular risk factors. The vast majority of participants in both study arms were older than 64 years, White, taking cardiovascular medications, and had multiple comorbidities. These are precisely the patients pharmacists see daily at the prescription counter.¹

COVID-19 survivors face increased cardiovascular event risk compared with the general population, even after the acute infection phase, with worse long-term outcomes. Pharmacists are well positioned to flag unvaccinated or undervaccinated patients with cardiovascular histories, reinforce the safety profile of boosters, and address hesitancy rooted in concerns about cardiac adverse effects—concerns that the accumulated evidence suggests are far more warranted for the infection itself than for the vaccine.²

As the study authors conclude, by reducing serious infection, COVID-19 vaccination may also offer downstream cardiovascular protection. For pharmacy teams on the front lines of vaccine access and patient education, that message is worth carrying forward.¹

REFERENCES

1. Tome J, Cowan L, Fung IC, Sullivan K, Schwind JS. Acute myocardial infarction risk following COVID-19 infection and vaccination in the United States. Presented at: American Heart Association EPI|Lifestyle Scientific Sessions 2026; March 18, 2026; Boston, MA.

2. Del Prete A, Conway F, Della Rocca DG, et al. COVID-19, acute myocardial injury, and infarction. Card Electrophysiol Clin. 2022;14(1):29-39. doi:10.1016/j.ccep.2021.10.004

3. Dai N, Tang X, Hu Y, et al. SARS-CoV-2 infection association with atherosclerotic plaque progression at coronary CT angiography and adverse cardiovascular events. Radiology. 2025;314:e240876. doi:10.1148/radiol.240876

4. Velásquez García HA, Wong S, Jeong D, et al. Risk of major adverse cardiovascular events after SARS-CoV-2 infection in British Columbia: a population-based study. Am J Med. 2025;138(3):524-531.e34. doi:10.1016/j.amjmed.2024.04.010

5. Xu Y, Li H, Santosa A, et al. Cardiovascular events following coronavirus disease 2019 vaccination in adults: a nationwide Swedish study. Eur Heart J. 2025;46(2):147-157. doi:10.1093/eurheartj/ehae639

6. Heidenreich PA, Bhatt A, Nazir NT, Schaffner W, Vardeny O. 2025 concise clinical guidance: an ACC expert consensus statement on adult immunizations as part of cardiovascular care: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2025;86(21):2085-2098. doi:10.1016/j.jacc.2025.07.003