Long COVID And Its Cardiometabolic Consequences: Strategies For Risk Stratification And Management

Abstract

Background: Long COVID has emerged as a significant worldwide health issue owing to its enduring symptoms, which linger beyond 12 weeks post-infection. Initially, respiratory and neurocognitive issues were predominant; however, increasing evidence indicates that substantial cardiometabolic complicationssuch as myocarditis, arrhythmias, dyslipidemia, new-onset diabetes, and thromboembolismare critical determinants of long-term morbidity and healthcare expenditures. Objectives: To evaluate management strategies relevant to addressing this evolving worldwide concern and to consolidate existing research on the epidemiology, pathophysiology, clinical implications, and risk stratification of cardiometabolic sequelae in survivors of Long COVID. Methods: This narrative review was done using the Preferred Reporting Items for Narrative Reviews framework. It was performed utilizing keywords associated with Long COVID and cardiometabolic outcomes. Investigations were performed on PubMed, Scopus, and Web of Science from January 2020 to May 2025. Original studies, systematic reviews, meta-analyses, and official guidelines were incorporated. The exclusion criteria encompassed case reports, unreviewed materials, preprints, and publications in languages other than English. Data extraction and study selection were conducted independently, employing consensus resolution. Results: Survivors of COVID-19 exhibit a markedly elevated risk of new-onset diabetes (46%), dyslipidemia, hypertension (HR 1.3–1.7), and cardiovascular events, including myocarditis (HR 6.1) and thromboembolism (HR 3.0), as indicated by extensive population studies and meta-analyses. The processes include immunological dysregulation, chronic inflammation, metabolic disruption, and direct viral injury to the pancreas and endothelium. Pre-existing comorbidities elevate the risks, evident even in individuals with moderate acute illness. Conclusion: Long COVID significantly affects cardiometabolic health and has extensive implications for public health policy and clinical care. For patients with pre-existing risk factors or those from socioeconomically disadvantaged backgrounds, early detection, ongoing risk stratification, and multidisciplinary care, including metabolic and cardiovascular monitoring, are recommended.