The coronavirus pandemic left behind a trail of devastation that went far beyond infections and immediate deaths. Now, years after the initial outbreak, health systems worldwide are grappling with a new and alarming challenge: a sharp rise in heart disease and related fatalities.
From Karachi to London, and from New York to Dar es Salaam, cardiologists report a noticeable increase in heart attacks, cardiac emergencies, and mortality among both older and younger populations. Yet, the reasons behind this surge remain hotly debated.
A troubling trend in Karachi
In Karachi, one of South Asia's largest urban centres, hospitals are witnessing a surge in patients with cardiac complaints. Doctors note that cases of heart attack, previously more common among the elderly, are now appearing among younger adults - even teenagers.
"Before the pandemic, between 2018 and 2019, our hospital admitted around 1,000 to 1,500 patients annually for urgent cardiac procedures such as angioplasty, angiography, or bypass surgery," explained Dr. Farhala Baloch, consultant cardiologist at Aga Khan University Hospital (AKUH). "Since 2021, the number has more than doubled, with 2,500-3,000 patients every year. While modern facilities have helped us save many lives, we are deeply concerned about the increasing number of younger patients who do not survive massive heart attacks."
One of the most alarming developments, according to Dr. Baloch, is the appearance of cardiogenic shock - a severe condition where the heart suddenly cannot pump enough blood - in patients as young as 40, and in some cases even 18-year-olds. "This was rarely seen before. It represents a dramatic shift in the pattern of heart disease," she noted.
Is COVID-19 to blame?
The surge has naturally raised questions about causation. Did Covid -19 itself trigger long-term cardiovascular damage? Did vaccines play a role? Or are lifestyle changes during the pandemic the real culprit?
"Some patients with severe Covid who required ICU care later developed heart complications. We know the virus severely impacted the lungs, but the heart was often the second most affected organ," said Dr. Baloch. "When oxygen supply in the body drops, the heart suffers. This often leads to multi-organ failure. However, to say the virus directly caused the global rise in heart attacks is still premature."
What is clearer is the indirect impact. Lockdowns confined millions to their homes, leading to reduced physical activity, poor eating habits, disrupted sleep patterns, and increased stress. Remote work, initially perceived as convenient, proved more stressful for many - particularly working women who had to balance professional and domestic responsibilities. Obesity levels rose, and with it, hypertension and diabetes - two of the strongest risk factors for cardiovascular disease.
"In our clinics, we see many patients who gained significant weight during lockdowns and are struggling to lose it," Dr. Baloch added. "These changes have lasting effects on cardiovascular health."
The vaccine debate
Alongside the pandemic, the global vaccination drive triggered a parallel wave of anxiety and speculation. Some vaccine recipients reported chest pain, palpitations, or high blood pressure. This led to rumours that vaccines themselves were fueling heart disease.
Dr. Baloch urged caution: "There is no conclusive evidence linking Covid -19 vaccines to heart attacks. Vaccines saved millions of lives. Some patients did experience temporary side effects such as irregular heartbeat or elevated blood pressure, but these effects were short-lived. Suggesting vaccines are harmful discourages people from taking not only Covid vaccines but also flu and pneumonia vaccines, which are lifesaving, especially for older adults and cardiac patients."
International studies have shown mixed results. A few small-scale investigations reported higher rates of myocarditis (inflammation of the heart muscle) in young men after vaccination, particularly following the second dose. However, these cases were typically mild and treatable. Meanwhile, large-scale data suggests that vaccinated populations had lower mortality rates overall, with protection outweighing potential risks.
Data from NICVD
The National Institute of Cardiovascular Diseases (NICVD) in Karachi - the largest heart hospital in South Asia - also reports a growing patient load. In 2024 alone, NICVD treated nearly 10,000 heart attack patients, performing more than 3,000 complex cardiac procedures, including bypass surgeries and valve replacements.
"This reflects not only population growth but also a real increase in the burden of disease," said an NICVD spokesperson. "We are treating younger patients than ever before, which is particularly concerning."
A global phenomenon
The post- Covid cardiac crisis is not limited to Pakistan. Studies across Europe, North America, and Africa report similar patterns. Dr. Javed Ahmed Jilbani, a cardiologist at the Aga Khan Hospital in Dar-es-Salaam, Tanzania, who previously worked at NICVD, has seen this transformation firsthand.
"During lockdowns, heart attack cases temporarily declined because people avoided hospitals. But once restrictions were lifted, we observed a fourfold increase globally," he said.
What stunned doctors was the speed of disease progression. "In the past, coronary artery disease typically advanced over 15-20 years. Post-Covid, we saw patients whose arteries worsened dramatically in just five years. It is as though the pandemic accelerated the natural course of heart disease," Dr. Jilbani explained.
The genetics factor
Recent research highlights another dimension: genetics. A study published using UK Biobank data revealed that individuals with blood groups A, B, or AB face higher risks of heart attack and stroke compared to those with blood group O.
This suggests that genetic predispositions may interact with Covid -19 or post-pandemic lifestyle factors to heighten cardiovascular risk.
Vaccination trends and outcomes
Interestingly, global trends show that heart attack cases initially rose after the first and second vaccine doses, then began to decline after the third dose. Younger populations reported more cases of myocarditis, while older groups remained at risk of strokes and heart attacks.
Experts argue that while vaccines may have short-term cardiovascular effects in rare cases, they likely reduced long-term risks by preventing severe COVID-19 infections.
"Early data did show higher death rates after initial vaccination drives, but whether these deaths were due to COVID, vaccines, or other health conditions remains a matter of investigation," said Dr. Jilbani. "What is certain is that the third dose reduced cardiac risks significantly."
Lifestyle and healthcare responses
The pandemic reshaped daily life in profound ways. Increased reliance on processed foods, lack of exercise, disrupted mental health, and prolonged stress all combined to create a fertile ground for cardiovascular disease.
Healthcare systems are now adapting. In Pakistan, angioplasty and stent procedures have surged. The Healthcare Devices Association of Pakistan reported a sharp increase in demand for cardiac devices post-pandemic, reflecting both rising cases and improved access to treatments.
But prevention remains the key. Cardiologists urge the public to adopt healthier lifestyles, manage stress, and undergo regular checkups, particularly for blood pressure, cholesterol, and blood sugar levels.
Looking ahead
Experts agree on one thing: more research is urgently needed. The link between Covid -19 and heart disease is complex and likely involves multiple factors - direct viral effects, immune responses, vaccines, lifestyle changes, and genetics.
"What we know so far is just the tip of the iceberg," said Dr. Baloch. "We must resist the temptation to jump to conclusions. Science takes time. But what is clear is that heart disease has emerged as a major post- Covid challenge, and societies must be prepared to confront it."
For now, the best defense remains vigilance - both in research laboratories and in everyday life. As the world continues to navigate the pandemic's long shadow, the battle for heart health may well define the next decade of global healthcare.
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