Dengue may increase susceptibility to subsequent cardiac events

Individuals who sustained an acute dengue virus (DENV) infection are predisposed to cardiovascular events up to 30 days after infection, although the excess risk was modest, according to a study from Singapore.

In the analysis of data from 65,207 Singaporean adults with documented laboratory-confirmed DENV infection and 1,616,865 population-based controls with no evidence of DENV infection, the odds of any cardiovascular events were more than tenfold increased up to 30 days post-DENV infection (adjusted odds ratio [aOR], 10.63, 95 percent confidence interval [CI], 7.56–15.48). [Lancet Reg Health West Pac 2025;doi:10.1016/j.lanwpc.2025.101713]

Similarly, the odds of major adverse cardiac event (MACE) (aOR, 2.92, 95 percent CI, 1.81–4.88), dysrhythmia (aOR, 18.44, 95 percent CI, 11.25–32.96), and ischaemic heart disease (aOR, 3.00, 95 percent CI, 1.83–5.15) were elevated up to 30 days post-DENV infection.

The associations between DENV infection and any cardiovascular events were consistently observed among both ambulatory (aOR, 6.93, 95 percent CI, 4.48–11.27) and hospitalized patients (aOR, 15.05, 95 percent CI, 9.13–27.00), DENV-IgG-positive (aOR, 9.02, 95 percent CI, 4.99–18.20) and DENV-IgG-negative (aOR, 13.16, 95 percent CI, 7.25–26.99) patients, and across DENV1/2-predominant (aOR, 9.58, 95 percent CI, 4.92–21.57) and DENV3-predominant (aOR, 11.01, 95 percent CI, 7.48–16.95) transmission.

However, the overall excess burden of acute cardiovascular events in DENV-infected adults was modest, with <1 excess event per 100 cases. The only exception was older adults aged ≥60 years (excess burden, 1.25, 95 percent CI, 1.05–1.44).

“Higher excess burden of acute cardiovascular events in older adults likely reflects the vulnerability of elderly dengue survivors and those with increased comorbidity burden vs younger counterparts,” the investigators said. [Expert Rev Anti Infect Ther 2017;15:729-735]

In the setting of low overall incidence in the population at-large, “surveillance and assessment of potential cardiovascular complications in patients recovering from acute DENV infection should therefore be focused on populations at highest risk, specifically in hospitalized cases and older adults with potential pre-existing comorbidities or cardiovascular risk factors,” they added.

The investigators emphasized that the approach of prioritizing high-risk patients for surveillance and assessment should be particularly beneficial in under-resourced tropical settings, wherein challenges including limited access to technology including cardiac imaging and lack of trained personnel are common. [Eur Heart J Cardiovasc Imaging 2025;26:1315-1332]

“Various alternatives, such as usage of portable cardiac point-of-care ultrasound and tele-echocardiography in remote areas, together with rapid cardiovascular magnetic resonance protocols to reduce cost and improve accessibility in low-to-middle income countries, could potentially enhance cardiovascular care following DENV infection, though additional longitudinal studies linking early imaging alterations with long-term cardiovascular outcomes are required,” they said.

Finally, additional studies are needed to assess if early detection and better management of cardiovascular complications in the acute phase translates into lower risk of postacute cardiovascular sequelae in at-risk groups, according to the investigators.