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Press release

Getting to the heart of COVID-19 vaccination and its cardiovascular risks

Ann Arbor | November 1, 2022

After mRNA vaccination, adults under 40 have a slightly greater chance of developing myocarditis or pericarditis, yet the vaccine’s benefits outweigh the risks, according to the American Journal of Preventive Medicine

A comprehensive review and meta-analysis of published research confirm that young adults (40 years old and younger) have a slightly elevated risk for myocarditis or pericarditis after mRNA COVID-19 vaccination. The analysis is reported in a new studyopens in new tab/window in the American Journal of Preventive Medicineopens in new tab/window, published by Elsevier.

“Our study analyzes data to identify who might be at high risk for myocarditis/pericarditis after COVID-19 vaccination and validates the rare adverse reaction in adults under 40,” explained lead investigator Chenyu Sun, MD, MSc, AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, USA.

Key findings include:

  • A second vaccine dose is associated with a greater risk of the cardiovascular reaction than the first dose.

  • The increased risk is only associated with mRNA (e.g., mRNA-1273 and BNT162b2 – the latter linked to a slightly lower risk than the former), but not other vaccine types (e.g., Corona-Vac.).

  • While males are more likely to develop myocarditis/pericarditis (established by research prior to the pandemic), female susceptibility increases after the COVID-19 vaccine.

  • The incidence of myocarditis/pericarditis for those infected with SARS-CoV-2 is higher than it is after vaccination.

Myocarditis is an inflammation of the cardiac muscle that may present with chest pain, fever, congestive heart failure, or arrhythmias and can lead to death. Pericarditis generally causes severe chest pain behind the sternum. Both are believed to result from autoinflammation and be related to the immune response to viral infection.

Dr. Sun pointed out, “When myocarditis or pericarditis develop after a COVID-19 vaccination, the symptoms are usually less severe and largely self-remitting compared with other cases. As a clinician, I strongly recommend that people get a COVID 19 vaccine unless there are absolute contraindications such as known allergies. The benefits and harms must be carefully assessed to determine the best management option for patients who are in the high risk-group.”

mRNA vaccination

After mRNA vaccination, adults under 40 have a slightly greater chance of developing myocarditis or pericarditis, yet the vaccine’s benefits outweigh the risks, according to the American Journal of Preventive Medicine (Credit:

Concerns about this rare but dangerous adverse reaction have caused confusion for both the general public and healthcare providers. “By exploring the relationship between COVID-19 vaccine and myocarditis/pericarditis through systemic review and meta-analysis, we hope to clarify the risks and help healthcare providers and public health policy makers to provide a safer vaccination strategy for high-risk groups. Vaccination is one of the most important measures we have in the fight against COVID-19. Different strategies of different doses or different types of COVID-19 vaccine can be adopted according to the characteristics of the population,” added co-investigator Linya Feng, MPH, Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China.

The study also explores several pathogenic mechanisms of the association between COVID-19 vaccination and myocarditis/pericarditis, the exact etiology of which remains uncertain. First author Juan Gao, MMS, Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China, commented, “I hope more studies can be done to explore adverse events after vaccination, so healthcare providers and public health professionals can be guided with even better evidence.”

The comprehensive literature search identified 1,123 relevant published papers. Of these the investigators selected 11 studies on COVID-19 vaccination and the risk of myocarditis or pericarditis that met their rigorous criteria; eight of them compared the incidence of myocarditis or pericarditis before and after COVID-19 vaccination and three analyzed the effect of different doses of vaccination on the incidence of myocarditis or pericarditis. Based on data on more than 58 million participants in these studies, the investigators analyzed the effects of different sexes, ages, regions, vaccination types, and doses on the risk of myocarditis or pericarditis.

More than 300 SARS-CoV-2 vaccines have been developed and 169 are currently in clinical trials.


Notes for editors

The article is “A Systematic Review and Meta-analysis of the Association Between SARS-CoV-2 Vaccination and Myocarditis or Pericarditisopens in new tab/window” by Juan Gao, MMS, Linya Feng, MPH, Yaru Li, DO, Scott Lowe, BS, Zhichun Guo, PharmD, Rachel Bentley, MS, Chuman Xie, PharmD, Birong Wu, MMS, Peng Xie, MMS, Weihang Xia, MMS, Shaodi Ma, MD, Haixia Liu, MD, Xianwei Guo, MMS, John Patrick N. Uy, MD, Qin Zhou, PhD, Hina Wazir, MD, and Chenyu Sun, MD, MSc ( in new tab/window). It appears online in advance of the American Journal of Preventive Medicine, volume 64, issue 2 (February 2023), published by Elsevier.

Full text of this article is also available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or [email protected]opens in new tab/window. Journalists wishing to interview the authors should contact Chenyu Sun, MD, MSc, at [email protected]opens in new tab/window.

Elsevier’s Novel Coronavirus Information Center provides expert-curated information for researchers, healthcare professionals and public health officials, including clinical guidance and a portal to access all of Elsevier’s COVID-19 research. All resources are freely available. We also have dedicated hubs for healthcare professionals; health educators and students; librarians; and R&D professionals. You can find these in our Coronavirus Resource Directory.

About the American Journal of Preventive Medicine

The American Journal of Preventive Medicineopens in new tab/window is the official journal of the American College of Preventive Medicineopens in new tab/window and the Association for Prevention Teaching and Researchopens in new tab/window. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials.

About Elsevier

As a global leader in scientific information and analytics, Elsevier helps researchers and healthcare professionals advance science and improve health outcomes for the benefit of society. We do this by facilitating insights and critical decision-making with innovative solutions based on trusted, evidence-based content and advanced AI-enabled digital technologies.

We have supported the work of our research and healthcare communities for more than 140 years. Our 9,500 employees around the world, including 2,500 technologists, are dedicated to supporting researchers, librarians, academic leaders, funders, governments, R&D-intensive companies, doctors, nurses, future healthcare professionals and educators in their critical work. Our 2,900 scientific journals and iconic reference books include the foremost titles in their fields, including Cell Press, The Lancet and Gray’s Anatomy.

Together with the Elsevier Foundationopens in new tab/window, we work in partnership with the communities we serve to advance inclusion and diversity in science, research and healthcare in developing countries and around the world.

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Jillian B. Morgan

MPH, Managing Editor AJPM

+1 734 936 1590

E-mail Jillian B. Morgan