Background Growing evidence suggests incident cardiovascular disease (CVD) may be a long‐term outcome of COVID‐19 infection, and chronic diseases, such as diabetes, may influence CVD risk associated with COVID‐19. We evaluated the postacute risk of CVD >30 days after a COVID‐19 diagnosis by diabetes status. Methods and Results We included adults ≥20 years old with a COVID‐19 diagnosis from March 1, 2020 through December 31, 2021 in a retrospective cohort study from the IQVIA PharMetrics Plus insurance claims database. A contemporaneous control group comprised adults without recorded diagnoses for COVID‐19 or other acute respiratory infections. Two historical control groups comprised patients with or without an acute respiratory infection. Cardiovascular outcomes included cerebrovascular disorders, dysrhythmia, inflammatory heart disease, ischemic heart disease, thrombotic disorders, other cardiac disorders, major adverse cardiovascular events, and any CVD. The total sample comprised 23 824 095 adults (mean age, 48.4 years [SD, 15.7 years]; 51.9% women; mean follow‐up, 8.5 months [SD, 5.8 months]). In multivariable Cox regression models, patients with a COVID‐19 diagnosis had a significantly greater risk of all cardiovascular outcomes compared with patients without a diagnosis of COVID‐19 (hazard ratio [HR], 1.66 [1.62–1.71], with diabetes; HR, 1.75 [1.73–1.78], without diabetes). Risk was attenuated but still significant for the majority of outcomes when comparing patients with COVID‐19 to both historical control groups. Conclusions In patients with COVID‐19 infection, postacute risk of incident cardiovascular outcomes is significantly higher than among controls without COVID‐19, regardless of diabetes status. Therefore, monitoring for incident CVD may be essential beyond the first 30 days after a COVID‐19 diagnosis.
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