Despite growing concerns about heatwaves, cold environment and temperature fluctuations could also pose great health risks. Winter sudden temperature drops (STD) from extreme warmth to extreme cold are emerging as increasingly frequent and intense extreme weather events in sub-tropical regions. To investigate the dynamic STD-associated health risks in Hong Kong winter time over the last three decades, this study identified STD events based on daily minimum temperatures and evaluated their impacts on ambulance callouts, hospitalizations, and mortality risks. From 1884 to 2024, 391 winter STD events were identified. STD was significantly associated with increased risks of respiratory-related (RR: 1.11, 95% CI: 1.04-1.19) and skin-related (RR: 1.29, 95% CI: 1.03-1.63) ambulance callouts, total hospitalization (RR: 1.09, 95% CI: 1.05-1.15), and mortality (RR: 1.31, 95% CI: 1.27-1.34), particularly for events with larger drop magnitude (9.42\(degrees C), longer duration (>= 4days), and faster cooling rate (2.81\(degrees C/day). Warm-initiated STDs were linked with increased skin-related ambulance demands (RR: 1.33, 95% CI: 1.07-1.66). For STDs declining to relatively cold levels, risks increased for ambulance demands (RR: 1.05, 95% CI: 1.01-1.10), hospitalizations (RR: 1.20, 95% CI: 1.13-1.27), and mortality (RR: 1.10, 95% CI: 1.07-1.14), with hospitalization (RR: 1.25, 95% CI: 1.04-1.50) and mortality (RR: 1.32, 95% CI: 1.21-1.44) risks progressively escalating as temperatures dropped to extreme cold level. Individuals under 18 years (RR: 1.20, 95% CI: 1.10-1.30) were more susceptible to STD-induced ambulance demands. Populations over 80 years and over 75 years were most vulnerable to hospitalization(RR: 1.13, 95% CI: 1.09-1.18) and mortality (RR: 1.35, 95% CI: 1.30-1.39), respectively. In summary, STD progressively contributes to dynamic health risks. Findings serve as references for local cold-adaptation strategies and guide future research on climate change and health.

Mycoplasma pneumoniae (MP) is a major cause of respiratory infections in children and adolescents. COVID-19 pandemic control measures may have disrupted the respiratory microenvironment and increased the risk of co-infection associated with severe community-acquired pneumonia (CAP). Previous studies on MP co-infections were limited by small samples and lacked generalizability, with little evidence on MP-bacterial co-infection. This retrospective cohort study investigated co-infections and clinical severity in pediatric MP patients in Guangzhou. In this single-center retrospective cohort study, patients aged ≤ 18 years with confirmed MP infection were recruited from July 2023 to January 2024 in Guangzhou, China. Blood and/or respiratory specimens were collected for respiratory pathogen testing. Participants who completed testing for all 8 viral and 5 bacterial pathogens were included in the multivariable analyses. Multivariate logistic regression and negative binomial regression models were applied to investigate the co-infection patterns and clinical severity of MP infection. A total of 1499 patients (mean [SD] age: 6.39 [3.49], 50.7

Background:While the WHO has outlined specific dengue clinical phases, detailed real-world comparisons across different clinical phases remain valuable for clinical management. This study evaluates clinical features of dengue hospitalizations during the 2024 outbreak in Guangzhou, China, where recent tracking confirmed a predominant circulation of highly homologous DENV-1. Methods:This is a retrospective study of hospitalized patients with dengue virus infection from May to October 2024 in Guangzhou. Both descriptive and inferential statistics were utilized to compare symptoms and laboratory results among patients in different clinical phases. Results:Of 151 hospitalized dengue cases, 101 (66.9%), 42 (27.8%), and 8 (5.3%) patients were in the febrile phase, critical phase and recovery phases at admission, respectively. The mean age was 44 years, with 76 (50%) female patients. Fifty-two (34%) patients had comorbidities. Median time from symptom onset to hospital admission was 1 day (IQR: 1-4), with a consequent median hospital length of stay of 5.2 days (3.8-6.5). While fever was the dominant symptom in the febrile phase (67%, P < 0.001), while rash prevalence peaked in the recovery phase (62.5%, P=0.009). Compared to the febrile phase, the critical phase exhibited significantly lower white blood cells (P=0.008), platelets (P<0.001), blood urea nitrogen (P=0.008), fibrinogen (P=0.043), and prothrombin time (P<0.001), but significantly elevated alanine aminotransferase (P=0.028), aspartate aminotransferase (P=0.001), and lactate dehydrogenase (P=0.001). Conclusion:Despite the limitation of lacking specific viral etiology identification, this descriptive study delineates the distinct symptomatology and macroscopic laboratory kinetics of dengue patients across different WHO clinical stages during the 2024 outbreak. The high prevalence of rash and altered laboratory parameters in the later stages indicate that additional care is required in the later stages of the disease.

Introduction:In China, the increase in high-risk pregnancies along with rising maternal age and complications has underscored the need for the development of maternal and newborn risk management programmes. The Chinese National Maternal and Newborn Safety Action Plan (CNMNSAP) was initiated in 2017. Given that neonatal mortality is a key indicator of healthcare quality, we evaluate the real-world effects of CNMNSAP against neonatal mortality among pregnant women with high-risk conditions. Methods:In this retrospective, matched, population-based cohort study, we collected information on all pregnant women with clinically diagnosed conditions from electronic medical records in Chengdu, China, between July 2014 and December 2019. Individual-level data, covering all healthcare services and testing records in public hospitals, were obtained and categorised into two groups based on the timing of CNMNSAP implementation (pre-CNMNSAP vs post-CNMNSAP). After 1:1 propensity score matching, we calculated the annual percentage change (APC) of neonatal mortality within 7 days post-delivery and compared outcomes between two groups of pregnant women with conditions. We then employed multivariate log-binomial regression models to examine the association between the CNMNSAP implementation and temporal changes in neonatal mortality. Results:During the 5-year study period, a total of 241 343 women with high-risk conditions delivered prior to CNMNSAP and 163 367 after its implementation. After 1:1 propensity score matching, 299 190 mothers were included for analysis. We estimated that the APC changed from 10.0% (95% CI -0.4% to 21.5%) prior to the maternal risk management programme to -28.5% (95% CI -44.2% to -8.4%) after its implementation, with an attributed risk reduction of 1.29 neonatal deaths per 1000 deliveries annually. In subgroup analysis, we found a significant reduction in neonatal mortality after policy implementation among mothers aged 18-34 years, those with a normal body mass index and those having a history of abortion. Conclusions:The CNMNSAP was found to be associated with a significant annual reduction in early neonatal mortality risk among pregnant women with high-risk conditions in Chengdu, China. The maternal risk management programme effectively improved outcomes for high-risk pregnancies, highlighting the importance of maternal risk classification and management throughout pregnancy.

OBJECTIVES:Immunocompromised status has been shown to be a risk factor for SARS-CoV-2 viral rebound. However, no studies have assessed the long-term clinical consequences of viral rebound in the immunocompromised population. This study aimed to examine the association of early viral rebound with postacute conditions among immunocompromised patients. METHODS:We conducted a retrospective cohort study using territory-wide electronic health records from the Hospital Authority and the Department of Health in Hong Kong. The study cohort consisted of immunocompromised adults aged 18 years or older who tested positive for SARS-CoV-2 between 26 February 2022 and 9 November 2023, and who were hospitalized with COVID-19. Patients were classified as having early viral rebound or not having early viral rebound based on the cycle threshold values within 21 days of the positive RT-PCR test result. The primary outcome was postacute all-cause inpatient death, evaluated starting from 21 days after the positive RT-PCR test. RESULTS:A total of 1296 immunocompromised adults were included in this study (46.4% [601 of 1296] were female; median [interquartile range] age, 68 [59-76] years). In all, 22.3% (289 of 1296) patients were categorized as having early viral rebound. Haematological malignancy was significantly associated with early viral rebound (hazard ratio 1.52, 95% CI 1.09-2.12, p 0.014). Early viral rebound was significantly associated with a higher risk of postacute inpatient death (hazard ratio 1.53, CI 1.16-2.02, p 0.002). CONCLUSIONS:This study demonstrated an association between early viral rebound and post-COVID mortality among immunocompromised individuals.

BACKGROUND:Accumulating evidence indicates that SARS-CoV-2 infection is associated with a broad spectrum of post-acute COVID sequelae, including diabetes. While nirmatrelvir/ritonavir and molnupiravir have demonstrated efficacy in reducing acute COVID-19 severity, their protective effects against post-COVID diabetes remain uncertain. In this study, we aimed to evaluate the effectiveness of these antiviral agents in reducing post-COVID diabetes risks, including new-onset diabetes in non-diabetic individuals and exacerbated diabetes in those with pre-existing diabetes. METHODS:We emulate target randomized controlled trials of COVID-19 antivirals in hospitalized patients who tested positive for SARS-CoV-2 between March 11, 2022, and October 10, 2023, in Hong Kong. Two analytic patient cohorts for assessing incident diabetes and exacerbation of diabetes for rehospitalization, including those with or without diabetes confirmed before the index date, were identified. Cloning, censoring, and weighting were used to emulate the target trials of nirmatrelvir/ritonavir and molnupiravir, involving treatment arm and control arm within each trial. Cause-specific Cox proportional hazard model and an extended form of Cox model for modeling recurrent hospitalizations were used to estimate the hazard ratio (HR) between arms in each trial, adjusting for baseline covariates. RESULTS:Among 88,643 hospitalized patients first time infected by SARS-CoV-2 identified, 35,997 and 18,865 eligible patients were included in the two analytic cohorts for the analysis on newly onset diabetes and exacerbated diabetes for rehospitalization, respectively. The median follow-up period ranged from 344 to 365 days across treatment and control arms of target trials. Compared with the no treatment arm, non-diabetic patients who received nirmatrelvir/ritonavir showed a significantly lower risk of post-COVID incident diabetes (HR: 0.75, 95% CI: 0.61 to 0.92). A reduced risk of diabetes rehospitalizations (HR: 0.70, 95% CI: 0.60 to 0.81) was observed among the diabetic patients. No significant associations were found for the use of molnupiravir and post-COVID diabetes outcomes. CONCLUSIONS:Our study demonstrates the effectiveness of nirmatrelvir/ritonavir in reducing the risks of post-acute COVID sequelae of diabetes in the hospitalized population, regardless of their diabetic status, whereas molnupiravir showed no significant benefit. Our findings offer valuable clinical insights for managing diabetes during the post-acute phase of SARS-CoV-2 infection.

Climate change has led to unpredictable, intense temperature fluctuations during warming winters, particularly in subtropical regions. Among that, abrupt shifts from warm to cold temperatures over short periods pose health challenges yet remain poorly understood. Historical data from Hong Kong revealed a rising trend in the frequency of temperature flip events, characterized by larger temperature drops and faster cooling rates. The temperature flip events were associated with increased risks of total non-external (RR: 1.08, 95% CI: 1.05-1.11) and cause-specific mortality, with a higher risk observed at or below the cold weather warning threshold (RR: 1.13, 95% CI: 1.09-1.17). Greater magnitude of temperature drops, shorter durations, and more rapid cooling during flip events intensified the mortality risk, while the starting temperature showed an inverse relationship. Events that began with warming temperature followed by rapid cooling were particularly associated with increased pneumonia mortality risk (RR: 3.17, 95% CI: 2.14-4.68), while cold-start flips with rapid (RR: 1.21, 95% CI: 1.14-1.29) or slow (RR: 1.08, 95% CI: 1.03-1.13) temperature declines were linked to increased total mortality. The health impacts varied across genders and causes of death, with the elderly being especially vulnerable under both cold-slow (RR: 1.11, 95% CI: 1.04-1.18) and cold-rapid (RR: 1.20, 95% CI: 1.11-1.30) flip scenarios. These findings highlight that the increased mortality risk among vulnerable populations caused by sudden temperature flips may be overlooked. The potential neglect underscores the urgent need to enhance cold weather warning systems and health interventions to better protect vulnerable populations from the adverse effects of temperature shifts in aging society of subtropical climate regions.

Background and Aims:Liver cancer is concurrently influenced by a number of risk factors, such as chronic viral hepatitis, heavy alcohol use, and metabolic associated conditions. This study aims to examine whether there are interaction patterns among factors associated with liver cancer risk among patients with diabetes. Methods:In this retrospective cohort study, patients who received care for type 2 diabetes in general outpatient clinics between 2010 and 2019 were identified using electronic health records of Hong Kong. Patients were followed up until a cancer diagnosis, death, or December 31st, 2019. The interaction patterns among factors associated with liver cancer risk were examined using conditional inference survival tree. Results:A total of 1,995 and 1,969 patients with and without liver cancer were included. Chronic viral hepatitis status appeared as most dominant factor in differentiating the risk of liver cancer. In the absence of chronic viral hepatitis, low lipids and elevated ALT were identified as key risk factor in older females (> 63years) and males respectively. Differential thresholds across different age groups in males were found, with a higher threshold for the younger group (39 U/L for ≤ 53years vs 31 U/L for > 53years). Conclusion:Chronic viral hepatitis, sex, age, ALT, and lipids appear to exhibit interaction patterns on liver cancer incidence among patients with diabetes, providing potential targets for public health prevention strategies.

Although no previous large-scale outbreak was reported in China in recent years, since July 2025, a surge in the number of chikungunya virus infections has been observed in multiple cities of Guangdong province following the introduction of imported cases, including Guangzhou. Using serological and epidemiological data obtained during a chikungunya outbreak in Guangzhou city, we estimated an attack rate of 22% for chikungunya virus infection. Accounting for case under-reporting is crucial for accurate disease burden assessment and planning of future vaccination programmes.

Introduction Unintended pregnancy and sexually transmitted infections (STIs) are major public health issues in developing countries. While long-acting reversible contraception (LARC) effectively prevents unintended pregnancy, there is limited evidence from large multinational studies on its association with condom use and STI-related outcomes. This study aimed to investigate the association between LARC use, condom use and STIs among women in developing countries.Methods This serial cross-sectional study extracted data from Demographic and Health Surveys (DHS), a series of nationally representative household surveys conducted in developing countries. The analysis included women aged 15 to 49 years, with data on contraceptive methods and demographics. Generalised linear mixed effect models (GLMMs) were used to estimate adjusted prevalence ratios (aPRs) for condom use and self-reported STI-related outcomes, comparing LARC users with both non-LARC users and oral contraceptive users. Subgroup analyses were conducted at the individual level and at the country level.Results Data from 2 171 884 women across 31 countries were analysed. Overall, the prevalence of self-reported STI-related outcomes was 7.4%, 3.9% of participants used LARC, and 7.5% of participants reported consistent condom use. LARC users were significantly less likely to use condoms compared with non-LARC users (aPR=0.40, 95% CI 0.30 to 0.53) and compared with oral contraceptive users (aPR=0.61, 95% CI 0.48 to 0.78). LARC use was associated with a higher prevalence of STI-related outcomes compared with non-LARC users (aPR=1.19, 95% CI 1.10 to 1.28) and compared with oral contraceptives users (aPR=1.14, 95% CI 1.05 to 1.24). Associations were stronger in low-Human Development Index (HDI) countries, especially among younger women (15–19 years), but were not significant in high-HDI countries. Country-level heterogeneity was observed.Conclusions LARC use is associated with reduced condom use and higher self-reported STI prevalence, particularly among younger women and in lower HDI developing countries. These findings support integrating STI prevention into LARC services and promoting dual-method use to prevent both unintended pregnancies and STIs.

Humid heat may pose greater health risk than heat alone, however, epidemiological studies have been limited in identifying humidity effects. This study assessed mortality impacts of compound hot-humid events to capture the joint effects of heat and humidity in subtropical Hong Kong. We investigated 22 definitions using specific and relative humidity under absolute and seasonally-determined thresholds. Generalized Linear Models and Distributed Lag Non-linear Models were used to estimate non-external mortality risk of compound events, further stratified by season, age, sex, and disease subgroups. Summer season compound hot-humid events were associated with increased mortality under seasonally-determined definitions of Hot_wet (all ages: Relative Risk RR: 1.026, 95 % CI: 1.003, 1.050, Attributable Number AN: 822) and Hot_wet95 (RR: 1.056, 95 % CI: 1.022, 1.091; AN: 901). Higher mortality risk was found for older adults, males, and pneumonia-related mortality. Pre-summer season analysis additionally found increased mortality with VHWW_wet and VHWW_wet95, when local weather warning is hoisted in 33 degrees C and above. Overall, compound hot-humid events using specific humidity and a seasonally-determined threshold captured the increased risk of high humidity on mortality. Under climate change, heat-health warning systems, heat action plans, and adaptation strategies need to be prepared for the impacts of compound hot-humid events and those early-in-season.

Nirmatrelvir-ritonavir is generally recommended to be initiated within five days of COVID-19 symptom onset. This study examined the association between the timing of nirmatrelvir-ritonavir initiation and post-acute outcomes more precisely using territory-wide data in Hong Kong. We included patients aged ≥18 years who tested positive for SARS-CoV-2 between March 16, 2022, and November 9, 2023, and were hospitalized with COVID-19. Treatment groups were formed based on the time from the positive RT-PCR date to nirmatrelvir-ritonavir initiation. Among 15,978 patients who received nirmatrelvir-ritonavir, 10,028 (62.8%) patients were included in Day 0 group, 4973 (31.1%) in Day 1 group, and 977 (6.1%) in Day 2 or later group. The control group comprised 22,312 patients who did not receive nirmatrelvir-ritonavir. Compared with the control group, the risks of post-acute mortality were significantly lower in Day 0 group (hazard ratio [HR] 0.51, 95% CI 0.46-0.56; p < 0.0001) and Day 1 group (HR 0.66, CI 0.59-0.74; p < 0.0001), but not in Day 2 or later group. Meta-regression results showed that more immediate initiation was associated with lower risks of death and all-cause hospitalization. Our findings suggested that the antiviral should be prescribed immediately after COVID-19 diagnosis for achieving its greatest benefit on improving post-COVID outcomes.

BACKGROUND:There is limited information on the association between walkability and health in Asian countries. OBJECTIVE:Our study aimed to investigate the association between neighborhood walkability and mortality in Taiwanese adults. METHODS:We selected 457,874 participants (≥18 y of age) from Taiwan who joined a standard medical examination program between 1998 and 2016 and followed them until 31 July 2021. Three walkability measures were estimated within a walking distance of 640m of participant's addresses: points of interest (POI), transit stations, and impedance (restrictions to walking due to absence of intersections and physical barriers). Walkability measures were applied as continuous and categorical (tertiles) variables in data analyses. Mortality data were obtained from the National Death Registry maintained by the Ministry of Health and Welfare in Taiwan. A time-varying Cox regression model was used to investigate the association of neighborhood walkability with deaths from natural causes and specific causes. RESULTS:This study identified 24,744 deaths over a median follow-up of 16.9 y. In comparison with participants living with the first tertile for numbers of POI and transit stations, those living with higher numbers of POI and transit stations were associated with a lower risk of natural-cause mortality, with hazard ratios (HRs) of 0.97 [95% confidence intervals (CIs): 0.94, 1.00] and 0.93 (95% CI: 0.90, 0.96) for second and third tertiles of numbers of POI, and 0.99 (95% CI: 0.96, 1.02) and 0.94 (95% CI: 0.92, 0.98) for second and third tertiles of numbers of transit stations, respectively. Each unit increase in POI and transit stations was associated with a 3% (HR= 0.97; 95% CI: 0.96, 0.99) and 2% (HR= 0.98; 95% CI: 0.97, 0.99) reduced risk of natural-cause mortality, respectively. In addition, in comparison with living in areas with the first tertile of impedance, living with the third tertile of impedance was associated a higher risk of natural-cause mortality, with HRs of 1.01 (95% CI: 1.00, 1.03). One unit increase in impedance was associated with a 1% (HR= 1.01; 95% CI: 1.00, 1.03) increased risk of natural-cause mortality. We also found significantly inverse associations between three walkability measures with deaths from cardiovascular diseases and between POI and death from chronic respiratory diseases. CONCLUSION:Our findings indicate that a higher level of neighborhood walkability was associated with a lower risk of mortality. Our data suggest that it is important to take into account neighborhood walkability in urban planning and health guideline development. https://doi.org/10.1289/EHP15209.

Background:As the COVID-19 pandemic shifted into the post-pandemic period in early 2023, following the COVID-19 normalization with relaxation of stringent control measures and high vaccination coverage in Hong Kong, its long-term impact on mortality remains challenging with necessary needs of data-driven insights. This study examined the pattern of post-pandemic excess mortality in Hong Kong. Methods:We analyzed weekly inpatient death data from public hospitals from January 1, 2013, to June 1, 2024, using a mixed model with over-dispersed Poisson regression. Expected mortality was estimated as the difference between observed mortality and baseline derived from pre-pandemic data. Age-stratified analyses of overall and cause-specific mortality were conducted across the pre-Omicron pandemic, Omicron, and post-pandemic periods. Findings:In the post-pandemic period, the excess mortality declined but remained six-fold higher (37.66 [95% CI: 32.72-42.60] per 100,000) than pre-Omicron level, maintaining significance after adjusting for age (32.79 [95% CI: 28.13-37.46] per 100,000). The older population experienced sustained excess mortality, with crude estimates of 100.51 and 586.74 per 100,000 among those aged 65-79 years and ≥80 years, respectively, primarily due to respiratory diseases. Younger population showed near-zero overall excess mortality, whereas increased excess mortality among them occurred in heart disease, cerebrovascular disease, and injuries. Interpretation:Our findings highlight the lasting mortality impact of pandemic among vulnerable populations, specifically the older population, possibly due to the post-COVID conditions and circulating COVID-19, suggesting the need for targeted interventions for this group. Funding:Health and Medical Research Fund.

In early 2025, Sudan virus (SUDV) caused an self-limited outbreak in Uganda including a total of 14 cases. We preliminarily assessed the transmission characteristics of Sudan virus disease, estimating mean serial interval of 13.7 days (95% CrI: 12.2, 15.8), and secondary attack rate of 17.8%, and we found a high transmission heterogeneity with 6.1% (95% CrI: 3.3, 12.5) of cases generated 80% of all transmission events. Timely and continuous monitoring of SUDV circulation, and real-time risk assessment were required at the local community level.

This study is aimed at investigating (i) whether diabetes is associated with each site-specific cancer and (ii) whether metabolic factors (lipids and liver enzyme) are differentially linked to different site-specific cancers by diabetes status. A retrospective cohort study was performed using electronic health records of Hong Kong. Patients who utilized public healthcare services between the year 1997 and 2021 with complete laboratory records and no cancer history were included. Patients were followed up until December 31, 2021. The associations with each site-specific cancer (colon and rectum, liver, pancreas, bladder, kidney, stomach, and lung) were assessed using Cox regression. A total of 197,906 patients were included. Patients with primarily Type 2 diabetes had a higher risk of developing liver and pancreatic cancers (aHRs for liver: 1.39, 95% CI = 1.11-1.75; pancreas: 2.04, 95% CI = 1.40-2.96) when compared to those without diabetes. Each 1 mmol/L increase in fasting glucose was associated with a 4% and 8% elevated risk of developing liver and pancreatic cancers, respectively. In general, lower lipids were linked to an increased risk of several malignancies (liver, pancreas, kidney, and stomach). In conclusion, diabetes is associated with an elevated risk of liver and pancreatic cancers. Baseline lipids and liver enzyme could be differentially linked to the risk of cancers at different organ sites by diabetes status.

While treatment with nirmatrelvir/ritonavir or molnupiravir is effective in lowering the rate of severe COVID-19, the effectiveness of these antivirals in reducing the risk of cardiovascular outcomes, especially among the hospitalized population, remains largely unknown. In this study, we assessed the real-world effectiveness of nirmatrelvir/ritonavir and molnupiravir on short- and long-term cardiovascular complications of COVID-19 using a target trial emulation design. Two target trials of COVID-19 antivirals were emulated by using a territory-wide, population-based, retrospective cohort of hospitalized patients in Hong Kong. Nine cardiovascular outcomes were evaluated in both short-term (day 0–21) and long-term (day 22–365) post-SARS-CoV-2 infection. Compared with the control group, the use of nirmatrelvir/ritonavir was associated with a significantly lower one-year risk of cardiovascular mortality, composite cardiovascular complications, major adverse cardiac events, cerebrovascular disorders, dysrhythmia, ischemic heart disease, and other cardiac disorders following infection. Molnupiravir use was associated with a short-term risk reduction in cardiovascular complications, but only a marginal risk reduction in long-term cardiovascular mortality among other complications. This study demonstrated the effectiveness of nirmatrelvir/ritonavir in reducing the risks of short- and long-term cardiovascular complications following a SARS-CoV-2 infection among the hospitalized population. Our findings suggested health-related benefits of prescribing nirmatrelvir/ritonavir over molnupiravir against severe cardiovascular post-acute sequelae of COVID-19 in the long term. While antivirals like nirmatrelvir/ritonavir and molnupiravir are known to reduce severe COVID-19, their impact on cardiovascular outcomes is unclear. Here, the authors use a target trial emulation design to show that nirmatrelvir/ritonavir significantly lowers long-term cardiovascular risks among hospitalized patients, highlighting its potentials over molnupiravir for mitigating post-COVID-19 cardiovascular complications.