BACKGROUND: The long-term health impacts of COVID-19, including post-acute sequelae of SARS-CoV-2, remain insufficiently explored, especially concerning pre-existing cardiovascular risk factors in older adults. This study examines the association between these risk factors and post-acute sequelae of SARS-CoV-2 in this population. METHODS: A retrospective study of Brazilian adults aged = 60 years assessed the persistence of post-acute sequelae of SARS-CoV-2 three months after infection in 2020. Cardiovascular risk factors (obesity, smoking, high blood pressure, diabetes mellitus, hypercholesterolemia, and chronic kidney disease) were analyzed in relation to sequelae and adjusting for sociodemographic variables. Data were obtained from the Department of Epidemiological Surveillance in Roraima, Brazil. RESULTS: Of the 1,322 participants (55% female
mean age 70.4 years, SD = 7.87), 61.7% (95% CI: 59.1-63.9) reported at least one post-acute sequelae of SARS-CoV-2 at the three-month follow-up. The likelihood of post-acute sequelae of SARS-CoV-2 was significantly higher in participants with diabetes mellitus (OR = 4.39
95% CI: 3.42-5.66), tobacco use (OR = 3.93
95% CI: 2.47-6.23), hypertension (OR = 3.62
95% CI: 2.73-4.78), or hypercholesterolemia (OR = 3.58
95% CI: 2.80-4.59). Chronic kidney disease (OR = 2.28
95% CI: 1.59-3.25) and obesity (OR = 1.83
95% CI: 1.28-2.61) were less strongly associated. CONCLUSIONS: Pre-existing cardiovascular risk factors are linked to a higher likelihood of long-term COVID-19 sequelae in adults aged = 60 years old. Preventing and managing these factors are crucial for reducing the long-term effects of COVID-19, particularly during a pandemic.