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The health implications of COVID-19 do not always go away when fevers break, coughs subside, and senses of smell and taste return. An estimated 4 million people suffer from long COVID, which has symptoms like brain fog, lingering cough, fatigue, and more. A new study out this week found that one out of 20 people who have had COVID-19 report that they still have symptoms six to 18 months after first getting sick.

Another risk after infection with COVID-19 is myocarditis, or an inflammation of the heart muscle. The inflammation can reduce the heart’s ability to pump blood and cause cause chest pain, shortness of breath, and rapid or irregular heart rhythms also called arrhythmias. A study published on Wednesday in the journal Frontiers in Cardiovascular Medicine found that risk of developing myocarditis is seven times higher with a COVID-19 infection than with the COVID-19 vaccine. It also finds that the risk of myocarditis was 15 times higher in COVID-19 patients, regardless of vaccination status.

[Related: How dangerous is myocarditis? The truth about the scary-sounding condition.]

“Our findings show that the risk of myocarditis from being infected by COVID-19 is far greater than from getting the vaccine,” Navya Voleti, a resident physician in the department of medicine at Penn State, said in a statement. “Moving forward, it will be important to monitor the potential long-term effects in those who develop myocarditis.”

A team from the Penn State College of Medicine reviewed an analyzed 22 international studies published between December 2019 and May 2022. The studies included nearly 58 million patients, all of whom reported cardiac issues.

The patients belonged to either the vaccination group or the COVID-19 group. The vaccination group included 55.5 million who were vaccinated against COVID-19 compared to those who were not vaccinated. The COVID-19 group included the 2.5 million who contracted the virus compared to those who did not contract the virus.

Within the vaccination group, the researchers separately compared the risk of myocarditis for various COVID-19 vaccines, including the mRNA vaccines (Pfizer, Moderna), Novavax, AstraZeneca, and Johnson and Johnson.

[Related: What you need to know about heart inflammation and COVID-19 vaccines.]

Among those diagnosed with myocarditis after receiving the vaccine or having COVID-19, the majority (61 percent) were male. Of patients diagnosed with myocarditis in both vaccination and COVID-19 groups, 1.07 percent were hospitalized and 0.015 percent died.

“COVID-19 infection and the related vaccines both pose a risk for myocarditis. However, the relative risk of heart inflammation induced by COVID-19 infection is substantially greater than the risk posed by the vaccines,” Paddy Ssentongo, a resident physician in the department of medicine at Penn State and the lead author of the study, said in a statement. “We hope our findings will help mitigate vaccine hesitancy and increase vaccine uptake.”

The findings come after claims on social media that the vaccine causes irreversible myocarditis cases. While heart complications following an mRNA vaccine are a rare side effect of the mRNA COVID-19 vaccination, the majority of medical professionals agree that the benefits of getting the vaccine outweigh the risks.