Abstract
BackgroundSeveral studies have investigated a possible association between respiratory infection and acute myocardial infarction (MI). As both influenza and pneumococcal infections are vaccine preventable, understanding the populations affected by virus-induced cardiovascular complications is important to guide public health and clinical practice.AimThis observational study aimed to quantify the association between laboratory-confirmed respiratory bacteria or virus infections and risk of first MI or stroke, by using self-controlled case series (SCCS) analysis of anonymised linked electronic Danish health records.MethodsThe SCCS method was used to determine the relative incidence of the first event of MI and stroke occurring within 28 days after laboratory-confirmed respiratory infections compared with the baseline time period.ResultsIn the age and season adjusted analyses for first acute MI, the incidence ratios (IR) of a MI event occurring during the risk period were significantly elevated following a Streptococcus pneumoniae infection with values of 20.1, 11.0 and 4.9 during 1–3, 4–7 and 8–14 days, respectively and following respiratory virus infection with values of 15.2, 4.5 and 4.4 during 1–3, 8–14 and 15–28 days, respectively. The significantly elevated IRs for stroke following an S. pneumoniae infection were 25.5 and 6.3 during 1–3 and 8–14 days, respectively and following respiratory virus infection 8.3, 7.8 and 6.2 during 1–3, 4–7 and 8–14 days, respectively.ConclusionThis study suggested a significant cardiovascular event triggering effect following infection with S. pneumoniae and respiratory viruses (mainly influenza), indicating the importance of protection against vaccine-preventable respiratory infections.
Highlights
The leading causes of death worldwide for the past 15 years were ischaemic heart disease and stroke [1], which is the case in Denmark
We investigated the relative incidence of a first myocardial infarction or stroke occurring within 28 days after the beginning of laboratory-confirmed respiratory infections with S. pneumoniae, human metapneumovirus, influenza virus, parainfluenza virus, respiratory syncytial virus, or rhinovirus as compared with the baseline time period for each individual using conditional Poisson regression
We found that the incidence ratios (IR) of first acute myocardial infarction and stroke were markedly elevated following infections with S. pneumoniae and selected respiratory viruses compared with baseline time periods using national linked records from Denmark
Summary
The leading causes of death worldwide for the past 15 years were ischaemic heart disease and stroke [1], which is the case in Denmark ( http://www.healthdata.org/denmark ). The respiratory viruses investigated included adenovirus, human metapneumovirus, influenza virus, respiratory syncytial virus and rhinovirus [6] These findings were supported by self-controlled case-series analyses of Scottish individuals, in which incidence ratios (IR) for myocardial infarction and stroke were significantly raised following laboratoryconfirmed Streptococcus pneumoniae and influenza virus infections, and raised point estimates were observed following other laboratory-confirmed. Results: In the age and season adjusted analyses for first acute MI, the incidence ratios (IR) of a MI event occurring during the risk period were significantly elevated following a Streptococcus pneumoniae infection with values of 20.1, 11.0 and 4.9 during 1–3, 4–7 and 8–14 days, respectively and following respiratory virus infection with values of 15.2, 4.5 and 4.4 during 1–3, 8–14 and 15–28 days, respectively. Conclusion: This study suggested a significant cardiovascular event triggering effect following infection with S. pneumoniae and respiratory viruses (mainly influenza), indicating the importance of protection against vaccine-preventable respiratory infections
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