Abstract
Acute respiratory infections are associated with increased risk of myocardial infarction (MI) and stroke; however, the role of different organisms is poorly characterized. Time-series analysis of English hospital admissions for MI and stroke (age-stratified: 45-64, 65-74, ≥75 years), laboratory-confirmed viral respiratory infections, and environmental data for 2004-2015. Weekly counts of admissions were modeled using multivariable Poisson regression with weekly counts of respiratory viruses (influenza, parainfluenza, rhinovirus, respiratory syncytial virus [RSV], adenovirus, or human metapneumovirus [HMPV]) investigated as predictors. We controlled for seasonality, long-term trends, and environmental factors. Weekly hospital admissions in adults aged ≥45 years averaged 1347 (interquartile range [IQR], 1217-1541) for MI and 1175 (IQR, 1023-1395) for stroke. Respiratory infections ranged from 11 cases per week (IQR, 5-53) for influenza to 55 (IQR, 7-127) for rhinovirus. In the adjusted models, all viruses except parainfluenza were significantly associated with MI and ischemic stroke admissions in those aged ≥75. Among 65- to 74-year-olds, adenovirus, rhinovirus, and RSV were associated with MI but not ischemic stroke admissions. Respiratory infections were not associated with MI or ischemic stroke in people aged 45-64 years, nor with hemorrhagic stroke in any age group. An estimated 0.4%-5.7% of MI and ischemic stroke admissions may be attributable to respiratory infection. We identified small but strongly significant associations in the timing of respiratory infection (with HMPV, RSV, influenza, rhinovirus, and adenovirus) and MI or ischemic stroke hospitalizations in the elderly. NCT02984280.
Highlights
Acute respiratory infections are associated with increased risk of myocardial infarction (MI) and stroke, the role of different organisms is poorly characterised
Such studies are needed to inform vaccination, antiviral and anti-thrombotic strategies for high-risk patients and for health service planning, especially in settings with limited healthcare infrastructure[14]. In this ecological study we aimed to describe the temporal associations between different laboratory-confirmed respiratory viruses and hospital admissions for MI and stroke using laboratoryconfirmed respiratory infections
There were strong temporal shifts in the frequency of MI and stroke, for MI in 2012, which coincides with the introduction of the third universal definition of MI reflecting the development of more sensitive assays for myocardial necrosis[17]
Summary
Acute respiratory infections are associated with increased risk of myocardial infarction (MI) and stroke, the role of different organisms is poorly characterised. Previous studies have shown a transient risk of acute vascular events including MI and cardiovascular deaths after clinically diagnosed acute respiratory infections (ARIs) from GP or hospital records[3,4,5]. Few ARIs are laboratory-confirmed in health records, so assessing the burden of specific infections is often done indirectly using time series models using laboratory surveillance datasets[7]. Few studies examine the effects of a comprehensive range of respiratory viruses on specific cardiovascular end-points. Such studies are needed to inform vaccination, antiviral and anti-thrombotic strategies for high-risk patients and for health service planning, especially in settings with limited healthcare infrastructure[14]
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