Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland

Charlotte Warren-Gash, Ruth Blackburn, Heather Whitaker, Jim McMenamin, Andrew C Hayward, Charlotte Warren-Gash, Ruth Blackburn, Heather Whitaker, Jim McMenamin, Andrew C Hayward

Abstract

While acute respiratory tract infections can trigger cardiovascular events, the differential effect of specific organisms is unknown. This is important to guide vaccine policy.Using national infection surveillance data linked to the Scottish Morbidity Record, we identified adults with a first myocardial infarction or stroke from January 1, 2004 to December 31, 2014 and a record of laboratory-confirmed respiratory infection during this period. Using self-controlled case series analysis, we generated age- and season-adjusted incidence ratios (IRs) for myocardial infarction (n=1227) or stroke (n=762) after infections compared with baseline time.We found substantially increased myocardial infarction rates in the week after Streptococcus pneumoniae and influenza virus infection: adjusted IRs for days 1-3 were 5.98 (95% CI 2.47-14.4) and 9.80 (95% CI 2.37-40.5), respectively. Rates of stroke after infection were similarly high and remained elevated to 28 days: day 1-3 adjusted IRs 12.3 (95% CI 5.48-27.7) and 7.82 (95% CI 1.07-56.9) for S. pneumoniae and influenza virus, respectively. Although other respiratory viruses were associated with raised point estimates for both outcomes, only the day 4-7 estimate for stroke reached statistical significance.We showed a marked cardiovascular triggering effect of S. pneumoniae and influenza virus, which highlights the need for adequate pneumococcal and influenza vaccine uptake. Further research is needed into vascular effects of noninfluenza respiratory viruses.

Conflict of interest statement

Conflict of interest: H. Whitaker has received grants from the MRC (methodology grant MR/L009005/1) and IMI/EFPIA (ADVANCE), outside the submitted work.

Copyright ©ERS 2018.

Figures

FIGURE 1
FIGURE 1
Example self-controlled case series timeline. RTI: respiratory tract infection. This timeline is based on age, and shows the risk period divided into 1–3, 4–7, 8–14 and 25–28 days after RTI. The grey solid line represents baseline time, the grey dashed line indicates excluded time, and the blue graduated line indicates risk periods and their proximity to the sample date. The incidence ratio for cardiovascular events occurring within each risk period compared with baseline time was calculated for each individual.

References

    1. Wang H, Naghavi M, Allen C, et al. . Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1459–1544.
    1. World Health Organization. The top 10 causes of death. Date last accessed: July 20, 2017. Date last updated: January, 2017.
    1. Barnes M, Heywood AE, Mahimbo A, et al. . Acute myocardial infarction and influenza: a meta-analysis of case-control studies. Heart 2015; 101: 1738–1747.
    1. Warren-Gash C, Smeeth L, Hayward AC. Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic review. Lancet Infect Dis 2009; 9: 601–610.
    1. Corrales-Medina VF, Suh KN, Rose G, et al. . Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies. PLoS Med 2011; 8: e1001048.
    1. Huijskens EGW, van Erkel AJM, Palmen FMH, et al. . Viral and bacterial aetiology of community-acquired pneumonia in adults. Influenza Other Respir Viruses 2013; 7: 567–573.
    1. Hirama T. A Real-time PCR-based diagnostic test for organisms in respiratory tract infection 2016. Date last accessed: May 23, 2017.
    1. Udell JA, Zawi R, Bhatt DL, et al. . Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA 2013; 310: 1711.
    1. Simonsen L, Taylor RJ, Viboud C, et al. . Mortality benefits of influenza vaccination in elderly people: an ongoing controversy. Lancet Infect Dis 2007; 7: 658–666.
    1. Ren S, Newby D, Li SC, et al. . Effect of the adult pneumococcal polysaccharide vaccine on cardiovascular disease: a systematic review and meta-analysis. Open Heart 2015; 2: e000247.
    1. Vlachopoulos CV, Terentes-Printzios DG, Aznaouridis KA, et al. . Association between pneumococcal vaccination and cardiovascular outcomes: a systematic review and meta-analysis of cohort studies. Eur J Prev Cardiol 2015; 22: 1185–1199.
    1. Ison MG, Campbell V, Rembold C, et al. . Cardiac findings during uncomplicated acute influenza in ambulatory adults. Clin Infect Dis 2005; 40: 415–422.
    1. Reyes LF, Restrepo MI, Hinojosa CA, et al. . Severe pneumococcal pneumonia causes acute cardiac toxicity and subsequent cardiac remodeling. Am J Respir Crit Care Med 2017; 196: 609–620.
    1. Singanayagam A, Singanayagam A, Elder DHJ, et al. . Is community-acquired pneumonia an independent risk factor for cardiovascular disease? Eur Respir J 2012; 39: 187–196.
    1. Petersen I, Douglas I, Whitaker H. Self controlled case series methods: an alternative to standard epidemiological study designs. BMJ 2016; 354: i4515.
    1. Whitaker HJ, Farrington CP, Spiessens B, et al. . Tutorial in biostatistics: the self-controlled case series method. Stat Med 2006; 25: 1768–1797.
    1. Public Health England. Surveillance of influenza and other respiratory viruses in the United Kingdom: winter 2014 to 2015. Report 2015046 2015. Date last accessed: July 20, 2017.
    1. Yang L, Ma S, Chen PY, et al. . Influenza associated mortality in the subtropics and tropics: results from three Asian cities. Vaccine 2011; 29: 8909–8914.
    1. Green HK, Andrews N, Fleming D, et al. . Mortality attributable to influenza in England and Wales prior to, during and after the 2009 pandemic. PLoS One 2013; 8: e79360.
    1. Hung IFN, Zhang AJ, To KKW, et al. . Unexpectedly higher morbidity and mortality of hospitalized elderly patients associated with rhinovirus compared with influenza virus respiratory tract infection. Int J Mol Sci 2017; 18: E259.
    1. Widmer K, Zhu Y, Williams JV, et al. . Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults. J Infect Dis 2012; 206: 56–62.
    1. van Asten L, van den Wijngaard C, van Pelt W, et al. . Mortality attributable to 9 common infections: significant effect of influenza A, respiratory syncytial virus, influenza B, norovirus, and parainfluenza in elderly persons . J Infect Dis 2012; 206: 628–639.
    1. Lee N, Lui GCY, Wong KT, et al. . High morbidity and mortality in adults hospitalized for respiratory syncytial virus infections. Clin Infect Dis 2013; 57: 1069–1077.
    1. Blackburn R, Hayward AC, Pebody R, et al. . Laboratory-confirmed respiratory infections as predictors of hospital admission for myocardial infarction and stroke: time-series analysis of English data for 2004–2015. Clin Infect Dis 2018; in press [].
    1. Smeeth L, Thomas SL, Hall AJ, et al. . Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med 2004; 351: 2611–2618.
    1. Warren-Gash C, Hayward AC, Hemingway H, et al. . Influenza infection and risk of acute myocardial infarction in England and Wales: a CALIBER self-controlled case series study. J Infect Dis 2012; 206: 1652–1659.
    1. Public Health England. Influenza immunisation programme for England: GP patient groups data collection survey season 2015–2016. Report 2016087 2016. Date last accessed: June 21, 2017.
    1. Ren S, Hure A, Peel R, et al. . Rationale and design of a randomized controlled trial of pneumococcal polysaccharide vaccine for prevention of cardiovascular events: the Australian Study for the Prevention through Immunization of Cardiovascular Events (AUSPICE). Am Heart J 2016; 177: 58–65.
    1. Wen Y-C, Hsiao F-Y, Chan KA, et al. . Acute respiratory infection and use of nonsteroidal anti-inflammatory drugs on risk of acute myocardial infarction: a nationwide case-crossover study. J Infect Dis 2017; 215: 503–509.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir