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Triggering of cardiovascular disease by infection type: The Atherosclerosis Risk in Communities study (ARIC)
Logan T Cowan1, Brian Buck1, Jessica S Schwind1
1Department of Biostatistics, Epidemiology, & Environmental Health Sciences, Georgia Southern University, PO Box 7989, Statesboro, GA 30460, United States of America.
Insights
Acute infections like pneumonia and urinary tract infections significantly increase cardiovascular disease risk, particularly within 14 days. This highlights the need for preventive strategies post-infection.
Area of Science:
- Infectious Disease Epidemiology
- Cardiovascular Disease Research
- Public Health
Background:
- Acute infections are recognized triggers for cardiovascular disease (CVD).
- The differential impact of various infection types on CVD risk remains unclear.
- Understanding these associations is crucial for risk stratification and prevention.
Purpose of the Study:
- To investigate the association between specific acute infections and the risk of acute coronary heart disease (CHD) and ischemic stroke.
- To determine if the strength of this association varies across different types of infections.
Main Methods:
- A case-crossover design was employed using data from the Atherosclerosis Risk in Communities Study (ARIC).
- Infections including cellulitis, pneumonia, urinary tract infections (UTI), and bloodstream infections were identified using ICD-9 codes from Medicare claims.
- Conditional logistic regression analyzed the risk of CHD and ischemic stroke events in the 14, 30, 42, and 90 days following infection compared to control periods.
Main Results:
- Pneumonia, UTI, bloodstream infections, and cellulitis were associated with increased acute CHD risk within 14 days post-infection.
- Pneumonia (OR=25.53) and UTI (OR=3.32) showed significant associations with acute CHD.
- Pneumonia (OR=5.59) and UTI (OR=3.16) were also linked to increased ischemic stroke risk within 14 days.
Conclusions:
- Patients experiencing pneumonia, UTI, or bloodstream infections face a substantially elevated risk of cardiovascular events.
- The risk elevation ranges from 2.5 to 25.5 fold, particularly in the initial 14 days post-infection.
- Consideration of preventive therapies during this high-risk period is recommended to mitigate CVD events.
Introduction:
Acute infections are known triggers of cardiovascular disease (CVD) but how this association varies across infection types is unknown. We hypothesized while acute infections increase CVD risk, the strength of this association varies across infection types.
Method:
Acute coronary heart disease (CHD) and ischemic stroke cases were identified in the Atherosclerosis Risk in Communities Study (ARIC). ICD-9 codes from Medicare claims were used to identify cellulitis, pneumonia, urinary tract infections (UTI), and bloodstream infections. A case-crossover design and conditional logistic regression were used to compare infection types among acute CHD and stroke cases 14, 30, 42, and 90 days before the event with two corresponding control periods (1 and 2 years prior).
Results:
Of the 1312 acute CHD cases, 116 had a UTI, 102 had pneumonia, 43 had cellulitis, and 28 had a bloodstream infection 90 days before the CHD event. Pneumonia (OR = 25.53 (9.21,70.78)), UTI (OR = 3.32 (1.93, 5.71)), bloodstream infections (OR = 5.93 (2.07, 17.00)), and cellulitis (OR = 2.58 (1.09, 6.13)) were associated with higher acute CHD risk within 14 days of infection. Of the 727 ischemic stroke cases, 12 had cellulitis, 27 had pneumonia, 56 had a UTI, and 5 had a bloodstream infection within 90 days of the stroke. Pneumonia (OR = 5.59 (1.77, 17.67)) and UTI (OR = 3.16 (1.68, 5.94)) were associated with higher stroke risk within 14 days of infection.
Conclusions:
Patients with pneumonia, UTI, or bloodstream infection appear to be at a 2.5 to 25.5 fold elevated CVD risk following infection. Preventive therapies during this high-risk period should be considered.
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