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Published on: September 17, 2014
Risk of myocardial infarction and stroke following bloodstream infection: a population-based self-controlled case
Jonathan Underwood1,2, Nicola Reeve3, Victoria Best4
1Infection and Immunity, Cardiff University, Cardiff, UK UnderwoodJ7@cardiff.ac.uk.
Insights
Bloodstream infections (BSIs) significantly increase the risk of heart attack and stroke, especially within the first two weeks post-infection. Higher inflammation levels, indicated by C-reactive protein (CRP), correlate with a greater cardiovascular disease event risk.
Area of Science:
- Infectious Diseases
- Cardiology
- Epidemiology
Background:
- Inflammation-triggered cardiovascular disease (CVD) events are a significant, under-recognized cause of mortality in bloodstream infection (BSI) patients.
- Quantifying the precise risk of myocardial infarction (MI) and stroke following BSI is crucial for patient management.
Purpose of the Study:
- To determine the risk of myocardial infarction (MI) and stroke in individuals following a bloodstream infection (BSI).
- To investigate the association between the magnitude of inflammatory response and the risk of CVD events post-BSI.
Main Methods:
- A self-controlled case series study utilized anonymised electronic health records from Wales (2010-2020).
- Adults with community-acquired BSI were analyzed for MI and stroke occurrences during predefined risk periods.
- Maximum C-reactive protein (CRP) levels within 7 days post-BSI served as a proxy for inflammatory response magnitude.
Main Results:
- BSI was associated with a significantly elevated risk of MI (IRR: 9.67) and stroke in the first 1-7 days, returning to baseline after 28 days.
- Individuals with maximal CRP >300 mg/L exhibited the highest risk magnitudes (MI IRR: 21.54; stroke IRR: 6.94).
Conclusions:
- Bloodstream infections substantially increase the risk of cardiovascular events, particularly within the initial two weeks.
- The severity of systemic inflammation post-BSI is directly correlated with the risk of CVD events, highlighting the potential benefit of targeting inflammation.
Background:
Cardiovascular disease (CVD) events triggered by inflammation are an underappreciated and poorly quantified cause of morbidity and mortality in patients with bloodstream infections (BSIs). We aimed to determine the risk of myocardial infarction (MI) and stroke after BSI.
Methods:
This self-controlled case series study was conducted within the Secure Anonymised Information Linkage Databank, containing anonymised population-scale electronic health record data for Wales, UK. We included adults with community-acquired BSI between 2010 and 2020. MI and stroke were determined from International Classification of Disease Version 10 coded admissions. Predefined risk periods after BSI were compared with the baseline period using pseudo-Poisson regression adjusted for age. Maximum C-reactive protein (CRP), a proxy for the magnitude of the inflammatory response, was determined within the first 7 days after BSI.
Results:
We identified 50 450 individuals with MI and 56 890 with stroke, of whom 1000 and 1290, respectively, also had at least one community-associated BSI. The risk of MI was most elevated in the first 1-7 days after BSI (adjusted incidence rate ratio (IRR) (95% CI): 9.67 (6.54 to 14.3)) and returned to baseline after 28 days. The risk was similarly elevated for stroke.The largest magnitude of risk was observed for those with a maximal CRP>300 mg/L (MI IRR: 21.54 (9.57 to 48.52); stroke IRR: 6.94 (3.14 to 15.32)).
Conclusion:
BSI is associated with an increased risk of CVD events in the first 2 weeks after infection. Greater systemic inflammation was associated with a higher risk of CVD events and suggests targeting the inflammatory response caused by BSI warrants further study.
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