Cardiovascular complications in acute dengue infection: a population-based cohort study

Acute dengue-virus (DENV) infection, while associated with mild disease in most instances, is anecdotally associated with more severe cardiovascular complications. However, more accurate estimates of cardiac complications are required to evaluate the actual burden of dengue-associated morbidity, given significant contribution of cardiovascular events to overall morbidity and rising incidence of DENV-infection attributable to climate change.

A population-based cohort of DENV-infected Singaporean adults (2017-2023) and population-based controls (without DENV-infection) was constructed using the national-dengue-registry. Overlap weights were employed to balance baseline covariates. Logistic regression was used to estimate odds of cardiovascular events in DENV-infected cases versus uninfected controls up to 30 days from T₀ (notification-date in DENV-infected adults; randomly assigned in population-based controls following distribution of T₀ amongst DENV-infected cases).

65,207 DENV-infected cases and 1,616,865 uninfected controls were included. Higher odds of any cardiovascular event (adjusted-odds-ratio, aOR = 10.63 [95% CI = 7.56, 15.48]), major-adverse-cardiac-event (MACE) (aOR = 2.92 [95% CI = 1.81-4.88]), dysrhythmia (aOR = 18.44 [95% CI = 11.25 = 32.96]) and ischemic-heart-disease (aOR = 3.00 [95% CI = 1.83-5.15]) were observed up to 30 days post-DENV-infection, versus uninfected controls. Odds of acute cardiovascular events remained higher in both ambulatory/hospitalised DENV-infected cases, DENV-IgG-positive/negative cases, and across DENV1/2 and DENV3-predominant transmission, versus uninfected controls. However, overall excess burden (EB) of acute cardiovascular events in DENV-infected adults was modest, with <1 excess event per-100-cases except amongst those aged ≥60 years (EB = 1.25 [95% CI = 1.05-1.44]).

Acute DENV-infection was associated with higher odds of cardiovascular events up to 30 days post-infection; though excess-burden was modest. Older adults at higher risk should be monitored for cardiac complications following acute DENV-infection.

National-Medical-Research-Council, Singapore.