Triggering of cardiovascular disease by infection type: The Atherosclerosis Risk in Communities study (ARIC)

Logan T. Cowan, Brian Buck, Jessica S. Schwind, Pamela L. Lutsey, James S. Pankow, Kunihiro Matsushita, Junichi Ishigami, Kamakshi Lakshminarayan

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)155-160
Number of pages6
JournalInternational Journal of Cardiology
Volume325
DOIs
StatePublished - Feb 15 2021

Bibliographical note

Funding Information:
The ARIC study was supported by National Heart, Lung, and Blood Institute (NHLBI) contracts

Funding Information:
We thank the staff and participants of the ARIC study for their important contributions. The ARIC study was supported by National Heart, Lung, and Blood Institute (NHLBI) contracts, HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C.

Publisher Copyright:
© 2020 Elsevier B.V.

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Keywords

  • Coronary heart disease
  • Crossover design
  • Epidemiology
  • Infection
  • Stroke
  • Trigger

PubMed: MeSH publication types

  • Journal Article

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