A1 Refereed original research article in a scientific journal
Severe Infection and Risk of Cardiovascular Disease: A Multicohort Study
Authors: Sipilä Pyry N., Lindbohm Joni V., Batty G. David, Heikkilä Nelli, Vahtera Jussi, Suominen Sakari, Väänänen Ari, Koskinen Aki, Nyberg Solja T., Meri Seppo, Pentti Jaana, Warren-Gash Charlotte, Hayward Andrew C., Kivimäki Mika
Publisher: Lippincott Williams & Wilkins
Publication year: 2023
Journal: Circulation
Journal name in source: CIRCULATION
Journal acronym: CIRCULATION
Volume: 147
Issue: 21
First page : 1582
Last page: 1593
Number of pages: 12
ISSN: 0009-7322
eISSN: 1524-4539
DOI: https://doi.org/10.1161/CIRCULATIONAHA.122.061183(external)
Web address : https://doi.org/10.1161/CIRCULATIONAHA.122.061183(external)
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/179871652(external)
Background: The excess risk of cardiovascular disease associated with a wide array of infectious diseases is unknown. We quantified the short- and long-term risk of major cardiovascular events in people with severe infection and estimated the population-attributable fraction.
Methods: We analyzed data from 331 683 UK Biobank participants without cardiovascular disease at baseline (2006-2010) and replicated our main findings in an independent population from 3 prospective cohort studies comprising 271 329 community-dwelling participants from Finland (baseline 1986-2005). Cardiovascular risk factors were measured at baseline. We diagnosed infectious diseases (the exposure) and incident major cardiovascular events after infections, defined as myocardial infarction, cardiac death, or fatal or nonfatal stroke (the outcome) from linkage of participants to hospital and death registers. We computed adjusted hazard ratios (HRs) and 95% CIs for infectious diseases as short- and long-term risk factors for incident major cardiovascular events. We also calculated population-attributable fractions for long-term risk.
Results: In the UK Biobank (mean follow-up, 11.6 years), 54 434 participants were hospitalized for an infection, and 11 649 had an incident major cardiovascular event at follow-up. Relative to participants with no record of infectious disease, those who were hospitalized experienced increased risk of major cardiovascular events, largely irrespective of the type of infection. This association was strongest during the first month after infection (HR, 7.87 [95% CI, 6.36-9.73]), but remained elevated during the entire follow-up (HR, 1.47 [95% CI, 1.40-1.54]). The findings were similar in the replication cohort (HR, 7.64 [95% CI, 5.82-10.03] during the first month; HR, 1.41 [95% CI, 1.34-1.48] during mean follow-up of 19.2 years). After controlling for traditional cardiovascular risk factors, the population-attributable fraction for severe infections and major cardiovascular events was 4.4% in the UK Biobank and 6.1% in the replication cohort.
Conclusions: Infections severe enough to require hospital treatment were associated with increased risks for major cardiovascular disease events immediately after hospitalization. A small excess risk was also observed in the long-term, but residual confounding cannot be excluded.
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