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JAMA. 2015 Jan 20;313(3):264-74. doi: 10.1001/jama.2014.18229.

Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease.

Author information

1
Department of Medicine, University of Ottawa, Ottawa Ontario, Canada2Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
2
Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
3
Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, Pennsylvania4Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsy.
4
Division of Cardiology, University of Pennsylvania, Philadelphia6Division of Cardiology, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
5
Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania7Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
6
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
7
Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill.
8
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
9
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York12Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
10
Department of Medicine, Wake Forest University, Winston-Salem, North Carolina.
11
Department of Biostatistics, School of Public Health, University of Washington, Seattle.
12
Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, Pennsylvania15Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.

Abstract

IMPORTANCE:

The risk of cardiovascular disease (CVD) after infection is poorly understood.

OBJECTIVE:

To determine whether hospitalization for pneumonia is associated with an increased short-term and long-term risk of CVD.

DESIGN, SETTINGS, AND PARTICIPANTS:

We examined 2 community-based cohorts: the Cardiovascular Health Study (CHS, n = 5888; enrollment age, ≥65 years; enrollment period, 1989-1994) and the Atherosclerosis Risk in Communities study (ARIC, n = 15,792; enrollment age, 45-64 years; enrollment period, 1987-1989). Participants were followed up through December 31, 2010. We matched each participant hospitalized with pneumonia to 2 controls. Pneumonia cases and controls were followed for occurrence of CVD over 10 years after matching. We estimated hazard ratios (HRs) for CVD at different time intervals, adjusting for demographics, CVD risk factors, subclinical CVD, comorbidities, and functional status.

EXPOSURES:

Hospitalization for pneumonia.

MAIN OUTCOMES AND MEASURES:

Incident CVD (myocardial infarction, stroke, and fatal coronary heart disease).

RESULTS:

Of 591 pneumonia cases in CHS, 206 had CVD events over 10 years after pneumonia hospitalization. CVD risk after pneumonia was highest in the first year. CVD occurred in 54 cases and 6 controls in the first 30 days (HR, 4.07; 95% CI, 2.86-5.27); 11 cases and 9 controls between 31 and 90 days (HR, 2.94; 95% CI, 2.18-3.70); and 22 cases and 55 controls between 91 days and 1 year (HR, 2.10; 95% CI, 1.59-2.60). Additional CVD risk remained elevated into the tenth year, when 4 cases and 12 controls developed CVD (HR, 1.86; 95% CI, 1.18-2.55). In ARIC, of 680 pneumonia cases, 112 had CVD over 10 years after hospitalization. CVD occurred in 4 cases and 3 controls in the first 30 days (HR, 2.38; 95% CI, 1.12-3.63); 4 cases and 0 controls between 31 and 90 days (HR, 2.40; 95% CI, 1.23-3.47); 11 cases and 8 controls between 91 days and 1 year (HR, 2.19; 95% CI, 1.20-3.19); and 8 cases and 7 controls during the second year (HR, 1.88; 95% CI, 1.10-2.66). After the second year, the HRs were no longer statistically significant.

CONCLUSIONS AND RELEVANCE:

Hospitalization for pneumonia was associated with increased short-term and long-term risk of CVD, suggesting that pneumonia may be a risk factor for CVD.

PMID:
25602997
PMCID:
PMC4687729
DOI:
10.1001/jama.2014.18229
[Indexed for MEDLINE]
Free PMC Article

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