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Eur Respir J. 2018 Mar 29;51(3). pii: 1701794. doi: 10.1183/13993003.01794-2017. Print 2018 Mar.

Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland.

Author information

Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Institute of Health Informatics, University College London, London, UK.
School of Mathematics and Statistics, Open University, Milton Keynes, UK.
Health Protection Scotland, NHS National Services Scotland, Glasgow, UK.
Institute of Epidemiology and Healthcare, University College London, London, UK.


While acute respiratory tract infections can trigger cardiovascular events, the differential effect of specific organisms is unknown. This is important to guide vaccine policy.Using national infection surveillance data linked to the Scottish Morbidity Record, we identified adults with a first myocardial infarction or stroke from January 1, 2004 to December 31, 2014 and a record of laboratory-confirmed respiratory infection during this period. Using self-controlled case series analysis, we generated age- and season-adjusted incidence ratios (IRs) for myocardial infarction (n=1227) or stroke (n=762) after infections compared with baseline time.We found substantially increased myocardial infarction rates in the week after Streptococcus pneumoniae and influenza virus infection: adjusted IRs for days 1-3 were 5.98 (95% CI 2.47-14.4) and 9.80 (95% CI 2.37-40.5), respectively. Rates of stroke after infection were similarly high and remained elevated to 28 days: day 1-3 adjusted IRs 12.3 (95% CI 5.48-27.7) and 7.82 (95% CI 1.07-56.9) for S. pneumoniae and influenza virus, respectively. Although other respiratory viruses were associated with raised point estimates for both outcomes, only the day 4-7 estimate for stroke reached statistical significance.We showed a marked cardiovascular triggering effect of S. pneumoniae and influenza virus, which highlights the need for adequate pneumococcal and influenza vaccine uptake. Further research is needed into vascular effects of noninfluenza respiratory viruses.

Conflict of interest statement

Conflict of interest: H. Whitaker has received grants from the MRC (methodology grant MR/L009005/1) and IMI/EFPIA (ADVANCE), outside the submitted work.

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