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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. Compared with controls, CVD risk among pneumonia cases was highest during the first year after hospitalization and remained significantly higher than among controls through 10 years. In ARIC, of 680 pneumonia cases, 112 had CVD events over 10 years after hospitalization. After the second year, CVD risk among pneumonia cases was not significantly higher than among controls. Pneumonia Cases Controls HR (95% CI) CHS No. of participants 591 1182 CVD events  0-30 d 54 6 4.07 (2.86-5.27)  31-90 d 11 9 2.94 (2.18-3.70)  91 d-1 y 22 55 2.10 (1.59-2.60)  9-10 y 4 12 1.86 (1.18-2.55) ARIC No. of participants 680 1360 CVD events  0-30 d 4 3 2.38 (1.12-3.63)  31-90 d 4 0 2.40 (1.23-3.47)  91 d-1 y 11 8 2.19 (1.20-3.19)  1-2 y 8 7 1.88 (1.10-2.66) 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.

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Kitzman DW, Nicklas B, Kraus WE, Lyles MF, Eggebeen J, Morgan TM, Haykowsky M. Skeletal muscle abnormalities and exercise intolerance in older patients with heart failure and preserved ejection fraction. Am J Physiol Heart Circ Physiol 306: H1364-H1370, 2014. First published March 21, 2014 doi:10.1152/ajpheart.00004.2014.-Heart failure (HF) with preserved ejection fraction (HFPEF) is the most common form of HF in older persons. The primary chronic symptom in HFPEF is severe exercise intolerance, and its pathophysiology is poorly understood. To determine whether skeletal muscle abnormalities contribute to their severely reduced peak exercise O2 consumption (V O2), we examined 22 older HFPEF patients (70 Ϯ 7 yr) compared with 43 age-matched healthy control (HC) subjects using needle biopsy of the vastus lateralis muscle and cardiopulmonary exercise testing to assess muscle fiber type distribution and capillarity and peak V O2. In HFPEF versus HC patients, peak V O2 (14.7 Ϯ 2.1 vs. 22.9 Ϯ 6.6 ml·kg Ϫ1 · min Ϫ1 , P Ͻ 0.001) and 6-min walk distance (454 Ϯ 72 vs. 573 Ϯ 71 m, P Ͻ 0.001) were reduced. In HFPEF versus HC patients, the percentage of type I fibers (39.0 Ϯ 11.4% vs. 53.7 Ϯ 12.4%, P Ͻ 0.001), type I-to-type II fiber ratio (0.72 Ϯ 0.39 vs. 1.36 Ϯ 0.85, P ϭ 0.001), and capillary-to-fiber ratio (1.35 Ϯ 0.32 vs. 2.53 Ϯ 1.37, P ϭ 0.006) were reduced, whereas the percentage of type II fibers was greater (61 Ϯ 11.4% vs. 46.3 Ϯ 12.4%, P Ͻ 0.001). In univariate analyses, the percentage of type I fibers (r ϭ 0.39, P ϭ 0.003), type I-to-type II fiber ratio (r ϭ 0.33, P ϭ 0.02), and capillary-to-fiber ratio (r ϭ 0.59, P Ͻ 0.0001) were positively related to peak V O2. In multivariate analyses, type I fibers and the capillary-to-fiber ratio remained significantly related to peak V O2. We conclude that older HFPEF patients have significant abnormalities in skeletal muscle, characterized by a shift in muscle fiber type distribution with reduced type I oxidative muscle fibers and a reduced capillary-to-fiber ratio, and these may contribute to their severe exercise intolerance. This suggests potential new therapeutic targets in this difficult to treat disorder. heart failure; exercise; aging APPROXIMATELY 50% OF HEART FAILURE (HF) patients living in the community have preserved left ventricular (LV) ejection fraction (HFPEF) (33,52,68). HFPEF is nearly exclusively a disorder of older persons and is most common in women. The primary symptom in patients with chronic HFPEF is severe exercise intolerance, measured objectively as decreased peak exercise O 2 uptake (peak V O 2 ) (2,3,5,26,30,34,35,41), and this is associated with a reduced quality of life. Despite its importance, the pathophysiology of exercise intolerance in HFPEF is not well understood.Several lines of evidence suggest that in older HFPEF patients, noncardiac factors may contribute to reduced peak V O 2 and may be major contributors to the improvement in peak V O 2 after endurance exercise training (2,5,23,24,26,36,47,54). It is known that aging results in alter...

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