Risk of Myocardial Infarction and Stroke after Acute Infection or Vaccination

Smeeth, Liam; Thomas, Sara L; Hall, Andrew J.; Hubbard, Richard; Farrington, Paddy; Vallance, Patrick

doi:10.1056/nejmoa041747

Cited by 1,209 publications

(830 citation statements)

References 28 publications

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“…There is a moderately increased acute risk of stroke following hospitalization for several types of infection, and infections have been identified as triggers of stroke in children 8, 20, 21, 22, 23, 24, 25, 26, 27. Our study replicates these findings for ILI, a more prevalent type of infection than other studies have investigated, and highlights that the risk of stroke is particularly high shortly after hospitalization for an ILI, with the odds decreasing as time increases.…”

Section: Discussionmentioning

confidence: 99%

“…Prior work has identified potential mechanisms as to why infection may serve as a trigger for stroke through mechanisms such as: causing a systemic release of cytokines and other inflammatory mediators, causing a pro‐thrombotic state, inflammation‐mediated endothelial injury, or effects on cardiac endothelium 8, 20, 21, 22, 23. The increase in odds may also be due to general effects of infection, such as fever and dehydration.…”

Section: Discussionmentioning

confidence: 99%

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Influenza‐like illness as a trigger for ischemic stroke

Boehme

Luna

Kulick

et al. 2018

Ann Clin Transl Neurol

122

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ObjectiveWe hypothesized that ILI is associated with risk of incident stroke, and that the risk would be highest closest in time to the event.MethodsThis case‐crossover analysis utilized data obtained from the California State Inpatient Database of the Healthcare Cost and Utilization Project (HCUP). The outcome of interest was ischemic stroke. Exposure was defined as a visit to the emergency department or hospitalization for influenza‐like illness (ILI) 365, 180, 90, 30, or 15 days before stroke (risk period) or similar time intervals exactly 1 or 2 years before stroke (control period). Conditional logistic regression was used to calculate the odds ratio and 95% confidence interval (OR, 95% CI).ResultsIn 2009, 36,975 hospitalized ischemic strokes met inclusion criteria, and of these strokes, 554 (1.5%) had at least 1 episode of ILI in the 365‐day risk period prior to their stroke. Using non‐overlapping time intervals from ILI to stroke, the odds of ischemic stroke was greatest in the first 15 days post ILI (OR: 2.88, 95% CI: 1.86–4.47). The strength of the relationship decreased as the time from ILI increased, and was no longer significant after 60 days. There was a significant interaction (P = 0.017) with age and ILI; the odds of stroke associated increased 7% with each 10‐year decrease in age (OR per 10‐year age decrease 1.07, 95% CI: 1.03–1.35).InterpretationWe found that ILI increases short‐term risk of stroke, particularly in people under the age of 45, and therefore may be considered to act as a trigger for stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influenza‐like illness as a trigger for ischemic stroke

Boehme

Luna

Kulick

et al. 2018

Ann Clin Transl Neurol

122

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“…Obesity is also a risk factor for conditions that, in turn, increase risk of severe respiratory infection or severe outcomes, for example, hyperglycemia, obstructive sleep apnea, and aspiration associated with gastroesophageal reflux disease 50 , 51 , 52 . An association between obesity and influenza‐related hospitalizations may also be attributed to the increased risk of cardiovascular events following influenza infection 53 . Furthermore, given that obesity is a risk factor for a number of chronic conditions, such as cardiovascular disease and obstructive sleep apnea, physicians may be more inclined to admit an obese patient than a non‐obese patient with similar influenza symptom severity.…”

Section: Discussionmentioning

confidence: 99%

Relationship between community prevalence of obesity and associated behavioral factors and community rates of influenza‐related hospitalizations in the United States

Charland

Buckeridge

Hoen

et al. 2012

Influenza Resp Viruses

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Please cite this paper as: Charland et al.(2012) Relationship between community prevalence of obesity and associated behavioral factors and community rates of influenza‐related hospitalizations in the United States. Influenza and Other Respiratory Viruses DOI: 10.1111/irv.12019. Background Findings from studies examining the association between obesity and acute respiratory infection are inconsistent. Few studies have assessed the relationship between obesity‐related behavioral factors, such as diet and exercise, and risk of acute respiratory infection. Objective To determine whether community prevalence of obesity, low fruit/vegetable consumption, and physical inactivity are associated with influenza‐related hospitalization rates. Methods Using data from 274 US counties, from 2002 to 2008, we regressed county influenza‐related hospitalization rates on county prevalence of obesity (BMI ≥ 30), low fruit/vegetable consumption (<5 servings/day), and physical inactivity (<30 minutes/month recreational exercise), while adjusting for community‐level confounders such as insurance coverage and the number of primary care physicians per 100 000 population. Results A 5% increase in obesity prevalence was associated with a 12% increase in influenza‐related hospitalization rates [adjusted rate ratio (ARR) 1·12, 95% confidence interval (CI) 1·07, 1·17]. Similarly, a 5% increase in the prevalence of low fruit/vegetable consumption and physical inactivity was associated with an increase of 12% (ARR 1·12, 95% CI 1·08, 1·17) and 11% (ARR 1·11, 95% CI 1·07, 1·16), respectively. When all three variables were included in the same model, a 5% increase in prevalence of obesity, low fruit/vegetable consumption, and physical inactivity was associated with 6%, 8%, and 7% increases in influenza‐related hospitalization rates, respectively. Conclusions Communities with a greater prevalence of obesity were more likely to have high influenza‐related hospitalization rates. Similarly, less physically active populations, with lower fruit/vegetable consumption, tended to have higher influenza‐related hospitalization rates, even after accounting for obesity.

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“…In particular, acute reactions to infectious agents are associated with an increased risk of both arterial ischaemic events and VTE and are accompanied by both arterial and venous endothelial dysfunction (40,43,44); increased circulating levels of some biomarkers of endothelial dysfunction, like endothelial microparticles or P-selectin, are associated with both an enhanced risk of cardiovascular events and of VTE (45)(46)(47); recent data have shown in patients with VTE an increase of circulating fibronectin, an endothelium-released plasma factor previously shown to correlate with arterial endothelial dysfunction (48,49); several other clinical conditions characterised by an impaired arterial endothelial function, like airpollution, chronic HIV infection, a family history of myocardial infarction, the metabolic syndrome, rheumatoid arthritis and microalbuminuria, have been reported to be associated not only with an increased risk of arterial events but also of venous thrombosis (12,14,16,19,21,22,(50)(51)(52).…”

Section: (ǡTable 2)mentioning

confidence: 99%

Endothelium, venous thromboembolism and ischaemic cardiovascular events

Gresele

Momi

Migliacci³

2010

Thromb Haemost

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SummaryThe association between venous thromboembolism and arterial thrombosis has emerged as consistent clinical observation in the last few years. While several experimental, epidemiological and pharmacologic studies support this association, the initial pathophysiological mechanism linking these two clinical conditions remains to be established. This review discusses the pathophysiological bases and a number of ex- perimental and clinical observations suggesting that the common link between venous thromboembolism and arterial thrombosis is represented by a dysfunctional endothelium.

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Risk of Myocardial Infarction and Stroke after Acute Infection or Vaccination

Cited by 1,209 publications

References 28 publications

Influenza‐like illness as a trigger for ischemic stroke

Influenza‐like illness as a trigger for ischemic stroke

Relationship between community prevalence of obesity and associated behavioral factors and community rates of influenza‐related hospitalizations in the United States

Endothelium, venous thromboembolism and ischaemic cardiovascular events

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