18 Infection is a risk factor for ischaemic heart disease and stroke and impacts long-term mortality: insights utilising big data from the UK acalm registry

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Abstract

Background

Atherosclerosis is a chronic inflammatory condition and growing evidence links systemic inflammation with accelerated atherogenesis. Infectious disease is a common cause of inflammation and it’s impact on atherosclerotic disease is less studied. Using a big data approach we studied the risk of atherosclerotic disease and outcome following respiratory and urinary tract infections.

Methods

We used a retrospective, longitudinal naturalistic follow-up design using the Algorithm for Comorbidities, Associations, Length of stay and Mortality (ACALM) study of 1,220,024 patients admitted to UK hospitals between 2000–2013. All patients aged 40 with urinary/chest infection on index admission (but no previous ischaemic heart disease (IHD) or ischaemic stroke) were followed-up for development of IHD or stroke and compared with an age/gender matched control group (n=34,02, 59% female, mean age 73±14). Logistic regression adjusted for cardiovascular risk factors and top causes of death was performed comparing rates of developing IHD, ischaemic stroke and mortality.

Results

Patients with a prior infection had higher unadjusted incidences of IHD (9.9% vs 5.9%) and stroke (4.2% vs 1.5%). Figure 1 shows adjusted risk factors associated with development of IHD and stroke.%). Logistic regression demonstrated that prior infection was associated with 36% higher risk of developing IHD (OR 1.36 95% CI 1.28–1.44), and, 3 fold higher risk of mortality in those who developed IHD (OR 2.98 95% CI 2.52–3.51). Similarly, prior infection was associated with 2.5 fold increased risk of stroke (OR 2.50, 95% CI 2.26–2.78) and 80% higher risk of subsequent mortality (OR 1.80, 95% CI 1.27–2.52).

Conclusion

In a large UK registry we demonstrate increased risk of atherosclerotic disease and greater subsequent mortality in patients with prior infection. In light of the CANTOS trial targeted therapy in reducing inflammation requires further exploration.

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