Association Between Hospitalization for Pneumonia and Subsequent Risk of Cardiovascular Disease | Cardiology | JAMA | JAMA Network
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Original Investigation
Caring for the Critically Ill Patient
January 20, 2015

Association Between Hospitalization for Pneumonia and Subsequent Risk of Cardiovascular Disease

Author Affiliations
  • 1Department of Medicine, University of Ottawa, Ottawa Ontario, Canada
  • 2Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • 3Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 4Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 5Division of Cardiology, University of Pennsylvania, Philadelphia
  • 6Division of Cardiology, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
  • 7Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 8Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 9Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
  • 10Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
  • 11Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
  • 12Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
  • 13Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
  • 14Department of Biostatistics, School of Public Health, University of Washington, Seattle
  • 15Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
JAMA. 2015;313(3):264-274. doi:10.1001/jama.2014.18229
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.

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