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Hospitalization for pneumonia associated with increased risk of cardiovascular disease

The JAMA Network Journals

Hospitalization with pneumonia in older adults was associated with an increased short-term and long-term risk of cardiovascular disease (CVD), suggesting that pneumonia may be an important risk factor for CVD, according to a study in the January 20 issue of JAMA.

Cardiovascular disease is the principal cause of illness and death worldwide. Characterizing the risk factors for CVD is important to design optimal preventive strategies. Several studies that examined the association between infection and subsequent long­term risk of CVD have had conflicting results. Characterizing the short-term and long-term risk of CVD after infection is important because it could suggest that infection is a risk factor for CVD, according to background information in the article.

Vicente F. Corrales-Medina, M.D., M.Sc., of the University of Ottawa, Ottawa Ontario, Canada, and colleagues examined whether hospitalization for pneumonia is associated with an increased short-term and long-term risk of CVD. The researchers chose pneumonia because respiratory tract infections have been consistently associated with increased risk of CVD, pneumonia is a well-characterized infectious syndrome that affects 1.2 percent of the population in the northern hemisphere each year, and it is the most common medical diagnosis responsible for hospitalizations in the United States.

The study included two community-based groups: the Cardiovascular Health Study (CHS, n = 5,888; enrollment age, 65 years or older; enrollment period, 1989-1994) and the Atherosclerosis Risk in Communities study (ARIC, n = 15,792; enrollment age, 45-64 years of age; enrollment period, 1987-1989). Participants hospitalized with pneumonia were matched to two controls. Pneumonia cases and controls were followed for occurrence of CVD over 10 years after matching.

Of 591 pneumonia cases in CHS, 206 had CVD events (heart attack, stroke, and fatal coronary heart disease) over 10 years after pneumonia hospitalization. In ARIC, of 680 pneumonia cases, 112 had CVD events over 10 years after hospitalization. Analysis indicated that hospitalization with pneumonia was associated with a subsequent increase in the risk of CVD. The risk was highest (4-fold) in the first 30 days after pneumonia, and although it progressively declined during the first year, it remained approximately 1.5-fold higher in subsequent years. This association persisted after adjusting for demographics, the burden of cardiovascular risk factors, crude measures of frailty, and was observed across a range of infection severity.

"Moreover, in our analyses, the magnitude of risk for CVD associated with pneumonia was similar or higher compared with the risk of CVD associated with traditional risk factors, such as smoking, diabetes, and hypertension. Thus, our results suggest that pneumonia is an important risk factor for CVD," the authors write.

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(doi:10.1001/jama.2014.18229; Available pre-embargo to the media at http://media.jamanetwork.com)

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