Severe Infection and Risk of Cardiovascular Disease: A Multicohort Study.

Autor:	Sipilä PN; Departments of Public Health (P.N.S., J.V.L., S.T.N., J.P., M.K.).; Finnish Institute of Occupational Health, Helsinki (P.N.S., A.V., A.K., S.T.N., J.P., M.K.)., Lindbohm JV; Departments of Public Health (P.N.S., J.V.L., S.T.N., J.P., M.K.).; UCL Brain Sciences (J.V.L., G.D.B., M.K.), University College London, UK., Batty GD; UCL Brain Sciences (J.V.L., G.D.B., M.K.), University College London, UK., Heikkilä N; Bacteriology and Immunology and Translational Immunology Research Program, University of Helsinki, Finland (N.H., S.M.)., Vahtera J; Department of Public Health, University of Turku, Finland (J.V., S.S., J.P.).; Centre for Population Health Research, University of Turku and Turku University Hospital, Finland (J.V.)., Suominen S; Department of Public Health, University of Turku, Finland (J.V., S.S., J.P.).; Turku University Hospital, Finland (S.S.).; School of Health and Education, University of Skövde, Sweden (S.S.)., Väänänen A; Finnish Institute of Occupational Health, Helsinki (P.N.S., A.V., A.K., S.T.N., J.P., M.K.)., Koskinen A; Finnish Institute of Occupational Health, Helsinki (P.N.S., A.V., A.K., S.T.N., J.P., M.K.)., Nyberg ST; Departments of Public Health (P.N.S., J.V.L., S.T.N., J.P., M.K.).; Finnish Institute of Occupational Health, Helsinki (P.N.S., A.V., A.K., S.T.N., J.P., M.K.)., Meri S; Bacteriology and Immunology and Translational Immunology Research Program, University of Helsinki, Finland (N.H., S.M.).; HUSLAB, Helsinki University Hospital, Finland (S.M.)., Pentti J; Departments of Public Health (P.N.S., J.V.L., S.T.N., J.P., M.K.).; Finnish Institute of Occupational Health, Helsinki (P.N.S., A.V., A.K., S.T.N., J.P., M.K.).; Department of Public Health, University of Turku, Finland (J.V., S.S., J.P.)., Warren-Gash C; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom (C.W.-G.)., Hayward AC; Institute of Epidemiology and Health Care (A.C.H.), University College London, UK., Kivimäki M; Departments of Public Health (P.N.S., J.V.L., S.T.N., J.P., M.K.).; Finnish Institute of Occupational Health, Helsinki (P.N.S., A.V., A.K., S.T.N., J.P., M.K.).; UCL Brain Sciences (J.V.L., G.D.B., M.K.), University College London, UK.
Jazyk:	angličtina
Zdroj:	Circulation [Circulation] 2023 May 23; Vol. 147 (21), pp. 1582-1593. Date of Electronic Publication: 2023 Mar 27.
DOI:	10.1161/CIRCULATIONAHA.122.061183
Abstrakt:	Background: The excess risk of cardiovascular disease associated with a wide array of infectious diseases is unknown. We quantified the short- and long-term risk of major cardiovascular events in people with severe infection and estimated the population-attributable fraction. Methods: We analyzed data from 331 683 UK Biobank participants without cardiovascular disease at baseline (2006-2010) and replicated our main findings in an independent population from 3 prospective cohort studies comprising 271 329 community-dwelling participants from Finland (baseline 1986-2005). Cardiovascular risk factors were measured at baseline. We diagnosed infectious diseases (the exposure) and incident major cardiovascular events after infections, defined as myocardial infarction, cardiac death, or fatal or nonfatal stroke (the outcome) from linkage of participants to hospital and death registers. We computed adjusted hazard ratios (HRs) and 95% CIs for infectious diseases as short- and long-term risk factors for incident major cardiovascular events. We also calculated population-attributable fractions for long-term risk. Results: In the UK Biobank (mean follow-up, 11.6 years), 54 434 participants were hospitalized for an infection, and 11 649 had an incident major cardiovascular event at follow-up. Relative to participants with no record of infectious disease, those who were hospitalized experienced increased risk of major cardiovascular events, largely irrespective of the type of infection. This association was strongest during the first month after infection (HR, 7.87 [95% CI, 6.36-9.73]), but remained elevated during the entire follow-up (HR, 1.47 [95% CI, 1.40-1.54]). The findings were similar in the replication cohort (HR, 7.64 [95% CI, 5.82-10.03] during the first month; HR, 1.41 [95% CI, 1.34-1.48] during mean follow-up of 19.2 years). After controlling for traditional cardiovascular risk factors, the population-attributable fraction for severe infections and major cardiovascular events was 4.4% in the UK Biobank and 6.1% in the replication cohort. Conclusions: Infections severe enough to require hospital treatment were associated with increased risks for major cardiovascular disease events immediately after hospitalization. A small excess risk was also observed in the long-term, but residual confounding cannot be excluded. Competing Interests: Disclosures Dr Sipilä reports grant support during the conduct of the study from NordForsk (75021), Academy of Finland (311492 and 329202), Helsinki Institute of Life Science, Emil Aaltonen Foundation, and Finnish Medical Foundation. Dr Lindbohm reports grant support during the conduct of the study from the Academy of Finland (339568) and Päivikki and Sakari Sohlberg Foundation. Dr Batty reports grant support from the UK Medical Research Council (MR/P023444/1) and US National Institute on Aging (1R56AG052519-01 and 1R01AG052519-01A1). Dr Vahtera reports grant support from the Academy of Finland (321409 and 329240) and NordForsk (75021). Dr Nyberg reports grant support from NordForsk (75021). Dr Warren-Gash reports support from Wellcome Fellowship (201440/Z/16/Z). Dr Kivimäki reports grant support during the conduct of the study from NordForsk (75021), UK Medical Research Council (MRC S011676/1 and R024227/1), US National Institute on Aging (R01AG056477), Academy of Finland (329202 and 350426), Finnish Foundation for Cardiovascular Research (a86898), Finnish Work Environment Fund (190424), and Wellcome Trust (221854/Z/20/Z). The other authors report no conflicts.
Databáze:	MEDLINE
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