肺炎住院治疗与后续心血管疾病风险之间的关联。

Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease.

作者信息

Corrales-Medina Vicente F, Alvarez Karina N, Weissfeld Lisa A, Angus Derek C, Chirinos Julio A, Chang Chung-Chou H, Newman Anne, Loehr Laura, Folsom Aaron R, Elkind Mitchell S, Lyles Mary F, Kronmal Richard A, Yende Sachin

机构信息

Department of Medicine, University of Ottawa, Ottawa Ontario, Canada2Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, Pennsylvania.

出版信息

JAMA. 2015 Jan 20;313(3):264-74. doi: 10.1001/jama.2014.18229.

DOI:10.1001/jama.2014.18229

PMID:25602997

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4687729/

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.

摘要

重要性

感染后心血管疾病（CVD）的风险尚不清楚。

目的

确定肺炎住院是否与短期和长期CVD风险增加相关。

设计、背景和参与者：我们研究了2个基于社区的队列：心血管健康研究（CHS，n = 5888；入组年龄≥65岁；入组时间1989 - 1994年）和社区动脉粥样硬化风险研究（ARIC，n = 15792；入组年龄45 - 64岁；入组时间1987 - 1989年）。参与者随访至2010年12月31日。我们将每例因肺炎住院的参与者与2名对照进行匹配。对肺炎病例和对照在匹配后10年内发生CVD的情况进行随访。我们估计了不同时间间隔CVD的风险比（HRs），并对人口统计学、CVD危险因素、亚临床CVD、合并症和功能状态进行了调整。

暴露因素

肺炎住院。

主要结局和测量指标

新发CVD（心肌梗死、中风和致命性冠心病）。

结果

在CHS的591例肺炎病例中，206例在肺炎住院后10年内发生了CVD事件。肺炎后的CVD风险在第一年最高。在最初30天内，54例病例和6例对照发生CVD（HR，4.07；95%CI，2.86 - 5.27）；31至90天之间，11例病例和9例对照发生CVD（HR，2.94；95%CI，2.18 - 3.70）；91天至1年之间，22例病例和55例对照发生CVD（HR，2.10；95%CI，1.59 - 2.60）。额外的CVD风险在第十年仍保持升高，此时4例病例和12例对照发生CVD（HR，1.86；95%CI，1.18 - 2.55）。在ARIC中，680例肺炎病例中，112例在住院后10年内发生CVD。在最初30天内，4例病例和3例对照发生CVD（HR，2.38；95%CI，1.12 - 3.63）；31至90天之间，4例病例和0例对照发生CVD（HR，2.40；95%CI，1.23 - 3.47）；91天至1年之间，11例病例和8例对照发生CVD（HR，2.19；95%CI，1.20 - 3.19）；第二年期间，8例病例和7例对照发生CVD（HR，1.88；95%CI，所1.10 - 2.66）。第二年之后，HRs不再具有统计学意义。