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.).
Circulation. 2023 May 23;147(21):1582-1593. doi: 10.1161/CIRCULATIONAHA.122.061183. Epub 2023 Mar 27.
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.
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.
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.
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.
大量传染病与心血管疾病风险增加相关，但具体风险尚不清楚。本研究旨在量化严重感染患者发生主要心血管事件的短期和长期风险，并估计人群归因分数。
本研究分析了来自 331683 名无心血管疾病的英国生物库参与者（基线时为 2006-2010 年）的数据，并在包含 271329 名芬兰社区居民的 3 项前瞻性队列研究的独立人群中对主要发现进行了复制（基线时间为 1986-2005 年）。基线时测量了心血管风险因素。通过参与者与医院和死亡登记处的链接，我们诊断了传染病（暴露）和感染后的主要心血管事件（结局），包括心肌梗死、心源性死亡或致命或非致命性卒中。我们计算了感染作为主要心血管事件短期和长期风险因素的调整后的风险比（HR）和 95%置信区间（CI）。我们还计算了长期风险的人群归因分数。
在英国生物库中（中位随访时间为 11.6 年），54434 名参与者因感染住院，11649 名参与者在随访期间发生了主要心血管事件。与无感染记录的参与者相比，住院患者发生主要心血管事件的风险增加，这主要与感染类型无关。这种关联在感染后第一个月最强（HR，7.87[95%CI，6.36-9.73]），但在整个随访期间仍处于较高水平（HR，1.47[95%CI，1.40-1.54]）。在复制队列中也发现了类似的结果（感染后第一个月的 HR 为 7.64[95%CI，5.82-10.03]；平均随访 19.2 年时的 HR 为 1.41[95%CI，1.34-1.48]）。在校正了传统心血管风险因素后，英国生物库中严重感染和主要心血管事件的人群归因分数为 4.4%，在复制队列中为 6.1%。
需要住院治疗的严重感染与住院后立即发生主要心血管疾病事件的风险增加有关。在长期观察中也观察到了一小部分额外风险，但不能排除残余混杂因素的影响。
