Cardiovascular Disease Risk Increases In Patients With Sepsis Or Pneumonia After Hospital Admission

Cardiovascular Disease Risk Increases In Patients With Sepsis Or Pneumonia After Hospital Admission

by Hannah Joy on  August 4, 2017 at 11:56 AM Health Watch
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Highlights
  • Cardiovascular disease (CVD) risk increased in patients with sepsis or pneumonia after hospital admission
  • CVD risk increases nearly six-fold in the first year after the infection
  • Further investigation for preventative therapies such as statins is needed to prevent CVD
Adults who were hospitalized for pneumonia or sepsis were found to be at a six-fold increased risk for cardiovascular disease in the first year, reveals a new study published in the European Journal of Preventive Cardiology.
Cardiovascular Disease Risk Increases In Patients With Sepsis Or Pneumonia After Hospital Admission

In two to three years, cardiovascular risk was found to be more than doubled and persisted for at least five years.

Professor Scott Montgomery, author, director of the clinical epidemiology group, Örebro University, Sweden, said that severe infections were linked with increased cardiovascular disease risk in adulthood and if this increased risk persists for several years or not after infection was not known.

Link Between Severe Infections And Cardiovascular Disease

In this study, the research team examined whether patients who were hospitalized for sepsis or pneumonia were linked to an increased cardiovascular disease risk in the next few years after infection. The team also examined whether there is a period of heightened risk in these patients.

Men who were born between 1952 and 1956 were included in the study. About 236 739 men who underwent physical and psychological examinations extensively around the age of 18 years as part of compulsory military conscription assessments were included in the study.

The research team obtained information from a register that has recorded all the information on patients admitted to the hospital since 1964, who were diagnosed with infection and cardiovascular disease. The men were followed from their late adolescence into their middle age. The follow-up was completed in 2010.

The link between the first infection in patients with sepsis or pneumonia which resulted from hospitalization with risk of cardiovascular disease later at pre-specified time intervals post-infection (0-1, >1-2, >2-3, >3-4, >4-5, and 5+ years after hospital admission for the infection) were examined by the research team..

A total of about 46 754 men (19.7%) during the follow-up period had a first diagnosis of cardiovascular disease and there were about 9 987 hospital admissions for sepsis or pneumonia among 8 534 men, who received these diagnoses.

The research team found that infection was linked to a 6.33-fold increased cardiovascular disease risk during the first year after the infection. Cardiovascular disease risk remained high by 2.47 and 2.12 times in the second and third years following an infection.

The risk of cardiovascular disease decreased with time. However, the risk was found to be still high by nearly two-folds (hazard ratio 1.87) for the next five years after the infection .

Similar findings were reported for cardiovascular diseases like coronary heart disease, stroke and fatal cardiovascular disease. The persistently increased risk in patients could not be explained by severe infections that followed.

Systemic Inflammation, A Major Risk Factor For Cardiovascular Disease

Dr Cecilia Bergh, lead author and an affiliated researcher at Örebro University, said that the cardiovascular disease risk such as coronary heart disease and stroke increased in patients with sepsis or pneumonia after hospital admission.

The risk of cardiovascular disease was notably high in patients for the next three years after infection and was found to increase nearly two-fold after five years.

In the first three years post-infection, the research team examined that the relationship between other risk factors like overweight, obesity, high blood pressure, poorer physical fitness and household crowding in childhood; it was found that infection was linked with the highest magnitude of cardiovascular disease risk.

Professor Montgomery said: "Conventional cardiovascular risk factors are still important but infection may be the primary source of risk for a limited time."

In this study, the results show that immediately after infection the risk of cardiovascular disease is very high and may reduce with time.

Systemic inflammation after a severe infection may persist and play a major role, as inflammation is a risk factor for cardiovascular disease.

Most patients who have sepsis or pneumonia recover. But many patients, even after the acute phase of infection still continue to have high circulating inflammatory markers .

Professor Montgomery said: "Our findings provide another reason to protect against infection and suggest that there is a post-infection window of increased cardiovascular disease risk. We did not study any interventions that could be initiated during this period, but preventative therapies such as statins could be investigated."

Reference

  1. Bergh C, et al. Severe infections and subsequent delayed cardiovascular disease. European Journal of Preventive Cardiology (2017). DOI: 10.1177/2047487317724009


Source: Medindia

Source: Medindia

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I wonder how much these retrospective results are influenced by a documentation bias or reporting bias. When a patient has an event [e.g. stroke] their history is carefully evaluated, and a risk factor in the past (e.g. pneumonia) is likely to be reported and documented in the EMR. Therefore you will always find more history (pneumonia) in patients having an event (stroke) than in patients not having the event, which leads us to conclude that pneumonia is a risk for stroke.

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