Association Between Hospitalization for Pneumonia and Subsequent Risk of Cardiovascular Disease | Journal Scan
What is the risk for cardiovascular disease (CVD) following pneumonia, and does this risk vary over a 10-year period?
The authors conducted a matched-cohort study nested within the two population-based, multicenter, observational cohorts: the Cardiovascular Health Study (CHS; n = 5,888; enrollment age, ≥65 years) cohort and the Atherosclerosis Risk in Communities (ARIC; n = 15,792; enrollment age, 45-64 years) cohort. Each patient who was hospitalized with pneumonia was matched to two controls. The primary outcome was new-onset CVD (including myocardial infarction, stroke, and fatal coronary heart disease). Hazard ratios (adjusted for demographics, traditional risk factors, comorbidities, and functional status) for CVD at different intervals were determined.
In the CHS cohort, the 10-year risk of CVD was higher among participants with pneumonia (p < 0.001) compared with controls. CVD occurred in 54 cases (10.6%) and six controls (0.5%) in the first 30 days (hazard ratio [HR], 4.07; 95% confidence interval [CI], 2.86-5.27). Risk for CVD remained elevated over 10 years for those hospitalized with pneumonia, compared to controls. Participants hospitalized with pneumonia in the ARIC cohort also had a higher risk of CVD, compared to controls (p < 0.001). Among those with pneumonia in ARIC, the risk for CVD was greatest during the first year and persisted through the second year, after which the risk among cases was not significantly higher than among controls.
The authors concluded that in a matched-cohort study nested with the CHS and ARIC cohorts, hospitalization was associated with an increased risk for CVD both in the short-term and for up to 10 years.
This study establishes hospitalization for pneumonia as a significant and independent risk factor for incident CVD. While others have demonstrated this, the added value from this analysis is that there is temporal variation in the risk of CVD. Even though the risk for CVD is greatest in the short-term, this risk persisted for 10 years in cases in the CHS cohort. Future studies should clarify the mechanisms through which hospitalization for pneumonia confers a long-term risk for CVD, and how to incorporate this observation into risk stratification.
Keywords: Coronary Disease, Pneumonia, Hospitalization, Risk, Risk Factors, Cohort Studies, Myocardial Infarction, Stroke
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