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European Heart Journal Advance Access published online on December 6, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm516
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org.

Recent respiratory infection and risk of cardiovascular disease: case-control study through a general practice database

Tim C. Clayton1,*, Mary Thompson2 and Tom W. Meade3

1 Medical Statistics Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
2 IMS Health, London, UK
3 Non-communicable Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK

Received 21 December 2006; revised 1 October 2007; accepted 18 October 2007.

* Corresponding author. Tel: +44 20 7927 2640, Fax: +44 20 7637 2853. Email: tim.clayton{at}lshtm.ac.uk

Aims: Respiratory infection may be associated with an increased risk of major cardiovascular events. This case-control study describes associations with these events of respiratory infection.

Methods and results: The IMS Disease Analyzer Mediplus primary care database was used to identify all cases of first-time diagnosis of myocardial infarction (MI) or stroke and single matched controls. Details were extracted on visits for respiratory infection over the preceding year. A total of 11 155 MI cases and 9208 stroke cases were identified. For MI and stroke respectively, there were 326 and 260 respiratory infections during the month preceding the index date. There was strong evidence of an increased risk of both events in the 7 days following infection, for MI adjusted odds ratio (OR) 2.10 (95% confidence interval 1.38–3.21), for stroke OR 1.92 (95% confidence interval 1.24–2.97). The strength of these associations fell over time. The associations for MI occurred at all levels of initial underlying cardiovascular risk.

Conclusions: There are strong associations between recent respiratory infection and major cardiovascular events, for MI at all levels of underlying risk. The benefits of reducing respiratory infection either through immunization or treating or preventing infection may be substantial.

Key Words: Myocardial infarction • Stroke • Respiratory infection • Urinary tract infection • Case-control study


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