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Risk of myocardial infarction and stroke following bloodstream infection: a population-based self-controlled case series

Jonathan Underwood Orcid Logo, Nicola Reeve, Victoria Best, Ashley Akbari Orcid Logo, Haroon Ahmed

Open Heart, Volume: 12, Issue: 1, Start page: e003241

Swansea University Authors: Victoria Best, Ashley Akbari Orcid Logo

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DOI (Published version): 10.1136/openhrt-2025-003241

Abstract

Background Cardiovascular disease (CVD) events triggered by inflammation are an underappreciated and poorly quantified cause of morbidity and mortality in patients with bloodstream infections (BSIs). We aimed to determine the risk of myocardial infarction (MI) and stroke after BSI.Methods This self-...

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Published in: Open Heart
ISSN: 2053-3624
Published: BMJ 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa69306
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spelling 2025-05-12T13:26:56.3546157 v2 69306 2025-04-17 Risk of myocardial infarction and stroke following bloodstream infection: a population-based self-controlled case series 0c82f7076d0fc5c916ecbcc472a6a9ae Victoria Best Victoria Best true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 2025-04-17 MEDS Background Cardiovascular disease (CVD) events triggered by inflammation are an underappreciated and poorly quantified cause of morbidity and mortality in patients with bloodstream infections (BSIs). We aimed to determine the risk of myocardial infarction (MI) and stroke after BSI.Methods This self-controlled case series study was conducted within the Secure Anonymised Information Linkage Databank, containing anonymised population-scale electronic health record data for Wales, UK. We included adults with community-acquired BSI between 2010 and 2020. MI and stroke were determined from International Classification of Disease Version 10 coded admissions. Predefined risk periods after BSI were compared with the baseline period using pseudo-Poisson regression adjusted for age. Maximum C-reactive protein (CRP), a proxy for the magnitude of the inflammatory response, was determined within the first 7 days after BSI.Results We identified 50 450 individuals with MI and 56 890 with stroke, of whom 1000 and 1290, respectively, also had at least one community-associated BSI. The risk of MI was most elevated in the first 1–7 days after BSI (adjusted incidence rate ratio (IRR) (95% CI): 9.67 (6.54 to 14.3)) and returned to baseline after 28 days. The risk was similarly elevated for stroke.The largest magnitude of risk was observed for those with a maximal CRP>300 mg/L (MI IRR: 21.54 (9.57 to 48.52); stroke IRR: 6.94 (3.14 to 15.32)).Conclusion BSI is associated with an increased risk of CVD events in the first 2 weeks after infection. Greater systemic inflammation was associated with a higher risk of CVD events and suggests targeting the inflammatory response caused by BSI warrants further study. Journal Article Open Heart 12 1 e003241 BMJ 2053-3624 25 3 2025 2025-03-25 10.1136/openhrt-2025-003241 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This work is funded by the Medical Research Council [grant number MR/ T023791/1]. 2025-05-12T13:26:56.3546157 2025-04-17T16:39:04.4703212 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Jonathan Underwood 0000-0001-6963-2821 1 Nicola Reeve 2 Victoria Best 3 Ashley Akbari 0000-0003-0814-0801 4 Haroon Ahmed 5 69306__34248__f0a3b605709743f48a75d7b960285a7a.pdf 69306.VoR.pdf 2025-05-12T12:31:06.3094331 Output 362007 application/pdf Version of Record true © Author(s) (or their employer(s)) 2025. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license. true eng https://creativecommons.org/licenses/by/4.0/
title Risk of myocardial infarction and stroke following bloodstream infection: a population-based self-controlled case series
spellingShingle Risk of myocardial infarction and stroke following bloodstream infection: a population-based self-controlled case series
Victoria Best
Ashley Akbari
title_short Risk of myocardial infarction and stroke following bloodstream infection: a population-based self-controlled case series
title_full Risk of myocardial infarction and stroke following bloodstream infection: a population-based self-controlled case series
title_fullStr Risk of myocardial infarction and stroke following bloodstream infection: a population-based self-controlled case series
title_full_unstemmed Risk of myocardial infarction and stroke following bloodstream infection: a population-based self-controlled case series
title_sort Risk of myocardial infarction and stroke following bloodstream infection: a population-based self-controlled case series
author_id_str_mv 0c82f7076d0fc5c916ecbcc472a6a9ae
aa1b025ec0243f708bb5eb0a93d6fb52
author_id_fullname_str_mv 0c82f7076d0fc5c916ecbcc472a6a9ae_***_Victoria Best
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
author Victoria Best
Ashley Akbari
author2 Jonathan Underwood
Nicola Reeve
Victoria Best
Ashley Akbari
Haroon Ahmed
format Journal article
container_title Open Heart
container_volume 12
container_issue 1
container_start_page e003241
publishDate 2025
institution Swansea University
issn 2053-3624
doi_str_mv 10.1136/openhrt-2025-003241
publisher BMJ
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Background Cardiovascular disease (CVD) events triggered by inflammation are an underappreciated and poorly quantified cause of morbidity and mortality in patients with bloodstream infections (BSIs). We aimed to determine the risk of myocardial infarction (MI) and stroke after BSI.Methods This self-controlled case series study was conducted within the Secure Anonymised Information Linkage Databank, containing anonymised population-scale electronic health record data for Wales, UK. We included adults with community-acquired BSI between 2010 and 2020. MI and stroke were determined from International Classification of Disease Version 10 coded admissions. Predefined risk periods after BSI were compared with the baseline period using pseudo-Poisson regression adjusted for age. Maximum C-reactive protein (CRP), a proxy for the magnitude of the inflammatory response, was determined within the first 7 days after BSI.Results We identified 50 450 individuals with MI and 56 890 with stroke, of whom 1000 and 1290, respectively, also had at least one community-associated BSI. The risk of MI was most elevated in the first 1–7 days after BSI (adjusted incidence rate ratio (IRR) (95% CI): 9.67 (6.54 to 14.3)) and returned to baseline after 28 days. The risk was similarly elevated for stroke.The largest magnitude of risk was observed for those with a maximal CRP>300 mg/L (MI IRR: 21.54 (9.57 to 48.52); stroke IRR: 6.94 (3.14 to 15.32)).Conclusion BSI is associated with an increased risk of CVD events in the first 2 weeks after infection. Greater systemic inflammation was associated with a higher risk of CVD events and suggests targeting the inflammatory response caused by BSI warrants further study.
published_date 2025-03-25T05:22:00Z
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