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Risk of myocardial infarction and stroke following microbiologically confirmed urinary tract infection: a self-controlled case series study using linked electronic health data

Nicola F Reeve Orcid Logo, Victoria Best, Rebecca Cannings-John Orcid Logo, David Gillespie Orcid Logo, Kathryn Hughes, Fiona V Lugg-Widger Orcid Logo, Fatemeh Torabi Orcid Logo, Mandy Wootton, Ashley Akbari Orcid Logo, Haroon Ahmed

BMJ Open, Volume: 15, Issue: 6, Start page: e097754

Swansea University Authors: Victoria Best, Fatemeh Torabi Orcid Logo, Ashley Akbari Orcid Logo

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DOI (Published version): 10.1136/bmjopen-2024-097754

Abstract

Objectives The inflammatory response from acute infection may trigger cardiovascular events. We aimed to estimate associations between microbiologically confirmed urinary tract infections (UTIs) and first acute myocardial infarction (MI) and stroke.Design We used a self-controlled case series, with...

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Published in: BMJ Open
ISSN: 2044-6055 2044-6055
Published: BMJ 2025
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We aimed to estimate associations between microbiologically confirmed urinary tract infections (UTIs) and first acute myocardial infarction (MI) and stroke.Design We used a self-controlled case series, with risk periods 1&#x2013;7, 8&#x2013;14, 15&#x2013;28 and 29&#x2013;90&#x2009;days after UTI. Included individuals experienced the outcome and exposure of interest and acted as their own controls.Setting We used individually linked general practice, hospital admission and microbiology data for the population of Wales held by the Secure Anonymised Information Linkage databank.Participants Included individuals were Welsh residents aged over 30 years with a record of a hospital admission for MI or stroke (outcomes) and evidence of a microbiologically confirmed UTI (exposure) during the study period of 1 January 2010 to 31 December 2020.Main outcome measures The primary outcome was acute MI or stroke identified using the International Classification of Disease V.10 codes from inpatient diagnoses recorded in the Patient Episode Database for Wales. We used Poisson regression to estimate incidence rate ratios (IRRs) and 95% CIs for MI and stroke during predefined risk periods, compared with baseline periods.Results During the study period, 51&#x2009;660 individuals had a hospital admission for MI, of whom 2320 (4.5%) had 3900 microbiologically confirmed UTIs, and 58&#x2009;150 had a hospital admission for stroke, of whom 2840 (4.9%) had 4600 microbiologically confirmed UTIs. There were 120 MIs during risk periods and 2190 during baseline periods, with an increased risk of MI for 1&#x2013;7&#x2009;days following UTI (IRR 2.49, 95%&#x2009;CI (1.65 to 3.77)). There were 200 strokes during risk periods and 2640 during baseline periods, with an increased risk of stroke for 1&#x2013;7&#x2009;days following UTI (IRR 2.34, 95%&#x2009;CI (1.61 to 3.40)).Conclusions UTI may be a trigger for MI or stroke. 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The Centre for Trials Research is funded by Health and Care Research Wales and Cancer Research UK. Population Data Science, Swansea University is supported by ADR Wales (grant ES/S007393/1). PRIME Centre Wales is funded by Health and Care Research Wales.</funders><projectreference/><lastEdited>2025-08-11T14:42:32.8479621</lastEdited><Created>2025-07-06T16:27:07.2561564</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Nicola F</firstname><surname>Reeve</surname><orcid>0000-0001-9602-6675</orcid><order>1</order></author><author><firstname>Victoria</firstname><surname>Best</surname><order>2</order></author><author><firstname>Rebecca</firstname><surname>Cannings-John</surname><orcid>0000-0001-5235-6517</orcid><order>3</order></author><author><firstname>David</firstname><surname>Gillespie</surname><orcid>0000-0002-6934-2928</orcid><order>4</order></author><author><firstname>Kathryn</firstname><surname>Hughes</surname><order>5</order></author><author><firstname>Fiona V</firstname><surname>Lugg-Widger</surname><orcid>0000-0003-0029-9703</orcid><order>6</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>7</order></author><author><firstname>Mandy</firstname><surname>Wootton</surname><order>8</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>9</order></author><author><firstname>Haroon</firstname><surname>Ahmed</surname><order>10</order></author></authors><documents><document><filename>69900__34937__3ceba76d0efc4b4c9e346a1fbc59e1a9.pdf</filename><originalFilename>69900.VoR.pdf</originalFilename><uploaded>2025-08-11T14:39:32.1503349</uploaded><type>Output</type><contentLength>1790785</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; Author(s) (or their employer(s)) 2025. 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spelling 2025-08-11T14:42:32.8479621 v2 69900 2025-07-06 Risk of myocardial infarction and stroke following microbiologically confirmed urinary tract infection: a self-controlled case series study using linked electronic health data 0c82f7076d0fc5c916ecbcc472a6a9ae Victoria Best Victoria Best true false f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 2025-07-06 MEDS Objectives The inflammatory response from acute infection may trigger cardiovascular events. We aimed to estimate associations between microbiologically confirmed urinary tract infections (UTIs) and first acute myocardial infarction (MI) and stroke.Design We used a self-controlled case series, with risk periods 1–7, 8–14, 15–28 and 29–90 days after UTI. Included individuals experienced the outcome and exposure of interest and acted as their own controls.Setting We used individually linked general practice, hospital admission and microbiology data for the population of Wales held by the Secure Anonymised Information Linkage databank.Participants Included individuals were Welsh residents aged over 30 years with a record of a hospital admission for MI or stroke (outcomes) and evidence of a microbiologically confirmed UTI (exposure) during the study period of 1 January 2010 to 31 December 2020.Main outcome measures The primary outcome was acute MI or stroke identified using the International Classification of Disease V.10 codes from inpatient diagnoses recorded in the Patient Episode Database for Wales. We used Poisson regression to estimate incidence rate ratios (IRRs) and 95% CIs for MI and stroke during predefined risk periods, compared with baseline periods.Results During the study period, 51 660 individuals had a hospital admission for MI, of whom 2320 (4.5%) had 3900 microbiologically confirmed UTIs, and 58 150 had a hospital admission for stroke, of whom 2840 (4.9%) had 4600 microbiologically confirmed UTIs. There were 120 MIs during risk periods and 2190 during baseline periods, with an increased risk of MI for 1–7 days following UTI (IRR 2.49, 95% CI (1.65 to 3.77)). There were 200 strokes during risk periods and 2640 during baseline periods, with an increased risk of stroke for 1–7 days following UTI (IRR 2.34, 95% CI (1.61 to 3.40)).Conclusions UTI may be a trigger for MI or stroke. Further work is needed to understand mechanisms and test interventions to reduce the risk of cardiovascular events among people with UTIs in primary care. Journal Article BMJ Open 15 6 e097754 BMJ 2044-6055 2044-6055 30 6 2025 2025-06-30 10.1136/bmjopen-2024-097754 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This work was supported by The British Heart Foundation, grant number PG/20/10419. The Centre for Trials Research is funded by Health and Care Research Wales and Cancer Research UK. Population Data Science, Swansea University is supported by ADR Wales (grant ES/S007393/1). PRIME Centre Wales is funded by Health and Care Research Wales. 2025-08-11T14:42:32.8479621 2025-07-06T16:27:07.2561564 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Nicola F Reeve 0000-0001-9602-6675 1 Victoria Best 2 Rebecca Cannings-John 0000-0001-5235-6517 3 David Gillespie 0000-0002-6934-2928 4 Kathryn Hughes 5 Fiona V Lugg-Widger 0000-0003-0029-9703 6 Fatemeh Torabi 0000-0002-5853-4625 7 Mandy Wootton 8 Ashley Akbari 0000-0003-0814-0801 9 Haroon Ahmed 10 69900__34937__3ceba76d0efc4b4c9e346a1fbc59e1a9.pdf 69900.VoR.pdf 2025-08-11T14:39:32.1503349 Output 1790785 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 microbiologically confirmed urinary tract infection: a self-controlled case series study using linked electronic health data
spellingShingle Risk of myocardial infarction and stroke following microbiologically confirmed urinary tract infection: a self-controlled case series study using linked electronic health data
Victoria Best
Fatemeh Torabi
Ashley Akbari
title_short Risk of myocardial infarction and stroke following microbiologically confirmed urinary tract infection: a self-controlled case series study using linked electronic health data
title_full Risk of myocardial infarction and stroke following microbiologically confirmed urinary tract infection: a self-controlled case series study using linked electronic health data
title_fullStr Risk of myocardial infarction and stroke following microbiologically confirmed urinary tract infection: a self-controlled case series study using linked electronic health data
title_full_unstemmed Risk of myocardial infarction and stroke following microbiologically confirmed urinary tract infection: a self-controlled case series study using linked electronic health data
title_sort Risk of myocardial infarction and stroke following microbiologically confirmed urinary tract infection: a self-controlled case series study using linked electronic health data
author_id_str_mv 0c82f7076d0fc5c916ecbcc472a6a9ae
f569591e1bfb0e405b8091f99fec45d3
aa1b025ec0243f708bb5eb0a93d6fb52
author_id_fullname_str_mv 0c82f7076d0fc5c916ecbcc472a6a9ae_***_Victoria Best
f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
author Victoria Best
Fatemeh Torabi
Ashley Akbari
author2 Nicola F Reeve
Victoria Best
Rebecca Cannings-John
David Gillespie
Kathryn Hughes
Fiona V Lugg-Widger
Fatemeh Torabi
Mandy Wootton
Ashley Akbari
Haroon Ahmed
format Journal article
container_title BMJ Open
container_volume 15
container_issue 6
container_start_page e097754
publishDate 2025
institution Swansea University
issn 2044-6055
2044-6055
doi_str_mv 10.1136/bmjopen-2024-097754
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
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description Objectives The inflammatory response from acute infection may trigger cardiovascular events. We aimed to estimate associations between microbiologically confirmed urinary tract infections (UTIs) and first acute myocardial infarction (MI) and stroke.Design We used a self-controlled case series, with risk periods 1–7, 8–14, 15–28 and 29–90 days after UTI. Included individuals experienced the outcome and exposure of interest and acted as their own controls.Setting We used individually linked general practice, hospital admission and microbiology data for the population of Wales held by the Secure Anonymised Information Linkage databank.Participants Included individuals were Welsh residents aged over 30 years with a record of a hospital admission for MI or stroke (outcomes) and evidence of a microbiologically confirmed UTI (exposure) during the study period of 1 January 2010 to 31 December 2020.Main outcome measures The primary outcome was acute MI or stroke identified using the International Classification of Disease V.10 codes from inpatient diagnoses recorded in the Patient Episode Database for Wales. We used Poisson regression to estimate incidence rate ratios (IRRs) and 95% CIs for MI and stroke during predefined risk periods, compared with baseline periods.Results During the study period, 51 660 individuals had a hospital admission for MI, of whom 2320 (4.5%) had 3900 microbiologically confirmed UTIs, and 58 150 had a hospital admission for stroke, of whom 2840 (4.9%) had 4600 microbiologically confirmed UTIs. There were 120 MIs during risk periods and 2190 during baseline periods, with an increased risk of MI for 1–7 days following UTI (IRR 2.49, 95% CI (1.65 to 3.77)). There were 200 strokes during risk periods and 2640 during baseline periods, with an increased risk of stroke for 1–7 days following UTI (IRR 2.34, 95% CI (1.61 to 3.40)).Conclusions UTI may be a trigger for MI or stroke. Further work is needed to understand mechanisms and test interventions to reduce the risk of cardiovascular events among people with UTIs in primary care.
published_date 2025-06-30T05:31:01Z
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