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Previous Volume 351:2611-2618 December 16, 2004 Number 25 Next

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ABSTRACT

Background There is evidence that chronic inflammation may promote atherosclerotic disease. We tested the hypothesis that acute infection and vaccination increase the short-term risk of vascular events.

Methods We undertook within-person comparisons, using the case-series method, to study the risks of myocardial infarction and stroke after common vaccinations and naturally occurring infections. The study was based on the United Kingdom General Practice Research Database, which contains computerized medical records of more than 5 million patients.

Results A total of 20,486 persons with a first myocardial infarction and 19,063 persons with a first stroke who received influenza vaccine were included in the analysis. There was no increase in the risk of myocardial infarction or stroke in the period after influenza, tetanus, or pneumococcal vaccination. However, the risks of both events were substantially higher after a diagnosis of systemic respiratory tract infection and were highest during the first three days (incidence ratio for myocardial infarction, 4.95; 95 percent confidence interval, 4.43 to 5.53; incidence ratio for stroke, 3.19; 95 percent confidence interval, 2.81 to 3.62). The risks then gradually fell during the following weeks. The risks were raised significantly but to a lesser degree after a diagnosis of urinary tract infection. The findings for recurrent myocardial infarctions and stroke were similar to those for first events.

Conclusions Our findings provide support for the concept that acute infections are associated with a transient increase in the risk of vascular events. By contrast, influenza, tetanus, and pneumococcal vaccinations do not produce a detectable increase in the risk of vascular events.

Source Information

From the Departments of Epidemiology and Population Health (L.S.) and Infectious and Tropical Diseases (S.L.T., A.J.H.), London School of Hygiene and Tropical Medicine, London; the Division of Respiratory Medicine, University of Nottingham, Nottingham (R.H.); the Division of Statistics, Open University, Milton Keynes (P.F.); and the Centre for Clinical Pharmacology, British Heart Foundation Laboratories, Division of Medicine, University College London (P.V.) — all in the United Kingdom.

Address reprint requests to Dr. Smeeth at the Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St., London WC1E 7HT, United Kingdom, or at liam.smeeth{at}lshtm.ac.uk.

Full Text of this Article

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Vascular Events after Acute Infection or Vaccination
Bursztyn M., Sharifi N., Mofrad P. S., Smeeth L., Thomas S., Vallance P.
Extract | Full Text | PDF  
N Engl J Med 2005; 352:1151-1153, Mar 17, 2005. Correspondence

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