Abstract 13447: Risk of Subsequent Cardiovascular Events Following a Respiratory Viral Infection
Background: Studies have found that respiratory viral infections (RVI) can trigger acute cardiovascular (CV) events. These studies are based on self-reported symptoms and outdated antibody testing. The purpose of this study is to determine the risk of subsequent CV events in subjects with confirmed RVI based on molecular polymerase chain reaction or direct immunofluorescence assay.
Methods: We studied Intermountain Healthcare patients from Jan 2007 to Dec 2013 tested for RVI with either positive (cases, n=9397) or negative (controls, n=27011) results. RVI included influenza A (seasonal or H1N1) or B, human metapneumovirus, parainfluenza, adenovirus, rhinovirus, respiratory syncytial virus, and coronavirus. A second control group (n=33210) seen for routine general medical examination were 1:5 matched using sex, age at visit (±5 yrs), time of presentation (±1 month), and history of CV disease to 6642 cases. All cohorts were followed for 90 days to determine subsequent CV events (including CV death, myocardial infarction, and stroke). Multivariable logistic regression was used to examine associations with combined outcome of any CV event.
Results: A total of 130 (1.4%) positive RVI cases had a subsequent CV event compared to 617 (2.3%) of the negative RVI controls. About half of the events were CV death (49% & 48% for positive and negative RVI, respectively), followed by non-fatal strokes (34% & 34%) and non-fatal MI (18% & 19%). After adjusting for age, Intermountain mortality risk score, history of CV disease, presence of pneumonia, tobacco use, heart rate, respiratory rate, BMI, and patient type (ED, outpatient or inpatient), positive RVI cases were less likely compared to negative RVI controls to have a subsequent CV event (OR=0.63, 95% CI: 0.52, 0.77; p<0.0001). After similar adjustments, positive RVI cases had the same risk of a CV event as compared to matched general healthy controls (OR=1.30; 95% CI: 0.70, 2.41; p=0.41).
Conclusion: Our study based on modern testing for RVI found positive RVI cases were at decreased risk of CV events within 90 days compared to negative RVI controls and similar risk as the general healthy controls. The decreased risk for the positive RVI may be due to the infection prompting changes in care that influence the 90 day CV outcomes.
Author Disclosures: S. Knight: None. R.R. Miller: None. T.L. Bair: None. B.D. Horne: None. B.K. Lopansri: None. J.L. Anderson: None. J.B. Muhlestein: None. J.F. Carlquist: None.
- © 2014 by American Heart Association, Inc.