Increased Risk of Acute Myocardial Infarction and Stroke During Hemorrhagic Fever with Renal Syndrome: A Self-Controlled Case Series Study
Background—We recently observed that cardiovascular causes of death were common in patients with hemorrhagic fever with renal syndrome (HFRS), which is caused by hantaviruses. But it is not known whether HFRS is a risk factor for acute cardiovascular events: acute myocardial infarction (AMI) and stroke.
Methods and Results—Personal identification numbers from the Swedish HFRS patient database (1997 to 2012; n = 6643) were cross-linked with the National Patient Register from 1987-2011. Using the self-controlled case series method, the incidence rate ratio (IRR) of AMI/stroke in the 21 days following HFRS were calculated against two different control periods either excluding (analysis 1) or including (analysis 2) fatal AMI/stroke events. The IRRs (95% confidence intervals) for analysis 1 and 2 for all AMI events were 5.53 (2.6-11.8) and 6.02 (2.95-12.3); and for first AMI events 3.53 (1.25-9.96) and 4.64 (1.83-11.77). The IRRs for analysis 1 and 2 for all stroke events were 12.93 (5.62-29.74) and 15.16 (7.21-31.87); and for first stroke events 14.54 (5.87-36.04) and 17.09 (7.49-38.96). The majority of stroke events occurred in the first week following HFRS. Seasonal effects were not observed, and apart from one study, neither sex nor age interacted with the associations observed in this study.
Conclusions—There is a significantly increased risk for AMI and stroke in the immediate time period following HFRS. Therefore HFRS patients should be carefully monitored during the acute phase of disease to ensure early recognition of symptoms of impending AMI or stroke.
- Hemorrhagic fever with renal syndrome
- acute myocardial infarction
- cerebrovascular disease/stroke
- Received September 30, 2013.
- Revision received December 17, 2013.
- Accepted December 20, 2013.