Risk of myocardial infarction and stroke after acute infection or vaccination
Risk of myocardial infarction and stroke after acute infection or vaccination
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DOI：
10.1056/nejmoa041747
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发表时间：
2004-12-16
影响因子：
158.5
通讯作者：
Vallance, P
中科院分区：
文献类型：
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作者：
Smeeth, L;Thomas, SL;Vallance, P
背景：有证据表明慢性炎症可促进动脉粥样硬化性疾病。我们检验了急性感染和疫苗接种增加血管事件短期风险的假设。方法：我们采用病例系列方法进行了人内比较，研究普通疫苗接种和自然感染后心肌梗死和卒中的风险。这项研究基于英国全科医学研究数据库，该数据库包含500多万患者的计算机化医疗记录。结果：共有20,486例首次心肌梗死患者和19,063例首次中风患者接受了流感疫苗，被纳入分析。在流感、破伤风或肺炎球菌疫苗接种后，心肌梗死或中风的风险没有增加。然而，在诊断为全身性呼吸道感染后，这两种事件的风险都要高得多，并且在前三天最高（心肌梗死的发病率为4.95,95%可信区间为4.43至5.53；卒中的发病率为3.19,95%可信区间为2.81至3.62）。在接下来的几周内，风险逐渐下降。在诊断为尿路感染后，风险显著增加，但程度较低。复发性心肌梗死和中风的结果与首次事件相似。结论：我们的研究结果支持急性感染与血管事件风险的短暂增加相关的概念。相比之下，流感、破伤风和肺炎球菌疫苗接种不会产生可检测到的血管事件风险增加。
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.