Background There is evidence that chronic inflammation may promoteatherosclerotic disease. We tested the hypothesis that acuteinfection and vaccination increase the short-term risk of vascularevents.
Methods We undertook within-person comparisons, using the case-seriesmethod, to study the risks of myocardial infarction and strokeafter common vaccinations and naturally occurring infections.The study was based on the United Kingdom General Practice ResearchDatabase, which contains computerized medical records of morethan 5 million patients.
Results A total of 20,486 persons with a first myocardial infarctionand 19,063 persons with a first stroke who received influenzavaccine were included in the analysis. There was no increasein the risk of myocardial infarction or stroke in the periodafter influenza, tetanus, or pneumococcal vaccination. However,the risks of both events were substantially higher after a diagnosisof systemic respiratory tract infection and were highest duringthe first three days (incidence ratio for myocardial infarction,4.95; 95 percent confidence interval, 4.43 to 5.53; incidenceratio for stroke, 3.19; 95 percent confidence interval, 2.81to 3.62). The risks then gradually fell during the followingweeks. The risks were raised significantly but to a lesser degreeafter a diagnosis of urinary tract infection. The findings forrecurrent myocardial infarctions and stroke were similar tothose for first events.
Conclusions Our findings provide support for the concept thatacute infections are associated with a transient increase inthe risk of vascular events. By contrast, influenza, tetanus,and pneumococcal vaccinations do not produce a detectable increasein 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.
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