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Risk of myocardial infarction and stroke after acute infection or vaccination

Smeeth, Liam; Thomas, Sara L.; Hall, Andrew J.; Hubbard, Richard; Farrington, Paddy and Vallance, Patrick (2004). Risk of myocardial infarction and stroke after acute infection or vaccination. New England Journal of Medicine, 351(25) pp. 2611–2618.

URL: http://content.nejm.org/cgi/content/abstract/351/2...
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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.

Item Type: Journal Article
Copyright Holders: 2004 Massachusetts Medical Society
ISSN: 0028-4793
Academic Unit/Department: Other Departments > Learning and Teaching Solutions
Mathematics, Computing and Technology > Mathematics and Statistics
Item ID: 18957
Depositing User: Colin Smith
Date Deposited: 19 Nov 2009 16:10
Last Modified: 24 Jul 2014 09:28
URI: http://oro.open.ac.uk/id/eprint/18957
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