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Risk of myocardial infarction and stroke after acute infection or vaccination.

Smeeth, L; Thomas, SL; Hall, AJ; Hubbard, R; Farrington, P; Vallance, P; (2004) Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med , 351 (25) pp. 2611-2618. 10.1056/NEJMoa041747. Green open access

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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.

Type: Article
Title: Risk of myocardial infarction and stroke after acute infection or vaccination.
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1056/NEJMoa041747
Keywords: Acute Disease, Adult, Aged, Aged, 80 and over, Databases, Factual, Humans, Incidence, Influenza Vaccines, Middle Aged, Myocardial Infarction, Pneumococcal Vaccines, Respiratory Tract Infections, Risk, Stroke, Tetanus Toxoid, United Kingdom, Urinary Tract Infections, Vaccines
UCL classification: UCL
URI: https://discovery.ucl.ac.uk/id/eprint/279
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