Warren-Gash, CMJ; (2013) The role of influenza and acute respiratory infections as triggers for acute myocardial infarction. Doctoral thesis , UCL (University College London).

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Abstract

Background: Influenza is an important global cause of morbidity and mortality. Though some cardiac complications of influenza, such as myocarditis, are well-recognised, its role as a trigger for acute cardiovascular events is less clear. Improved understanding of this relationship will add to evidence to support appropriate prevention and treatment strategies. Methods: I investigated evidence that influenza and acute respiratory infections could trigger acute myocardial infarction (AMI) through a systematic literature review and meta-analysis (chapter 2) and original research studies (chapters 3-7). These were an ecological weekly time series study using Poisson regression models adjusted for temporal and environmental confounders in England & Wales and Hong Kong (chapter 3); two self-controlled case series analyses using the General Practice Research Database linked to influenza surveillance data (chapter 4) and to cardiac disease registry and hospitalisation data (chapter 5); a case control study in AMI patients and surgical controls during the 2009 influenza pandemic in London (chapter 6); an exploratory mechanistic study (chapter 7). Key findings: • Acute respiratory infections, and seasonal influenza, triggered AMI • A triggering effect may be greater for influenza than for other respiratory infections (p=0.011) • AMI risk was highest in the first three days after acute infection – adjusted incidence ratio 4.19 (95% CI 3.18-5.53) – and persisted for around 28 days • The proportion of AMI deaths due to seasonal influenza ranged from 3-5%, rising to 13% in periods of highest influenza circulation • The relative risk of AMI after acute respiratory infection was highest in people aged ≥80 years • Influenza vaccination protected against some adverse cardiac outcomes in people with existing cardiovascular disease Conclusions: Reducing the burden of influenza would benefit cardiovascular health. Questions remain about key groups to target, as well as the optimal type and delivery of interventions to reduce influenza-associated AMI risk.

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