Recent Respiratory Infection Predicts Atherothrombotic Stroke

Abstract

Background and Purpose-Increasing evidence links infections to atherosclerosis. Case-control and cohort studies have found that infections, especially respiratory and dental, are associated with coronary heart disease. However, data on the association of infections with cerebrovascular disease are limited, especially beyond Europe and the United States. We assessed the relationship between recent infections and atherothrombotic disease in a South American cohort. Methods-We conducted a case-control study of 105 cases and 354 control subjects in a Buenos Aires healthcare system matched by age (mean age, 73.2Ϯ12.3 and 72.9Ϯ12.8 years), sex, and major cardiovascular risk factors. Cases were patients hospitalized with atherothrombotic ischemic stroke from December 2006 to October 2007. Control subjects were randomly assigned from an electronic outpatient database. Data from the preceding year on inpatient and ambulatory respiratory, urinary and abdominal infections as well as peripheral white blood cell count were collected. Results-Infections were more frequent in cases than control subjects (29% versus 13%; OR, 2.6; 95% CI, 1.4 to 4.5;Pϭ0.0004); however, this was driven by community-acquired respiratory tract infections (19% versus 6%; OR, 3.9; 95% CI, 1.9 to 8; PϽ0.001) because there were no differences between cases and control subjects for other types of infection. Respiratory tract infections were the most prevalent type of infection during the 3 months before an atherothrombotic ischemic event, occurring more in cases compared with control subjects (17% versus 4%; OR, 5; 95% CI, 2.2 to 11.3; PϽ0.001). In multivariable analysis adjusting for major vascular risk factors, history of respiratory infection in the prior year was associated more with cases than control subjects (OR, 4.9; 95% CI, 2.3 to 10.2;PϽ0.001). White blood cell count was slightly higher in cases versus control subjects (7602Ϯ2058 versus 7121.6Ϯ1947, Pϭ0.01). Conclusion-In this South American cohort, recent respiratory tract infections were significantly associated with atherothrombotic stroke, suggesting that prompt identification and treatment of individuals with or at risk for these infections may mitigate the burden from this type of stroke.

Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

“…Consistent with previous reports of increased stroke risk following infection, [31][32][33][34][35] our study demonstrates that patients with severe sepsis had a six-fold increased risk for in-hospital stroke compared with hospitalized patients without severe sepsis. Importantly, patients with severe sepsis who developed new-onset AF had a greater risk of in-hospital stroke than patients with pre-existing AF and individuals without a history of AF.…”

Influenza‐like illness as a trigger for ischemic stroke

“…There is a moderately increased acute risk of stroke following hospitalization for several types of infection, and infections have been identified as triggers of stroke in children 8, 20, 21, 22, 23, 24, 25, 26, 27. Our study replicates these findings for ILI, a more prevalent type of infection than other studies have investigated, and highlights that the risk of stroke is particularly high shortly after hospitalization for an ILI, with the odds decreasing as time increases.…”

“…Prior work has identified potential mechanisms as to why infection may serve as a trigger for stroke through mechanisms such as: causing a systemic release of cytokines and other inflammatory mediators, causing a pro‐thrombotic state, inflammation‐mediated endothelial injury, or effects on cardiac endothelium 8, 20, 21, 22, 23. The increase in odds may also be due to general effects of infection, such as fever and dehydration.…”

Pneumonia: A Challenging Health Concern with the Climate Change

“…Cardiac arrhythmias are also observed sometimes induced by the use of macrolides alone or in combination therapy [61]. Respiratory infections were more frequent (19 vs. 6%) in a comparison study of stroke patients and control [62], suggesting the comorbidity of this condition.…”