Risk of acute respiratory infection and acute cardiovascular events following acute respiratory infection among adults with increased cardiovascular risk in England between 2008 and 2018: a retrospective, population-based cohort study

Summary: Background: Although acute respiratory infections can lead to cardiovascular complications, the effect of underlying cardiovascular risk on the incidence of acute respiratory infections and cardiovascular complications following acute respiratory infection in individuals without establishe...

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Autores principales:	Jennifer A Davidson, MSc, Amitava Banerjee, ProfDPhil, Liam Smeeth, ProfFRCGP, Helen I McDonald, PhD, Daniel Grint, PhD, Emily Herrett, PhD, Harriet Forbes, PhD, Richard Pebody, PhD, Charlotte Warren-Gash, PhD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Computer applications to medicine. Medical informatics R858-859.7
Acceso en línea:	https://doaj.org/article/f85f91cfd1434c8bbf6fd795f0ada1a5
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id	oai:doaj.org-article:f85f91cfd1434c8bbf6fd795f0ada1a5
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	Computer applications to medicine. Medical informatics R858-859.7
spellingShingle	Computer applications to medicine. Medical informatics R858-859.7 Jennifer A Davidson, MSc Amitava Banerjee, ProfDPhil Liam Smeeth, ProfFRCGP Helen I McDonald, PhD Daniel Grint, PhD Emily Herrett, PhD Harriet Forbes, PhD Richard Pebody, PhD Charlotte Warren-Gash, PhD Risk of acute respiratory infection and acute cardiovascular events following acute respiratory infection among adults with increased cardiovascular risk in England between 2008 and 2018: a retrospective, population-based cohort study
description	Summary: Background: Although acute respiratory infections can lead to cardiovascular complications, the effect of underlying cardiovascular risk on the incidence of acute respiratory infections and cardiovascular complications following acute respiratory infection in individuals without established cardiovascular disease is unknown. We aimed to investigate whether cardiovascular risk is associated with increased risk of acute respiratory infection and acute cardiovascular events after acute respiratory infection using 10 years of linked electronic health record (EHR) data in England. Methods: In this retrospective, population-based cohort study we used EHRs from primary care providers registered on the Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases in England. Eligible individuals were aged 40–64 years, did not have established cardiovascular disease or a chronic health condition that would make them eligible for influenza vaccination, were registered at a general practice contributing to the CPRD, and had linked Hospital Episode Statistics Admitted Patient Care data in England from Sept 1, 2008, to Aug 31, 2018. We classified cardiovascular risk on the basis of diagnosed hypertension and overall predicted cardiovascular risk, estimated by use of the QRISK2 risk-prediction tool (comparing a score of ≥10% [increased risk] with a score of <10% [low risk]). Using multivariable Poisson regression models, we calculated incidence rate ratios (IRRs) for systemic acute respiratory infection. Among individuals who had an acute respiratory infection, we used multivariable Cox regression to calculate hazard ratios (HRs) for the risk of acute cardiovascular events within 1 year of infection. Findings: We identified 6 075 321 individuals aged 40–64 years with data in the CPRD and linked data in the Hospital Episode Statistics Admitted Patient Care database between Sept 1, 2008, and Aug 31, 2018. Of these individuals, 4 212 930 (including 526 480 [12·5%] with hypertension and 607 087 [14·4%] with a QRISK2 score of ≥10%) were included in the assessment of the incidence of acute respiratory infection. After adjusting for confounders (age, sex, ethnicity, socioeconomic status, body-mass index, alcohol consumption, smoking status, and consultation frequency in the hypertension analysis; and alcohol consumption and consultation frequency in the QRISK2 analysis), the incidence of acute respiratory infection was higher in individuals with hypertension than those without (IRR 1·04 [95% CI 1·03–1·05]) and higher in those with a QRISK2 score of 10% or higher than in those with a QRISK2 score of less than 10% (1·39 [1·37–1·40]). Of the 442 408 individuals who had an acute respiratory infection, 4196 (0·9%) had an acute cardiovascular event within 1 year of infection. After adjustment (for age, sex, ethnicity, socioeconomic status, body-mass index, alcohol consumption, and smoking status in the hypertension analysis; and for alcohol consumption in the QRISK2 analysis), hypertension (HR 1·98 [95% CI 1·83–2·15]) and a QRISK2 score of 10% or higher (3·65 [3·42–3·89]) were associated with a substantially increased risk of acute cardiovascular events after acute respiratory infection. Interpretation: People with increased cardiovascular risk but without diagnosed cardiovascular disease, measured by diagnosed hypertension or overall predicted cardiovascular risk, could benefit from influenza and pneumococcal vaccine prioritisation to reduce their risk of both acute respiratory infection and cardiovascular complications following an acute respiratory infection. Funding: British Heart Foundation and the Wellcome Trust.
format	article
author	Jennifer A Davidson, MSc Amitava Banerjee, ProfDPhil Liam Smeeth, ProfFRCGP Helen I McDonald, PhD Daniel Grint, PhD Emily Herrett, PhD Harriet Forbes, PhD Richard Pebody, PhD Charlotte Warren-Gash, PhD
author_facet	Jennifer A Davidson, MSc Amitava Banerjee, ProfDPhil Liam Smeeth, ProfFRCGP Helen I McDonald, PhD Daniel Grint, PhD Emily Herrett, PhD Harriet Forbes, PhD Richard Pebody, PhD Charlotte Warren-Gash, PhD
author_sort	Jennifer A Davidson, MSc
title	Risk of acute respiratory infection and acute cardiovascular events following acute respiratory infection among adults with increased cardiovascular risk in England between 2008 and 2018: a retrospective, population-based cohort study
title_short	Risk of acute respiratory infection and acute cardiovascular events following acute respiratory infection among adults with increased cardiovascular risk in England between 2008 and 2018: a retrospective, population-based cohort study
title_full	Risk of acute respiratory infection and acute cardiovascular events following acute respiratory infection among adults with increased cardiovascular risk in England between 2008 and 2018: a retrospective, population-based cohort study
title_fullStr	Risk of acute respiratory infection and acute cardiovascular events following acute respiratory infection among adults with increased cardiovascular risk in England between 2008 and 2018: a retrospective, population-based cohort study
title_full_unstemmed	Risk of acute respiratory infection and acute cardiovascular events following acute respiratory infection among adults with increased cardiovascular risk in England between 2008 and 2018: a retrospective, population-based cohort study
title_sort	risk of acute respiratory infection and acute cardiovascular events following acute respiratory infection among adults with increased cardiovascular risk in england between 2008 and 2018: a retrospective, population-based cohort study
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/f85f91cfd1434c8bbf6fd795f0ada1a5
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spelling	oai:doaj.org-article:f85f91cfd1434c8bbf6fd795f0ada1a52021-11-24T04:33:26ZRisk of acute respiratory infection and acute cardiovascular events following acute respiratory infection among adults with increased cardiovascular risk in England between 2008 and 2018: a retrospective, population-based cohort study2589-750010.1016/S2589-7500(21)00203-Xhttps://doaj.org/article/f85f91cfd1434c8bbf6fd795f0ada1a52021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S258975002100203Xhttps://doaj.org/toc/2589-7500Summary: Background: Although acute respiratory infections can lead to cardiovascular complications, the effect of underlying cardiovascular risk on the incidence of acute respiratory infections and cardiovascular complications following acute respiratory infection in individuals without established cardiovascular disease is unknown. We aimed to investigate whether cardiovascular risk is associated with increased risk of acute respiratory infection and acute cardiovascular events after acute respiratory infection using 10 years of linked electronic health record (EHR) data in England. Methods: In this retrospective, population-based cohort study we used EHRs from primary care providers registered on the Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases in England. Eligible individuals were aged 40–64 years, did not have established cardiovascular disease or a chronic health condition that would make them eligible for influenza vaccination, were registered at a general practice contributing to the CPRD, and had linked Hospital Episode Statistics Admitted Patient Care data in England from Sept 1, 2008, to Aug 31, 2018. We classified cardiovascular risk on the basis of diagnosed hypertension and overall predicted cardiovascular risk, estimated by use of the QRISK2 risk-prediction tool (comparing a score of ≥10% [increased risk] with a score of <10% [low risk]). Using multivariable Poisson regression models, we calculated incidence rate ratios (IRRs) for systemic acute respiratory infection. Among individuals who had an acute respiratory infection, we used multivariable Cox regression to calculate hazard ratios (HRs) for the risk of acute cardiovascular events within 1 year of infection. Findings: We identified 6 075 321 individuals aged 40–64 years with data in the CPRD and linked data in the Hospital Episode Statistics Admitted Patient Care database between Sept 1, 2008, and Aug 31, 2018. Of these individuals, 4 212 930 (including 526 480 [12·5%] with hypertension and 607 087 [14·4%] with a QRISK2 score of ≥10%) were included in the assessment of the incidence of acute respiratory infection. After adjusting for confounders (age, sex, ethnicity, socioeconomic status, body-mass index, alcohol consumption, smoking status, and consultation frequency in the hypertension analysis; and alcohol consumption and consultation frequency in the QRISK2 analysis), the incidence of acute respiratory infection was higher in individuals with hypertension than those without (IRR 1·04 [95% CI 1·03–1·05]) and higher in those with a QRISK2 score of 10% or higher than in those with a QRISK2 score of less than 10% (1·39 [1·37–1·40]). Of the 442 408 individuals who had an acute respiratory infection, 4196 (0·9%) had an acute cardiovascular event within 1 year of infection. After adjustment (for age, sex, ethnicity, socioeconomic status, body-mass index, alcohol consumption, and smoking status in the hypertension analysis; and for alcohol consumption in the QRISK2 analysis), hypertension (HR 1·98 [95% CI 1·83–2·15]) and a QRISK2 score of 10% or higher (3·65 [3·42–3·89]) were associated with a substantially increased risk of acute cardiovascular events after acute respiratory infection. Interpretation: People with increased cardiovascular risk but without diagnosed cardiovascular disease, measured by diagnosed hypertension or overall predicted cardiovascular risk, could benefit from influenza and pneumococcal vaccine prioritisation to reduce their risk of both acute respiratory infection and cardiovascular complications following an acute respiratory infection. Funding: British Heart Foundation and the Wellcome Trust.Jennifer A Davidson, MScAmitava Banerjee, ProfDPhilLiam Smeeth, ProfFRCGPHelen I McDonald, PhDDaniel Grint, PhDEmily Herrett, PhDHarriet Forbes, PhDRichard Pebody, PhDCharlotte Warren-Gash, PhDElsevierarticleComputer applications to medicine. Medical informaticsR858-859.7ENThe Lancet: Digital Health, Vol 3, Iss 12, Pp e773-e783 (2021)

Risk of acute respiratory infection and acute cardiovascular events following acute respiratory infection among adults with increased cardiovascular risk in England between 2008 and 2018: a retrospective, population-based cohort study

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