Coronary and Cerebrovascular Events and Exacerbation of Existing Conditions After Laboratory‐Confirmed Influenza Infection Among US Veterans: A Self‐Controlled Case Series Study

ABSTRACT Background Influenza may contribute to coronary/cerebrovascular events and exacerbate underlying conditions. Methods We used self‐controlled case series (SCCS) design to analyze data from US Veterans ≥18 years with coronary/cerebrovascular or exacerbation event +/−1 year of lab‐confirmed in...

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Published in:Influenza and other respiratory viruses 2024-06, Vol.18 (6), p.e13304-n/a
Main Authors: Korves, Caroline, Neupane, Nabin, Smith, Jeremy, Young‐Xu, Yinong, Aalst, Robertus, Mahmud, Salaheddin M., Loiacono, Matthew M.
Format: Article
Language:English
Subjects:
AMI
Asthma
Atherosclerosis
Biomarkers
cerebrovascular
Chronic obstructive pulmonary disease
Congestive heart failure
coronary
Data analysis
Health care policy
Health risks
Heart attacks
Heart failure
Hemorrhage
Hospitalization
Immunization
Infections
Influenza
Ischemia
Laboratories
Leukocytes
Lung diseases
Medicare
Mortality
Original
Regression analysis
Risk management
Stroke
Veterans
Viral infections
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Summary:ABSTRACT Background Influenza may contribute to coronary/cerebrovascular events and exacerbate underlying conditions. Methods We used self‐controlled case series (SCCS) design to analyze data from US Veterans ≥18 years with coronary/cerebrovascular or exacerbation event +/−1 year of lab‐confirmed influenza (LCI) during 2010–2018. We estimated the incidence ratio (IR) (95% CI) of the event for risk interval (Days 1–7 post‐LCI) versus control interval (all other times +/−1 year of LCI) with fixed‐effects conditional Poisson regression. We included biomarker data for mediation analysis. Results We identified 3439 episodes with coronary/cerebrovascular‐related hospitalizations. IRs (95% CI) for LCI risk versus control interval were STEMI 0.6 (0.1, 4.4), NSTEMI 7.3 (5.8, 9.2), ischemic stroke 4.0 (3.0, 5.4), hemorrhagic stroke 6.2 (3.4, 11.5), and coronary spasm 1.3 (0.5, 3.0). IR significantly increased for NSTEMI and ischemic stroke among those ≥ 65 years. IR for NSTEMI and ischemic stroke dropped 26% and 10%, respectively, when white blood cell (WBC) and platelet count were considered. LCI was significantly associated with exacerbation of preexisting asthma, chronic obstructive pulmonary disease, and congestive heart failure. Conclusions We found significant association between LCI and hospitalization for NSTEMI, ischemic stroke, and hemorrhagic stroke, the latter possibly due to unaccounted time‐varying confounding in SCCS design.
ISSN:1750-2640
1750-2659
1750-2659
DOI:10.1111/irv.13304