Impact of severe infections on the risk of acute cardiovascular and cerebrovascular diseases: A prospective cohort study

Background: Severe infections, particularly those requiring hospitalization, have been widely recognized as potential risk factors for cardiovascular and cerebrovascular diseases. However, the precise relationship remains unclear, particularly regarding how factors such as different time windows, repeated infections, infections caused by various pathogens, and infections involving different organ systems may influence the risk of acute cardiovascular and cerebrovascular events. This study aimed to evaluate the impact of severe infections on the incidence of these acute events by specifically focusing on these factors. Methods: We conducted a prospective cohort study involving 55,338 participants, with a median follow-up duration of 6.42 years (IQR: 4.56-7.01). Hospitalization events related to infectious diseases and incident cardiovascular and cerebrovascular diseases were identified using passive follow-up methods. Segmented Cox regression analyses were performed to evaluate the effects of various infection-related factors on the risk of acute cardiovascular and cerebrovascular diseases, including different time windows after infection, repeated infections, infections caused by various pathogens, and infections involving different organ systems. Results: The risk of cardiovascular and cerebrovascular events after severe infection was elevated during the whole follow-up (HR=4.07, 95% CI: 3.62-4.57) and was most significantly elevated in 3 months following severe infection (HR=8.24, 95% CI: 6.16-11.02). Repeated infections were positively correlated with the excess risk of stroke (HR=4.73, 95% CI: 1.75-12.79 for ≥3 infections, p for difference = 0.013). Infections involving different organ systems carried a much higher risk compared to single-system infections (HR= 13.11, 95% CI: 7.3-23.53). Viral infections notably increased the risk of acute ischemic heart disease (HR=4.22, 95% CI: 2.29-7.76). Conclusion: The study found that severe infections were associated with the elevated risk of cardiovascular and cerebrovascular events. The findings suggest that more attention should be given to preventing and intervening in cardiovascular events among high-risk infection populations.