Preventing Cardiovascular Complications of Acute Infection

> … this is an experimental verification of this medical concept, relatively new, suggesting that infections merit an important place in the etiology of human atheromatous arteritis …> > —Gilbert and Lion, 1889,> > Comptes Rendus Hebdomadairesdes > > Seances et Memoires de la Societe de Biologie 1The connections between infection and cardiovascular disease have been postulated for at least 125 years, when Gilbert and Lion1 observed that acute infection with the typhoid bacillus resulted in atherosclerotic changes to the rabbit aorta. In the past few decades, much work has investigated the role for chronic viral and atypical bacterial infections in the progression of atherosclerosis; however, trials of antibiotics as secondary prevention for cardiovascular events have been disappointing.2 More recently, epidemiological studies demonstrated an association between acute infection and cardiovascular events, such as acute myocardial infarction,3 stroke,4 cardiomyopathy,5 or atrial fibrillation.6Article see p 1387In this issue of Circulation , Dalager-Pedersen et al7 explore the association between community-acquired bacteremia and acute myocardial infarction and ischemic stroke using a population-based cohort study of bacteremic patients from northern Denmark. The authors compare rates of myocardial infarction and stroke among 4389 bacteremia patients to rates among 43 831 matched community-dwelling controls and 21 893 matched hospitalized controls. The use of a hospitalized control group allows for the assessment of excess cardiovascular risks associated with bacteremia compared with age-, sex-, and admission year–matched acutely ill, hospitalized patients and reduces potential detection bias for cardiovascular events during a hospitalization. The community-dwelling cohort allows for the assessment of excess cardiovascular risk compared with matched general population controls. The authors found that patients with community-acquired bacteremia had higher rates of a composite end point of acute ischemic stroke or acute myocardial infarction (3.6% incidence) compared with both hospitalized patients (1.7%) and …