CME: Pneumonia & CVD: Making the Link

CME: Pneumonia & CVD: Making the Link
Author Information (click to view)

Sachin Yende, MD, MS

Vice President, Critical Care
VA Pittsburgh
Associate Professor, Critical Care Medicine and Clinical and Translational Sciences
Director, Clinical Epidemiology Program
CRISMA Center
University of Pittsburgh Medical Center

Sachin Yende, MD, MS, has indicated to Physician’s Weekly that he has no financial interests to disclose.

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  • Discuss the findings of a study that sought to determine if the risk of cardiovascular disease varies over 10 years following hospitalization for pneumonia.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwMar5.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

FACULTY DISCLOSURES

Christopher Cole – Senior Editor
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Sachin Yende, MD, MS
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Sachin Yende, MD, MS (click to view)

Sachin Yende, MD, MS

Vice President, Critical Care
VA Pittsburgh
Associate Professor, Critical Care Medicine and Clinical and Translational Sciences
Director, Clinical Epidemiology Program
CRISMA Center
University of Pittsburgh Medical Center

Sachin Yende, MD, MS, has indicated to Physician’s Weekly that he has no financial interests to disclose.

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Research indicates that hospitalizations for pneumonia appear to increase both short- and long-term risks of cardiovascular disease (CVD). Efforts to prevent pneumonia may help reduce the burden of CVD.
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Studies have shown that patients with respiratory tract infections (RTIs) often have higher risk for cardiovascular events than those without RTIs. However, these studies have mostly assessed risk within the first few months after an RTI. Investigations that have assessed long-term risk have had conflicting results. By better characterizing the short- and long-term risks of CVD after an RTI, clinicians may be able to clarify whether these infections are risk factors for CVD and help explain the short- and long-term morbidity and mortality among patients with RTIs.

Assessing Risk

For a study published in JAMA, Sachin Yende, MD, MS, and colleagues examined community-based cohorts from the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities study (ARIC). “CHS enrolled patients older than 65 from 1989 to 1994, and we have follow-up data for about 15 years,” explains Dr. Yende. “The ARIC study enrolled patients aged 45 to 65 from 1987 to 1989, and has similar follow-up data.”

To determine if the risk of CVD varied over 10 years following hospitalization for pneumonia, the authors identified pneumonia hospitalizations in the CHS and ARIC cohorts. These individuals were then matched with patients without pneumonia and monitored for the development of CVD. Risk was assessed within the 30 days of hospitalization, from 30 to 90 days, from 90 days to 1 year, and then annually thereafter. The researchers also sought to determine if any associations between pneumonia and CVD risk persisted after adjusting for traditional and cardiovascular risk factors.

Persistent CVD Risk

“Our study confirmed that the risk of CVD events is indeed higher among patients who have had pneumonia when compared with those who have not had it,” says Dr. Yende. “This risk persisted for up to about 10 years among elderly patients in the CHS cohort and up to about 2 years in younger adults in the ARIC study. This is longer than what has been previously reported [Table].”

Nearly 35% of patients with pneumonia in the CHS cohort had CVD events over the 10-year study. Risk for CVD among patients with pneumonia was highest in the first year, with hazard ratios of 4.07 in the first 30 days, 2.94 for days 31 to 90, and 2.10 for 91 days to 1 year when compared with those without pneumonia. CVD risk remained elevated into the tenth year among patients with pneumonia, with a hazard ratio of 1.86.

In the younger ARIC cohort, the risk for CVD over 10 years was much lower than that of the CHS cohort but still significant a significant 16%. When compared with patients without pneumonia, those with it had CVD hazard ratios of 2.38 in the first 30 days, 2.40 between 31 and 90 days, 2.19 between 91 days and 1 year, and 1.88 during the second year. Hazard ratios were no longer statistically significant beyond 2 years.

“We went to great lengths to try to address whether pneumonia is a marker of CVD or if it could potentially be in the causal pathway,” explains Dr. Yende. “The cohorts we studied had detailed information about chronic diseases, especially CVD risk factors, and echocardiography findings. We adjusted for differences in risk factors between those with and without pneumonia. Even after these efforts, we still saw that patients with pneumonia had a higher risk of CVD. Although we cannot assign causality, our findings suggest that there could be a causal association between pneumonia and CVD.”

The study investigators also assessed how the increased risk of CVD due to pneumonia compared with the risk associated with well-known CVD risk factors like diabetes and smoking. “We found that the risk associated with pneumonia is either similar or actually higher in some cases, suggesting that it is probably as important to consider pneumonia as it is to think about most other traditionally considered risk factors,” Dr. Yende says. This increased risk for CVD occurred regardless of whether patients had mild or severe cases of pneumonia.

Important Implications

According to Dr. Yende, the study findings reinforce the importance of discussing the benefits of vaccinating patients for pneumonia as well as influenza. “Vaccination will not only prevent patients from being hospitalized with these infections, but also the potential downstream consequences, including CVD,” he says.

The reasons behind the high mortality rates for pneumonia—even years after hospitalization—have remained poorly defined in currently available research. “Our study indicates that a potential explanation for these high rates could be that patients who are hospitalized with pneumonia subsequently have more CVD events years later,” says Dr. Yende. “These events may increase the long-term risk of death.”

Research is needed to define interventions to reduce the risk of CVD among patients who are hospitalized with pneumonia, according to Dr. Yende. “Whether assessing CVD risk factors in these patients and putting them on aspirin or statin therapy can improve their long-term outcomes remains to be addressed,” he says. “It’s important to begin considering what can be done differently to improve the care of patients hospitalized with pneumonia and reduce their short- and long-term risk of CVD.”

Readings & Resources (click to view)

Corrales-Medina V, Alvarez K, Weissfeld L, et al. Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA. 2015;313:264-274. Available at http://jama.jamanetwork.com/article.aspx?articleid=2091304.

Corrales-Medina V, Madjid M, Musher D. Role of acute infection in triggering acute coronary syndromes. Lancet Infect Dis. 2010;10:83-92.

Corrales-Medina V, Musher D, Shachkina S, Chirinos J. Acute pneumonia and the cardiovascular system. Lancet. 2013;381:496-505.

Yende S, D’Angelo G, Mayr F, et al. Elevated hemostasis markers after pneumonia increases 1-year risk of all-cause and cardiovascular deaths. PLoS One. 2011;6:e22847.

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