Viral Infections and Risk of Cardiovascular Disease: Systematic Review and Meta‐Analysis

BACKGROUND: We conducted a systematic review and meta-analysis of studies examining the association of viral infections with the risk of cardiovascular disease, including coronary heart disease (CHD) and stroke. METHODS: MEDLINE, Embase, Web of Science, African-Wide Information, and the Cochrane Library database were searched from inception to July 2024. RESULTS: We included 155 studies. HIV infection was consistently associated with an elevated risk of CHD (pooled adjusted risk ratio RR, 1.60 95% CI, 1.38-1.85) and stroke (RR, 1.45 95% CI, 1.26-1.67). SARS-CoV-2 infection was associated with an increased risk of CHD (RR, 1.74 95% CI, 1.44-2.11) and stroke (RR, 1.69 95% CI, 1.23-2.31). In self-controlled case series studies, laboratory-confirmed influenza infection was associated with an elevated risk of acute myocardial infarction (pooled incidence rate ratio, 4.01 95% CI, 2.66-6.05) and stroke during the first 1 month (incidence rate ratio, 5.01 95% CI, 3.41-7.37). In cohort studies, hepatitis C virus infection was associated with a higher risk of CHD (RR, 1.27 95% CI, 1.13-1.42) and stroke (RR, 1.23 95% CI, 1.04-1.46). Herpes zoster was also associated with an elevated risk of CHD (RR, 1.12 95% CI, 1.08-1.15) and stroke (RR, 1.18 95% CI, 1.09-1.27). There is insufficient evidence to determine the effect of cytomegalovirus on cardiovascular disease. Although on a limited basis, hepatitis A virus, herpes simplex virus type 1, respiratory syncytial virus, human papillomavirus, dengue, and chikungunya have been linked to an increased risk of cardiovascular disease. CONCLUSIONS: Influenza, SARS-CoV-2, HIV, hepatitis C virus, and herpes zoster were associated with an increased risk of major cardiovascular events. Vaccines may play an important role in preventing the risk of cardiovascular disease.