Key result
Hospitalization with pneumonia did not significantly accelerate overall coronary artery calcium progression compared to matched controls (difference in slope 7.7, p=0.18), though progression was greater among those with high baseline cardiovascular risk.
Why the study?
Does hospitalization for pneumonia accelerate the progression of coronary artery calcium compared to matched controls?
Observational (n=108)
Yes
Does hospitalization for pneumonia accelerate the progression of coronary artery calcium compared to matched controls?
Mean Difference: 7.7 (95% CI -9–24.6)
Absolute Event Rate: 21.8% vs 15.8%
p-value: p=0.18
Hospitalization for pneumonia may accelerate the progression of coronary atherosclerosis specifically in individuals with a high baseline risk for atherosclerotic cardiovascular disease.
No overall CAC acceleration after pneumonia hospitalization; leaves open possible effect in high-risk patients.
BACKGROUND: Epidemiological analyses demonstrate that pneumonia survivors have a higher risk of myocardial infarction than people with similar load of risk factors for atherosclerotic cardiovascular disease (ASCVD) but without pneumonia. This may be due to a higher baseline burden of ASCVD in patients with pneumonia that is not captured by the accounting of known ASCVD risk factors in epidemiological analyses or to unfavorable accelerating effects of pneumonia on atherosclerosis. METHODS: We analyzed data from the Multi-Ethnic Study of Atherosclerosis. We identified 54 participants that were hospitalized for pneumonia during study follow-up and that also had assessment of coronary artery calcium (CAC, an objective marker of coronary atherosclerotic burden) before and after this hospitalization. We matched them to 54 participants who were not hospitalized for pneumonia but that had CAC assessments at the same study visits as the pneumonia cases. We compared baseline CAC scores and their progression between groups. RESULTS: Baseline CAC scores were similar in both groups (median [IQR]; 6.3 [0-356.8] in pneumonia participants vs. 10.8 [0-178.3] in controls; p = 0.25). After a median of 4.8 years, the direction and magnitude of CAC score change, and the slope of CAC score progression between groups was also similar (median change [IQR], 21.8 [0 to 287.29] in participants with pneumonia versus 15.8 [0 to 140.94] in controls, p = 0.28; difference in slope, 7.7, 95% CI -9.0 to 24.6, p = 0.18). However, among participants with high baseline ASCVD risk (i.e. ACC/AHA 10-year risk estimate ≥7.5%), participants with pneumonia showed a larger increase in CAC scores (median change [IQR]; 159.10 [38.55-407.34] versus 48.72 [0.97-246.99] in controls; p = 0.02) and a trend towards a steeper slope of CAC score progression (difference in slope, 19.7, 95% CI -6.6 to 45.6, p = 0.07). CONCLUSION: Pneumonia may accelerate the progression of atherosclerosis in people with high baseline ASCVD risk.
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Corrales‐Medina et al. (2018) conducted an observational in Atherosclerotic cardiovascular disease (ASCVD) and Pneumonia (n=108). Hospitalization with pneumonia vs. Matched participants not hospitalized for pneumonia was evaluated on Slope of coronary artery calcium (CAC) score progression (Difference in slope 7.7, 95% CI -9.0 to 24.6, p=0.18). Hospitalization with pneumonia did not significantly accelerate overall coronary artery calcium progression compared to matched controls (difference in slope 7.7, p=0.18), though progression was greater among those with high baseline cardiovascular risk.
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