Cardiovascular Risk Following Pneumonia in Older Males: A Longitudinal Cohort Study

Aim We aimed to examine the association between pneumonia hospitalisations and major adverse cardiovascular events (MACE) in a population-based male cohort. Method The Health In Men Study followed community-dwelling Western Australian men over >20 years using state-wide linked hospital and mortality data. Pneumonia was modelled as a time-varying exposure (hospitalisation to 30 days post-discharge), with sensitivity analysis extending exposure to 365 days, and lifetime. Outcomes included cardiovascular death (CVD), MACE1 (CVD, myocardial infarction, ischaemic or unspecified stroke), and MACE2 (MACE1 plus heart failure and unstable angina). Cox models adjusted for age, smoking, and baseline cardiovascular and metabolic comorbidities. Results Among 12 201 men (mean age: 72.1 years), baseline risk factors included smoking (70.8%), hypertension (86.2%), dyslipidaemia (31.3%) and existing cardiovascular disease (29.5%). Nearly 18% (n=2,183) were hospitalised with pneumonia. Within 30 days, adjusted hazard ratios (HRs) were 11.26 (95% CI 8.78–14.44), 7.40 (5.71–9.61) and 7.04 (5.46–9.07) for CVD, MACE1 and MACE 2, respectively. Elevated risk remained over the first year following exposure; with HRs of 4.71 (4.04–5.49) for CVD, 3.26 (2.80–3.80) for MACE1, and 3.35 (2.91–3.87) for MACE2. When modelled as a lifetime exposure, pneumonia conferred an elevated but reduced risk: CVD: HR 3.00 (2.69–3.36), MACE1: HR 2.26 (2.04–2.50), MACE2: HR 2.32 (2.10–2.55). Conclusion Pneumonia hospitalisations in older men are associated with markedly increased short-term and sustained long-term cardiovascular risk, acting as an acute trigger and a powerful late-life risk signal. Hospitalisation for pneumonia should prompt structured cardiovascular reassessment and optimisation of preventive therapy.