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Acute myocardial infarctions, strokes and influenza: seasonal and pandemic effects

  • E. D. FOSTER (a1), J. E. CAVANAUGH (a1), W. G. HAYNES (a2), M. YANG (a1), A. K. GERKE (a3), F. TANG (a1) and P. M. POLGREEN (a4) (a5)...

The incidence of myocardial infarctions and influenza follow similar seasonal patterns. To determine if acute myocardial infarctions (AMIs) and ischaemic strokes are associated with influenza activity, we built time-series models using data from the Nationwide Inpatient Sample. In these models, we used influenza activity to predict the incidence of AMI and ischaemic stroke. We fitted national models as well as models based on four geographical regions and five age groups. Across all models, we found consistent significant associations between AMIs and influenza activity, but not between ischaemic strokes and influenza. Associations between influenza and AMI increased with age, were greatest in those aged >80 years, and were present in all geographical regions. In addition, the natural experiment provided by the second wave of the influenza pandemic in 2009 provided further evidence of the relationship between influenza and AMI, because both series peaked in the same non-winter month.

Corresponding author
*Author for correspondence: Mr E. D. Foster, Department of Biostatistics, College of Public Health, 105 River Street, The University of Iowa, Iowa City, IA 52242, USA. (Email:
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1. WW Thompson , Influenza-associated hospitalizations in the United States. Journal of the American Medical Association 2004; 292: 13331340.

2. S Collins . Excess mortality from causes other than influenza and pneumonia during influenza epidemics. Public Health Reports 1932; 47: 21592179.

3. TA Reichert , Influenza and the winter increase in mortality in the United States, 1959–1999. American Journal of Epidemiology 2004; 160: 492502.

4. C Warren-Gash , Circulating influenza virus, climatic factors, and acute myocardial infarction: a time series study in England and Wales and Hong Kong. Journal of Infectious Diseases 2011; 203: 17101718.

5. VF Corrales-Medina , M Madjid , DM Musher . Role of acute infection in triggering acute coronary syndromes. Lancet Infectious Diseases 2010; 10: 8392.

6. F Lamontagne , Pneumococcal vaccination and risk of myocardial infarction. Canadian Medical Association Journal 2008; 179: 773777.

7. M Madjid , Influenza epidemics and acute respiratory disease activity are associated with a surge in autopsy-confirmed coronary heart disease death: results from 8 years of autopsies in 34 892 subjects. European Heart Journal 2007; 28: 12051210.

8. C Warren-Gash , L Smeeth , AC Hayward . Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic review. Lancet Infectious Diseases 2009; 9: 601610.

9. PJ Lindsberg , AJ Grau . Inflammation and infections as risk factors for ischemic stroke. Stroke 2003; 34: 25182532.

10. RF Macko , Impairments of the protein C system and fibrinolysis in infection-associated stroke. Stroke 1996; 27: 20052011.

11. M Naghavi , Influenza infection exerts prominent inflammatory and thrombotic effects on the atherosclerotic plaques of apolipoprotein E-deficient mice. Circulation 2003; 107: 762768.

12. AM Toschke , Temporal relationship between influenza infections and subsequent first-ever stroke incidence. Age and Ageing 2009; 38: 100103.

13. AJ Grau , Association of symptoms of chronic bronchitis and frequent flu-like illnesses with stroke. Stroke 2009; 40: 32063210.

14. KL Nichol , Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. New England Journal of Medicine 2003; 348: 13221332.

15. S Muhammad , Influenza virus infection aggravates stroke outcome. Stroke 2011; 42: 783791.

16. A Ciszewski , Influenza vaccination in secondary prevention from coronary ischaemic events in coronary artery disease: FLUCAD study. European Heart Journal 2008; 29: 13501358.

17. SM Gwini , CAC Coupland , AN Siriwardena . The effect of influenza vaccination on risk of acute myocardial infarction: Self-controlled case-series study. Vaccine 2011; 29: 11451149.

18. AJ Grau , Influenza vaccination is associated with a reduced risk of stroke. Stroke 2005; 36: 15011506.

19. IFN Hung , Prevention of acute myocardial infarction and stroke among elderly persons by dual pneumococcal and influenza vaccination: a prospective cohort study. Clinical Infectious Diseases 2010; 51: 10071016.

20. A Phrommintikul , Influenza vaccination reduces cardiovascular events in patients with acute coronary syndrome. European Heart Journal 2011; 32: 17301735.

21. T Fischer , Secular trends and seasonality in first-time hospitalization for acute myocardial infarction – a Danish population-based study. International Journal of Cardiology 2004; 97: 425431.

22. ES Jensen , A 20-year ecological study of the temporal association between influenza and meningococcal disease. European Journal of Epidemiology 2004; 19: 181187.

23. K Katsouyanni , Short term effects of air pollution on health: a European approach using epidemiologic time series data: the APHEA protocol. Journal of Epidemiology and Community Health 1996; 50 Suppl 1: S1218.

24. J Schwartz , Methodological issues in studies of air pollution and daily counts of deaths or hospital admissions. Journal of Epidemiology and Community Health 1996; 50 (Suppl. 1): S311.

29. RH Shumway , DS Stoffer . Time Series Analysis and its Applications: with R Examples, 3rd edn. New York: Springer, 2011, pp. 1589.

30. A Paganini-Hill , Infection and risk of ischemic stroke – differences among stroke subtypes. Stroke 2003; 34: 452457.

32. AA Bavry , Harmful effects of NSAIDs among patients with hypertension and coronary artery disease. American Journal of Medicine 2011; 124: 614620.

35. CA Reardon , Effect of immune deficiency on lipoproteins and atherosclerosis in male apolipoprotein E-deficient mice. Arteriosclerosis Thrombosis and Vascular Biology 2001; 21: 10111016.

36. CA Reardon , Genetic background selectively influences innominate artery atherosclerosis – immune system deficiency as a probe. Arteriosclerosis Thrombosis and Vascular Biology 2003; 23: 14491454.

37. BJ Bennett , Genetic regulation of atherosclerotic plaque size and morphology in the innominate artery of hyperlipidemic mice. Arteriosclerosis Thrombosis and Vascular Biology 2009; 29: 348–A18.

38. M Christoffersen , Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study. British Medical Journal 2011; 343: d5497.

39. N Marden-Haug , Code-based syndromic surveillance for influenza like illness by International Classification of Diseases, Ninth Revision. Emerging Infectious Diseases 2007; 13: 207216.

40. CL Roumie , Validation of ICD-9 codes with a high positive predictive value for incident strokes resulting in hospitalization using Medicaid health data. Pharmacoepidemiology and Drug Safety 2008; 17: 2026.

41. E Birman-Deych , Accuracy of ICD-9-CM codes for identifying cardiovascular and stroke risk factors. Medical Care 2005; 43: 480485.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
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