Risk of Major Adverse Cardiovascular Events During Acute Streptococcus pneumoniae Infection in COPD Patients

Nicoline Meyer Riisberg; Daniel Modin; Barbara Bonnesen Bertelsen; Anna K Vognsen; Josefin Eklöf; Jonas Bredtoft Boel; Christian Østergaard; Ram Benny Dessau; Tor Biering-Sørensen; Jens-Ulrik Stæhr Jensen; Pradeesh Sivapalan

doi:10.1016/j.jacadv.2025.102172

Risk of Major Adverse Cardiovascular Events During Acute Streptococcus pneumoniae Infection in COPD Patients

JACC Adv. 2025 Oct;4(10 Pt 2):102172. doi: 10.1016/j.jacadv.2025.102172. Epub 2025 Sep 22.

Affiliations

¹ Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark. Electronic address: Nicoline@riisberg.dk.
² CTCPR, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
³ Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
⁴ Department of Clinical Microbiology, Copenhagen University Hospital-Herlev, Herlev, Denmark.
⁵ Department of Clinical Microbiology, Copenhagen University Hospital-Herlev, Herlev, Denmark; Diagnostic Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark.
⁶ Department of Clinical Microbiology, Copenhagen University Hospital-Herlev, Herlev, Denmark; Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark.
⁷ CTCPR, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Steno Diabetes Center Copenhagen, Copenhagen, Denmark.
⁸ Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Department of clinical Medicine, Faculty of Health Sciences, University of Copenhagen.

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) are at an increased risk of severe complications and death from community-acquired pneumonia such as Streptococcus pneumoniae. Previous studies suggest that acute infection heightens the short-term risk of cardiovascular events.

Objectives: This study investigates the risk of major adverse cardiovascular events (MACE) during the acute phase of S pneumoniae infection in patients with COPD.

Methods: We conducted a self-controlled case series study in patients with COPD and a positive lower respiratory tract or blood culture for S pneumoniae between 2010 and 2017 using Danish Nationwide register data. The primary outcome was incidence of MACE and the risk interval was defined as the first 14 days after an airway or blood culture positive for S. pneumonia. The control interval was defined as 180 days before and 180 days after the risk interval. Statistical analysis involved conditional Poisson regression models to calculate incidence rate ratios.

Results: We identified 327 patients with a positive culture for S pneumoniae, who experienced a MACE during the study period. Sixty patients died during the study period leaving 267 patients for analysis. Pneumococcal infection was associated with a 4.6-fold increased incidence of MACE (P < 0.001) within 14 days after the infection and a 9.1-fold increased incidence of acute myocardial infarction (P < 0.001).

Conclusions: Pneumococcal infection in patients with COPD was associated with an increased risk of MACE within 14 days postinfection. Further studies should address whether preventative interventions could mitigate risks in patients with COPD and pneumococcal infections.

Keywords: Streptococcus pneumoniae; cardiovascular risk; chronic obstructive pulmonary disease; major adverse cardiovascular events; self-controlled case series.