Laboratory-confirmed influenza infection and acute myocardial infarction among United States senior Veterans
Previous studies established an association between laboratory-confirmed influenza infection (LCI) and hospitalization for acute myocardial infarction (AMI) but not causality. We aimed to explore the underlying mechanisms by adding biological mediators to an established study design used by earlier...
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description | Previous studies established an association between laboratory-confirmed influenza infection (LCI) and hospitalization for acute myocardial infarction (AMI) but not causality. We aimed to explore the underlying mechanisms by adding biological mediators to an established study design used by earlier studies.
With data on biomarkers, we used a self-controlled case-series design to evaluate the effect of LCI on hospitalization for AMI among Veterans Health Administration (VHA) patients. We included senior Veterans (age 65 years and older) with LCI between 2010 through 2015. Patient-level data from VHA electronic medical records were used to capture laboratory results, hospitalizations, and baseline patient characteristics. We defined the "risk interval" as the first 7 days after specimen collection and the "control interval" as 1 year before and 1 year after the risk interval. More importantly, using mediation analysis, we examined the role of abnormal white blood cell (WBC) and platelet count in the relationship between LCI and AMI to explore the thrombogenic nature of this association, thus potential causality.
We identified 391 hospitalizations for AMI that occurred within +/-1 year of a positive influenza test, of which 31 (31.1 admissions/week) occurred during the risk interval and 360 (3.5/per week) during the control interval, resulting in an incidence ratio (IR) for AMI admission of 8.89 (95% confidence interval [CI]: 6.16-12.84). In stratified analyses, AMI risk was significantly elevated among patients with high WBC count (IR, 12.43; 95% CI: 6.99-22.10) and high platelet count (IR, 15.89; 95% CI: 3.59-70.41).
We confirmed a significant association between LCI and AMI. The risk was elevated among those with high WBC or platelet count, suggesting a potential role for inflammation and platelet activation in the underlying mechanism. |
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With data on biomarkers, we used a self-controlled case-series design to evaluate the effect of LCI on hospitalization for AMI among Veterans Health Administration (VHA) patients. We included senior Veterans (age 65 years and older) with LCI between 2010 through 2015. Patient-level data from VHA electronic medical records were used to capture laboratory results, hospitalizations, and baseline patient characteristics. We defined the "risk interval" as the first 7 days after specimen collection and the "control interval" as 1 year before and 1 year after the risk interval. More importantly, using mediation analysis, we examined the role of abnormal white blood cell (WBC) and platelet count in the relationship between LCI and AMI to explore the thrombogenic nature of this association, thus potential causality.
We identified 391 hospitalizations for AMI that occurred within +/-1 year of a positive influenza test, of which 31 (31.1 admissions/week) occurred during the risk interval and 360 (3.5/per week) during the control interval, resulting in an incidence ratio (IR) for AMI admission of 8.89 (95% confidence interval [CI]: 6.16-12.84). In stratified analyses, AMI risk was significantly elevated among patients with high WBC count (IR, 12.43; 95% CI: 6.99-22.10) and high platelet count (IR, 15.89; 95% CI: 3.59-70.41).
We confirmed a significant association between LCI and AMI. The risk was elevated among those with high WBC or platelet count, suggesting a potential role for inflammation and platelet activation in the underlying mechanism.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0243248</identifier><identifier>PMID: 33306675</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Aged, 80 and over ; Biology and Life Sciences ; Biomarkers ; Confidence intervals ; Demographic aspects ; Diabetes ; Distribution ; Electronic health records ; Electronic medical records ; Epidemiology ; Female ; Health aspects ; Health care policy ; Health risks ; Heart attack ; Heart attacks ; Hospitalization ; Humans ; Incidence ; Infections ; Influenza ; Influenza, Human - complications ; Influenza, Human - diagnosis ; Laboratories ; Leukocytes ; Male ; Medicare ; Medicine and Health Sciences ; Myocardial infarction ; Myocardial Infarction - diagnosis ; Myocardial Infarction - etiology ; Pharmacy ; Platelets ; Risk analysis ; Risk Factors ; Statistical analysis ; United States - epidemiology ; Veterans ; White blood cells</subject><ispartof>PloS one, 2020-12, Vol.15 (12), p.e0243248-e0243248</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication: https://creativecommons.org/publicdomain/zero/1.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-287ccc40d44cd600b151a1c183cec55ae952293b754c8af6faf1654f2cd7beb43</citedby><cites>FETCH-LOGICAL-c692t-287ccc40d44cd600b151a1c183cec55ae952293b754c8af6faf1654f2cd7beb43</cites><orcidid>0000-0002-2440-3352</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732109/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732109/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33306675$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Rahman, Muhammad Aziz</contributor><creatorcontrib>Young-Xu, Yinong</creatorcontrib><creatorcontrib>Smith, Jeremy</creatorcontrib><creatorcontrib>Mahmud, Salaheddin M</creatorcontrib><creatorcontrib>Van Aalst, Robertus</creatorcontrib><creatorcontrib>Thommes, Edward W</creatorcontrib><creatorcontrib>Neupane, Nabin</creatorcontrib><creatorcontrib>Lee, Jason K H</creatorcontrib><creatorcontrib>Chit, Ayman</creatorcontrib><title>Laboratory-confirmed influenza infection and acute myocardial infarction among United States senior Veterans</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Previous studies established an association between laboratory-confirmed influenza infection (LCI) and hospitalization for acute myocardial infarction (AMI) but not causality. We aimed to explore the underlying mechanisms by adding biological mediators to an established study design used by earlier studies.
With data on biomarkers, we used a self-controlled case-series design to evaluate the effect of LCI on hospitalization for AMI among Veterans Health Administration (VHA) patients. We included senior Veterans (age 65 years and older) with LCI between 2010 through 2015. Patient-level data from VHA electronic medical records were used to capture laboratory results, hospitalizations, and baseline patient characteristics. We defined the "risk interval" as the first 7 days after specimen collection and the "control interval" as 1 year before and 1 year after the risk interval. More importantly, using mediation analysis, we examined the role of abnormal white blood cell (WBC) and platelet count in the relationship between LCI and AMI to explore the thrombogenic nature of this association, thus potential causality.
We identified 391 hospitalizations for AMI that occurred within +/-1 year of a positive influenza test, of which 31 (31.1 admissions/week) occurred during the risk interval and 360 (3.5/per week) during the control interval, resulting in an incidence ratio (IR) for AMI admission of 8.89 (95% confidence interval [CI]: 6.16-12.84). In stratified analyses, AMI risk was significantly elevated among patients with high WBC count (IR, 12.43; 95% CI: 6.99-22.10) and high platelet count (IR, 15.89; 95% CI: 3.59-70.41).
We confirmed a significant association between LCI and AMI. 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complications</topic><topic>Influenza, Human - diagnosis</topic><topic>Laboratories</topic><topic>Leukocytes</topic><topic>Male</topic><topic>Medicare</topic><topic>Medicine and Health Sciences</topic><topic>Myocardial infarction</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - etiology</topic><topic>Pharmacy</topic><topic>Platelets</topic><topic>Risk analysis</topic><topic>Risk Factors</topic><topic>Statistical analysis</topic><topic>United States - epidemiology</topic><topic>Veterans</topic><topic>White blood cells</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Young-Xu, Yinong</creatorcontrib><creatorcontrib>Smith, Jeremy</creatorcontrib><creatorcontrib>Mahmud, Salaheddin M</creatorcontrib><creatorcontrib>Van Aalst, Robertus</creatorcontrib><creatorcontrib>Thommes, Edward W</creatorcontrib><creatorcontrib>Neupane, Nabin</creatorcontrib><creatorcontrib>Lee, Jason K H</creatorcontrib><creatorcontrib>Chit, Ayman</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>Coronavirus Research Database</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Young-Xu, Yinong</au><au>Smith, Jeremy</au><au>Mahmud, Salaheddin M</au><au>Van Aalst, Robertus</au><au>Thommes, Edward W</au><au>Neupane, Nabin</au><au>Lee, Jason K H</au><au>Chit, Ayman</au><au>Rahman, Muhammad Aziz</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Laboratory-confirmed influenza infection and acute myocardial infarction among United States senior Veterans</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-12-11</date><risdate>2020</risdate><volume>15</volume><issue>12</issue><spage>e0243248</spage><epage>e0243248</epage><pages>e0243248-e0243248</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Previous studies established an association between laboratory-confirmed influenza infection (LCI) and hospitalization for acute myocardial infarction (AMI) but not causality. We aimed to explore the underlying mechanisms by adding biological mediators to an established study design used by earlier studies.
With data on biomarkers, we used a self-controlled case-series design to evaluate the effect of LCI on hospitalization for AMI among Veterans Health Administration (VHA) patients. We included senior Veterans (age 65 years and older) with LCI between 2010 through 2015. Patient-level data from VHA electronic medical records were used to capture laboratory results, hospitalizations, and baseline patient characteristics. We defined the "risk interval" as the first 7 days after specimen collection and the "control interval" as 1 year before and 1 year after the risk interval. More importantly, using mediation analysis, we examined the role of abnormal white blood cell (WBC) and platelet count in the relationship between LCI and AMI to explore the thrombogenic nature of this association, thus potential causality.
We identified 391 hospitalizations for AMI that occurred within +/-1 year of a positive influenza test, of which 31 (31.1 admissions/week) occurred during the risk interval and 360 (3.5/per week) during the control interval, resulting in an incidence ratio (IR) for AMI admission of 8.89 (95% confidence interval [CI]: 6.16-12.84). In stratified analyses, AMI risk was significantly elevated among patients with high WBC count (IR, 12.43; 95% CI: 6.99-22.10) and high platelet count (IR, 15.89; 95% CI: 3.59-70.41).
We confirmed a significant association between LCI and AMI. The risk was elevated among those with high WBC or platelet count, suggesting a potential role for inflammation and platelet activation in the underlying mechanism.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33306675</pmid><doi>10.1371/journal.pone.0243248</doi><tpages>e0243248</tpages><orcidid>https://orcid.org/0000-0002-2440-3352</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Aged Aged, 80 and over Biology and Life Sciences Biomarkers Confidence intervals Demographic aspects Diabetes Distribution Electronic health records Electronic medical records Epidemiology Female Health aspects Health care policy Health risks Heart attack Heart attacks Hospitalization Humans Incidence Infections Influenza Influenza, Human - complications Influenza, Human - diagnosis Laboratories Leukocytes Male Medicare Medicine and Health Sciences Myocardial infarction Myocardial Infarction - diagnosis Myocardial Infarction - etiology Pharmacy Platelets Risk analysis Risk Factors Statistical analysis United States - epidemiology Veterans White blood cells |
title | Laboratory-confirmed influenza infection and acute myocardial infarction among United States senior Veterans |
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