Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct;4(10 Pt 2):102172.
doi: 10.1016/j.jacadv.2025.102172. Epub 2025 Sep 22.

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

Nicoline Meyer Riisberg  1 , Daniel Modin  2 , Barbara Bonnesen Bertelsen  3 , Anna K Vognsen  3 , Josefin Eklöf  3 , Jonas Bredtoft Boel  4 , Christian Østergaard  5 , Ram Benny Dessau  6 , Tor Biering-Sørensen  7 , Jens-Ulrik Stæhr Jensen  8 , Pradeesh Sivapalan  8
Affiliations

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

Nicoline Meyer Riisberg et al. JACC Adv. 2025 Oct.

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.

PubMed Disclaimer

Conflict of interest statement

Funding support and author disclosures Dr Biering-Sørensen has received research grant from Sanofi Pasteur, Novo Nordisk, Novatis, Pfizer, GSK, AstraZeneca, Boston Scientific, and GE Healthcare; has received consulting fees from Novo Nordisk, IQVIA, Parexel, Amgen, CSL Seqirus, GSK, and Sanofi Pasteur; has received honoraria for lectures from AstraZeneca, Bayer, Novartis, Sanofi Pasteur, GE healthcare, and GSK; has received support for attending meetings and/or travel from AstraZeneca; and has borrowed an echo machine from GE Healthcare. Dr Dessau has received support for attending meetings and/or travel for the Chair scientific session, ECCMID Copenhagen 2023 (Invited by ESCMID), and participation in ECCCMID/ESCMID Global 2024(Invited by CMI/ESCMID); has participated on a Data Safety Monitoring Board or Advisory Board: Pfizer Advisory Board (one meeting in 2022 and one in 2024). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Flowchart of Patients Included in the Study All patients had a positive culture with Streptococcus pneumoniae, and experienced a MACE within the study period. COPD = chronic obstructive pulmonary disease; LIS = the laboratory information system.
Figure 2
Figure 2
Illustration Showing SCCS Study Design The study had a risk period which was defined as starting 5 days before the date of the positive culture of S. pneumoniae and lasting for 14 days. The control periods were defined as the period from day 0 and 180 days before, and 194 days after (excluded the risk interval). SCCS = self-controlled case series.
Figure 3
Figure 3
Barchart of the Distribution of Events On the x-axis timeline of the study period are shown in days before and after day 0. On the y-axis number of events are shown. Each bar shows the cumulative number of events per 37 days. AMI = acute myocardial infarction; MACE = major adverse cardiovascular events.
Figure 4
Figure 4
Bar Chart of the IRRs With the 95% CI The charts show incidence rate ratios for both primary and secondary outcomes. IRR = incidence rate ratio; other abbreviations as in Figure 3.
Central Illustration
Central Illustration
A Self-Controlled Case Series Design of 267 COPD Patients With Streptococcus pneumoniae Infection Who Experienced a MACE, Was Conducted Using Danish Nationwide Data (2010-2017) The first 14 days postinfection showed a 4.6-fold increased risk of MACE and a 9.1-fold increased risk of AMI. This demonstrates a markedly elevated short-term cardiovascular risk following pneumococcal infection in COPD patients. AMI = acute myocardial infarction; COPD = chronic obstructive pulmonary disease; MACE = major adverse cardiovascular events.
See this image and copyright information in PMC

References

    1. Identification of new risk factors for pneumonia: population-based case-control study | British Journal of General practice [Internet] https://bjgp.org/content/59/567/e329.long - PMC - PubMed
    1. Yu Y., Liu W., Jiang H.L., Mao B. Pneumonia is associated with increased mortality in hospitalized COPD patients: a systematic review and meta-analysis. Respiration. 2021;100(1):64–76. - PubMed
    1. Community-acquired pneumonia - the lancet [Internet] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60733...
    1. Cillóniz C., Dominedò C., Garcia-Vidal C., Torres A. Community-acquired pneumonia as an emergency condition. Curr Opin Crit Care. 2018;24(6):531–539. - PubMed
    1. Restrepo M.I., Sibila O., Anzueto A. Pneumonia in patients with chronic obstructive pulmonary disease. Tuberc Respir Dis (Seoul) 2018;81(3):187–197. - PMC - PubMed

LinkOut - more resources