Respiratory health risks: The relationship between pneumonia and cardiovascular disease goes both ways: Pneumonia can increase the risk of heart disease, and history of heart disease increase the risk of pneumonia.
World Pneumonia Day 2024: Pneumonia is an infection that can cause inflammation throughout the body. This inflammation can lead to other complications, including an increased risk that bits of plaque can break free from your vessel walls and lead to heart attack or stroke.
According to Dr Haresh Shah, Consultant Pulmonologist, Bhailal Amin General Hospital, Vadodara, the relationship between pneumonia and cardiovascular disease goes both ways: Pneumonia can increase the risk of heart disease, and history of heart disease increase the risk of pneumonia.
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“Although traditionally regarded as a disease confined to the lungs, acute pneumonia has important effects on the cardiovascular system at all severities of infection. Pneumonia tends to affect individuals who are also at high cardiovascular risk. Results of recent studies show that about a quarter of adults admitted to hospital with pneumonia develop a major acute cardiac complication during their hospital stay, which is associated with a 60% increase in short-term mortality. These findings suggest that outcomes of patients with pneumonia can be improved by prevention of the development and progression of associated cardiac complications,” Dr. Shah told Financial Express.com.
Pneumonia and cardiac disease are leading causes of morbidity and mortality worldwide. Community-acquired pneumonia affects more than 5 million adults, and causes 1.1 million hospital admissions and more than 60 000 deaths every year in the USA.
“Cardiac disease affects more than 30 million US adults and leads to 5 million hospital admissions and more than 300 000 deaths every year. Disease burdens in Europe are similar. Pneumonia and cardiac disease often coexist in the same patients. For example, more than half of elderly patients admitted to hospital with pneumonia also have a chronic cardiac disorder—an association that will become more prevalent as the population continues to age,” Dr. Shah revealed.
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What are the physiological mechanism behind the connection between pneumonia and cardiovascular health?
The present understanding of the human cardiovascular response to infections, including pneumonia, is derived mainly from studies of critically ill patients with septic shock.
According to Dr. Shah, this disorder is characterised by inability of the peripheral vasculature to constrict despite increased concentrations of catecholamines and increased activity of the renin–angiotensin–aldosterone system; myocardial systolic and diastolic dysfunction, mainly of the left ventricle, with some myocardial injury manifested as heart attack or heart failure.
Why are people with preexisting heart conditions more vulnerable to severe outcomes when diagnosed with pneumonia?
Among patients hospitalised with severe pneumonia (viral or bacterial), pre-existing established cardiovascular heart diseases appears to be a more important contributor to in-hospital mortality than cardiovascular risk factors without co-existent cardiovascular disease, particularly in patients below the age of 70 years.
“This enhanced risk may be driven, at least in part, by a higher incidence of cardiac complications and myocardial injury in patients with pre-existing CVD. Decompensation in preexisting heart disease is faster. Optimal management of pre-existing CVD may serve to modify outcomes related to pneumonia in this group. In addition, heightened vigilance for arrhythmias and myocardial injury should be considered for patients with pre-existing CVD, to enable early detection and intervention where needed,” he highlighted.
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How can pneumonia trigger inflammation that negatively impacts cardiovascular system?
Several mechanisms can contribute to myocardial dysfunction in patients with pneumonia. “Circulating inflammatory mediators (ie, cytokines and/or endotoxins) or direct infection of cardiomyocytes with pneumonia-causing organisms, or both these mechanisms, can lead to non-ischaemic myocardial injury. Acute myocardial ischaemia can lead to heart attack/ failure/arrythmia,” Dr. Shah told Financial Express.com.
What preventive measures should people with heart disease take?
Clinicians and public health officials should optimise rates of influenza and pneumococcal vaccination, especially in elderly patients and individuals with chronic cardiac disorders.
“Because more than 50% of cardiac complications are recognised at or within 24 h of presentation with acute pneumonia, a thorough investigation for the presence of cardiac complications should be part of the initial assessment of patients presenting with this infection. Clinicians should specifically investigate for preexisting cardiac disorder and marker of cardiac damage,” he added.
