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Recent respiratory infection and the risk of myocardial infarction
  1. T C Clayton1,
  2. N E Capps2,
  3. N G Stephens3,
  4. J A Wedzicha4,
  5. T W Meade1
  1. 1London School of Hygiene & Tropical Medicine, London, UK
  2. 2Princess Royal Hospital, Telford, UK
  3. 3Northwick Park Hospital, Harrow, UK
  4. 4St Bartholomew’s and Royal London School of Medicine and Dentistry, London, UK
  1. Correspondence to:
    Tim C Clayton
    Medical Statistics Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK;

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Mounting interest over the past 10 or 15 years in the possible role of infection in the risk of myocardial infarction (MI) has mainly centred on serological evidence of infection that often has occurred several years or months previously.1 However, recent rather than distant infection may be more strongly associated with coronary events, as shown by the excess of coronary deaths in the winter months not accounted for by the concomitant increase in deaths from respiratory disease.2 The most suggestive evidence comes from two studies carried out through the General Practice Research Database (GPRD).3,4 In the first, the adjusted odds ratio (OR) for MI within 10 days of a respiratory infection was 3.0 (95% confidence interval (CI) 2.1 to 4.4, p < 0.0001) and was nearly 4.0 within five days of infection. In the second study, incidence ratios for MI were 4.95, 3.20, 2.81, and 1.95 at days 1–3, 4–7, 8–14, and 15–28 after infection, respectively. We therefore carried out a clinical case–control study, collecting information directly from patients admitted with MI and matched controls through a structured questionnaire to try to confirm or refute the indications of the GPRD studies based on documentary information.


Cases were recruited from patients admitted with a clinical diagnosis of MI to the coronary care units at two hospitals. Potential controls were recruited from neighbouring general practices matched for age, sex, and area deprivation score. In total 119 cases and 214 matched controls were …

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  • Role of the funding source: The Medical Research Council, who funded the study, had no role in the study design, in the collection, analysis, and interpretation of the data, in the writing of the report, or in the decision to submit the paper for publication.

  • Conflict of interest statement: The authors declare no conflict of interest with respect to this case-control study. However, Professor Tom Meade is a member of the IMS Health Independent Scientific Ethics Advisory Committee and receives payment for his work in this capacity.

  • Ethical approval: The study was approved by the Local Research Ethics Committees of the two hospitals (Northwick Park Hospital, Harrow, and the Princess Royal Hospital, Telford).