The risk of cardiovascular, cerebrovascular and thromboembolic events after community-acquired pneumonia among adults: a systematic literature review

Abstract

Background Community-acquired pneumonia (CAP) may prompt long-term complications. We reviewed the absolute and relative risks of cardiac/vascular events after pneumococcal (PCAP) and all-cause CAP (aCAP) in adults. Methods We searched Embase and PubMed for publications from high-income countries between 2000 and 2021, comparing the relative risk of cardiac/vascular events after CAP in adults to those without CAP. We also reviewed event risks among patients with CAP. In this review, CAP has been used as an umbrella term, including both PCAP and aCAP. Results We included 19 of 6917 identified publications. CAP was independently associated with cardiovascular disease (CVD), including heart failure and acute coronary syndrome, as well as deep-vein thrombosis and pulmonary embolism. The relative risk for cardiac/vascular events in the year post-CAP ranged from 1.4 to 4.1 compared to non-CAP patients. The highest risk occurred immediately after the CAP episode, but the risk remained elevated for years. The risk for CVD <1 year post-CAP was 4.6% in individuals aged 45–64 years and 17.9% for those aged 65+ years. The cumulative risk of cardiac/vascular events after CAP increased with time of follow-up and comorbidities. Conclusions Cardiac/vascular events occur frequently after CAP and the association persists beyond the acute phase of infection. Public health evaluations of interventions for the prevention of CAP should consider these long-term sequelae.