RSV is linked to cardiovascular disease and its complications

By Wayne Kuznar, for MDLinx
Published April 23, 2018

Key Takeaways

Pre-existing cardiovascular disease (CVD) appears to be a risk factor for respiratory syncytial virus (RSV), according to a study published in the Journal of the American College of Cardiology by researchers at Vanderbilt University in Nashville, TN. In addition, patients with cardiac disease were also found to be at increased risk of illness and morbidity from RSV.

Clinicians should be aware that cardiovascular complications, including congestive heart failure (CHF) and myocardial infarction (MI), occur in up to 22% of adult patients hospitalized with RSV, the authors asserted.

Their literature review also suggested that pre-existing cardiovascular disease is “not only associated with an increased risk of having symptomatic RSV infection, but it may also be associated with higher rates of health care utilization and worse outcomes for RSV-related illness.”

The authors pointed to two prospective studies conducted in Tennessee and a Canadian study that showed approximately one-half of patients with RSV had underlying CVD. Rates of underlying CVD are even higher in studies that included individuals 65 years of age and older. In addition, high rates of CHF and coronary heart disease have been reported in patients with confirmed RSV.

Pre-existing CVD in patients with RSV was found to be an independent predictor of the need for hospitalization and a greater likelihood of having a severe hospital outcome (ie, admission to an intensive care unit, mechanical ventilation, or death).

Acute respiratory infection, including RSV, is known to precede MI and other forms of myocardial injury and cardiovascular complications, including arrhythmias and acute coronary events. In children with RSV, myocarditis, tachycardia, pericardial effusion, and heart block have also been reported.

Exacerbation of CHF has also been documented during RSV infection. In a study of older adults or those with chronic cardiopulmonary conditions, RSV was found to be an important pathogen responsible for an estimated 5.4% of all hospital admissions for CHF.

In an attempt to explain the link between RSV and cardiovascular injury, the authors propose that some cardiac manifestations may be due the indirect effects from the impact on the respiratory tract (eg, right ventricular strain due to pulmonary hypertension) or from the inflammatory response. They also mention reports of the identification of RSV directly from myocardial tissue, which suggests that the virus may cause injury to the myocardium directly.

An effective RSV vaccine “may provide an opportunity to prevent cardiovascular complications among at-risk adult populations,” the authors wrote.

They noted that vaccination against influenza has cardioprotective benefits, and cited data showing a reduction in cardiovascular mortality by 55% in a vaccinated group with existing cardiac disease compared with an unvaccinated group. Separately, the rate of all-cause mortality was reduced by 19% with influenza vaccination of patients with CHF.

 To read more about this study, click here

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