Pneumococcal Infection Increases Risk of MACE for Patients With COPD

Pneumococcal infection for patients with chronic obstructive pulmonary disease (COPD) was associated with an increased risk of major adverse cardiac events (MACE) 14 days after infection, according to results of a study published in Journal of the American College of Cardiology: Advances. The study authors said that future studies should revolve around whether preventative interventions could lower the risk in patients with COPD and pneumococcal infections.¹

The study results highlight the importance of pneumococcal vaccination for patients with chronic respiratory diseases, particularly chronic obstructive pulmonary disease. | Image Credit: Dr_Microbe - stock.adobe.com

“We found that the risk of experiencing a MACE in patients with COPD was four-times higher within the 14-day period following a pneumococcus infection compared to the 180-day period before the infection and the 14 to 194 days after,” the study authors said.¹

Patients with chronic respiratory diseases, included COPD, are vulnerable to viral and bacterial pulmonary infection, according to authors of a review published in the International Journal of Chronic and Obstructive Pulmonary Disease. Although published in 2017, the authors found that vaccination with pneumococcal and influenza vaccines can prevent community-acquired pneumonia and acute exacerbations for COPD. Further, for pneumococcal vaccination, they said that early vaccination in the course of COPD can maintain stable health status.²

In the 2024 Global Initiative for Chronic Obstructive Pulmonary Disease guidelines, the authors stress the importance of vaccination for patients with COPD. It is recommended that patients receive the influenza and the tetanus, diphtheria, and pertussis vaccines. Patients older than 60 years should receive the respiratory syncytial virus vaccine, and patients 50 years and older should receive the herpes zoster vaccine. For pneumococcal, the authors noted that patients should receive 1 dose of pneumococcal conjugate vaccine 20 (PCV20) or 1 dose of PCV15 followed by pneumococcal polysaccharide vaccine 23-valent. However, in 2024, investigators updated the recommendation to include PCV21.³

In the current study, investigators used Danish registers to identify patients with COPD and a positive culture of Streptococcus pneumoniae from January 1, 2010, to October 31, 2017. A 14-day observation interval was chosen, which started 5 days before the positive culture. The primary outcome included a composite of cardiovascular events requiring hospitalization, including acute myocardial infarction, stroke, unstable angina pectoris, and cardiovascular events requiring revascularization. Secondary outcomes included severe MACE, including all primary outcome events except for cardiovascular events requiring the first prescription of adenosine diphosphate receptor inhibitors.¹

Of 4707 patients who had both COP and a positive pneumococcus culture, 372 had a first event in the study period. Investigators noted that 60 patients died during the period, which left 267 eligible for inclusion in the analysis. Patients had a mean age of 71.5 years, and 45% were female. The study authors reported that exposure to pneumococcal infections was associated with a 4.6-fold increased risk of experiencing a MACE within the first 14 days compared to the control period. The rates were similar for patients without previous MACE, according to the results. For specific events, severe MACE, acute myocardial infarction, stroke, and revascularization procedures all showed higher risk when compared with the primary outcome. For acute myocardial infarction, the incidence rate ratio was almost 10-fold in the risk period compared with the control period.¹

“To our knowledge, this is the first study to specifically investigate the short-term risk of MACE following confirmed pneumococcal infection in patients with COPD,” the study authors concluded.¹ “Our findings are consistent with previous research demonstrating a similar increased risk of MACE following recent infection with influenza or respiratory syncytial virus.¹

READ MORE: Pneumococcal Resource Center

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REFERENCES

1. Riisberg NM, Modin D, Bertelsen BB, et al. Risk of Major Adverse Cardiovascular Events During Acute Streptococcus pneumoniae Infection in COPD Patients. JACC Adv. Published online September 22, 2025. doi:10.1016/j.jacadv.2025.102172

2. Froes F, Roche N, Blasi F. Pneumococcal vaccination and chronic respiratory diseases. Int J Chron Obstruct Pulmon Dis. 2017;12:3457-3468. Published 2017 Dec 5. doi:10.2147/COPD.S140378

3. Saleh N. 2024 GOLD guidelines stress the importance of vaccination for patients with COPD. Pulmonology Advisor. January 5, 2024. Accessed September 25, 2025. https://www.pulmonologyadvisor.com/features/2024-gold-guidelines-recommend-patients-with-copd-receive-all-vaccines/