1. Enfermedad Cardiovascular, Neumonía y Complicaciones Prof. Francesco Blasi Department of Pathophysiology and Transplantation University of Milan, Italy

2. Disclosures I have accepted grants, speaking and conference invitations from AstraZeneca, Almirall, Bayer, GSK, Novartis, Pfizer, Chiesi, Guidotti-Malesci, Menarini and Zambon I have had recent or ongoing consultancy with AstraZeneca, GSK, Mundipharma,Novartis, Almirall, Menarini

4. Multiple Comorbidities Further Increase Pneumococcal Pneumonia Risk in Adults Estimated Annual Incidence of Pneumococcal Pneumonia in the United States in Adults, by Number of Comorbidities Persons with ≥2 at-risk conditions accounted for 9% – 32% of all at-risk adults, depending on age 4 Pelton SI, et al. Presented at ISPPD 2014, Hyderabad, India. OP-390.

5. Pneumonia and Cardiovascular events PATHOPHYSIOLOGICAL MECHANISMS Corrales-Medina. Lancet 2012

11. Identification and prevention of cardiovascular events in pneumonia

12. ER C C C C Cardiovascular events and pneumonia

14. Ramirez J. CID 2008; 47:182–7 On Hospital admission: AMI

15. During the hospital course: Failure and AMI Aliberti S. Chest 2008; 134:955–962

16. During the hospital course: Improvement and AMI Ramirez J. CID 2008; 47:182–7

17. The concurrence of pneumonia and a new cardiac event was often unrecognized, especially in the first 12–24 h of hospitalization, resulting in some patients not receiving cardiac monitoring or anticoagulant therapy. Musher DM. CID 2007; 45:158–65 Pneumococcal CAP & Cardiac events

18. Jasti H. CID 2008; 46:550–6 After Hospital discharge: cardiovascular events Reason of Rehospitalization

19. ReferenceYearn.PtsDesignCVEHeart Failure Arrhytmias AMI Muscher2007170In-pts VARetro Single 19%15%6%7% Becker2007391In-ptsRetro multi 17%12%3%8% Ramirez2008500In-pts VARetro Single -- 6% Corrales- Medina 2009206In-pts VARetro Single -- 11% Perry201150,119In-pts VARetro Multi ICD --9%8%1% Mandal20114,408In-ptsRetro Multi ICD -- 9%3% Corrales- Medina 20122,287In-pts Out pts Retro Multi (PORT) 27% 2% 18% 1% 6% 1% 0 Griffin20133,068In-ptsRetro Multi CAPO 12%4%8%2% Pneumonia and Cardiovascular events State of the Art

20. Corrales-Medina VF. Circulation 2012 1343 inpatients and 944 outpatients CAP The 30-day mortality CAP: 2.8% CAP + CVE: 15% Pneumonia and Cardiovascular events IMPACT on MORTALITY Viasus D. Journal of Infection (2013) 66, 27e33

21. Pneumonia and Cardiovascular events RISK FACTORS for CVE VariableGriffin 2013 Viasus 2013 Corrales-Medina 2012 Age--1.781.03 Nursing Home1.8 Hyperlipidemia2.01 Cardiac Arrhytmias1.8 CAD1.5 Hypertension1.5 CHD/CHF3.054.3 Hypoalbuminemia2.3 Statins0.52 PSI1.02 Septic Shock1.7 Tachycardia1.6 RR>301.6 Multilobar1.36 S. aureu1.61 K. pneumoniae2.95 S. pneumoniae1.39 Demographics Comorbidities Severity on admission Pathogen

26. From epidemiology to intervention

27. 300mg of aspirin daily for 1 month.

28. From epidemiology to intervention

31. Protective effect of statins against the development of CAP From epidemiology to intervention

32. Protective effect of statins against the development of CAP Statin use was significantly associated with reduced mortality in patients with CAP. From epidemiology to intervention

33. Protective effect of statins against the development of CAP Statin use was significantly associated with reduced mortality in patients with CAP. Low quality evidence From epidemiology to intervention

36. KEY POINTS -CVEs in CAP patients could be mediated by plaque related mechanisms (leading to acute myocardial infarction) versus plaque-unrelated mechanisms (leading to arrhythmias and heart failure). -The prevalence of CVEs in CAP varies broadly from 10 to 30%, with a substantial impact of both short and long-term outcomes.

37. Clinical tools that stratify CAP patients according to their risk to develop cardiac complications may be useful for both clinical and research purposes Interventions to prevent the development and progression of cardiac complications in high-risk patients with pneumonia and characterise the effect of these strategies on pneumonia-associated morbidity, mortality, health-care utilisation, and costs KEY POINTS

38. THANK YOU FOR YOUR ATTENTION!