title: Cardiovascular disease after Escherichia coli O157:H7 gastroenteritis.
abstract: BACKGROUND
  Escherichia coli O157:H7 is one cause of acute bacterial gastroenteritis, which can be devastating in outbreak situations. We studied the risk of cardiovascular disease following such an outbreak in Walkerton, Ontario, in May 2000.
  
  
  METHODS
  In this community-based cohort study, we linked data from the Walkerton Health Study (2002-2008) to Ontario's large healthcare databases. We included 4 groups of adults: 3 groups of Walkerton participants (153 with severe gastroenteritis, 414 with mild gastroenteritis, 331 with no gastroenteritis) and a group of 11 263 residents from the surrounding communities that were unaffected by the outbreak. The primary outcome was a composite of death or first major cardiovascular event (admission to hospital for acute myocardial infarction, stroke or congestive heart failure, or evidence of associated procedures). The secondary outcome was first major cardiovascular event censored for death. Adults were followed for an average of 7.4 years.
  
  
  RESULTS
  During the study period, 1174 adults (9.7%) died or experienced a major cardiovascular event. Compared with residents of the surrounding communities, the risk of death or cardiovascular event was not elevated among Walkerton participants with severe or mild gastroenteritis (hazard ratio [HR] for severe gastroenteritis 0.74, 95% confidence interval [CI] 0.38-1.43, mild gastroenteritis HR 0.64, 95% CI 0.42-0.98). Compared with Walkerton participants who had no gastroenteritis, risk of death or cardiovascular event was not elevated among participants with severe or mild gastroenteritis.
  
  
  CONCLUSIONS
  There was no increase in the risk of cardiovascular disease in the decade following acute infection during a major E. coli O157:H7 outbreak.
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Ont., Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Hizo-Abes
authors.forename: William F
authors.initials: WF
authors.lastname: Clark
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Sontrop
authors.forename: Ann
authors.initials: A
authors.lastname: Young
authors.forename: Anjie
authors.initials: A
authors.lastname: Huang
authors.forename: Heather
authors.initials: H
authors.lastname: Thiessen-Philbrook
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology* / Q000382:microbiology; D016009:Chi-Square Distribution; D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D019453:Escherichia coli O157; D005260:Female; D005759:Gastroenteritis / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D006333:Heart Failure / Q000209:etiology / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000382:microbiology; D009864:Ontario / Q000453:epidemiology; D012307:Risk Factors; D018709:Statistics, Nonparametric; D020521:Stroke / Q000209:etiology / Q000382:microbiology