Risk of heart failure among individuals tested for Borrelia burgdorferi sensu lato antibodies, and serum Borrelia burgdorferi sensu lato seropositive individuals; a nationwide population-based, registry-based matched cohort study

Malte M Tetens; Lars Haukali Omland; Ram B Dessau; Svend Ellermann-Eriksen; Nanna S Andersen; Charlotte Sværke Jørgensen; Christian Østergaard; Jacob Bodilsen; Kirstine K Søgaard; Jette Bangsborg; Alex Christian Yde Nielsen; Jens Kjølseth Møller; Ming Chen; Jesper Hastrup Svendsen; Niels Obel; Anne-Mette Lebech

doi:10.1016/j.ttbdis.2024.102345

Risk of heart failure among individuals tested for Borrelia burgdorferi sensu lato antibodies, and serum Borrelia burgdorferi sensu lato seropositive individuals; a nationwide population-based, registry-based matched cohort study

Ticks Tick Borne Dis. 2024 Apr 17;15(4):102345. doi: 10.1016/j.ttbdis.2024.102345. Online ahead of print.

Authors

Malte M Tetens¹, Lars Haukali Omland², Ram B Dessau³, Svend Ellermann-Eriksen⁴, Nanna S Andersen⁵, Charlotte Sværke Jørgensen⁶, Christian Østergaard⁷, Jacob Bodilsen⁸, Kirstine K Søgaard⁹, Jette Bangsborg¹⁰, Alex Christian Yde Nielsen¹¹, Jens Kjølseth Møller¹², Ming Chen¹³, Jesper Hastrup Svendsen¹⁴, Niels Obel¹⁵, Anne-Mette Lebech¹⁵

Affiliations

¹ Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. Electronic address: malte.mose.tetens.01@regionh.dk.
² Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
³ Department of Clinical Microbiology, Zealand Hospital, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
⁴ Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark.
⁵ Clinical Centre for Emerging and Vector-borne Infections, Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark.
⁶ Department of Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark.
⁷ Department of Clinical Microbiology, Copenhagen University Hospital - Hvidovre Hospital, Copenhagen, Denmark.
⁸ Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
⁹ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
¹⁰ Department of Clinical Microbiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark.
¹¹ Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
¹² Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.
¹³ Department of Clinical Microbiology, Sønderborg Hospital, Sønderborg, Denmark.
¹⁴ Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
¹⁵ Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

PMID: 38636178
DOI: 10.1016/j.ttbdis.2024.102345

Abstract

Background: Lyme borreliosis is a tick-borne disease caused by the bacterium Borrelia burgdorferi (Bb) sensu lato complex. Previous studies have suggested an association between Lyme borreliosis and heart failure, which have been suggested to be a possible manifestation of Lyme carditis. We aimed to investigate the risk of heart failure among individuals tested for serum Bb antibodies, and serum Bb seropositive individuals.

Methods: We performed a matched nationwide cohort study (Denmark, 1993-2020) and included 52,200 Bb seropositive individuals, and two age- and sex-matched comparison cohorts: 1) 104,400 Bb seronegative comparison cohort members, and 2) 261,000 population controls. We investigated the risk associated with 1) being tested for serum Bb antibodies, and 2) being Bb seropositive. Outcomes were: 1) a composite of heart failure, cardiomyopathy, and/or myocarditis diagnosis, and 2) redemption of cardiovascular medicine used for treatment of heart failure. We calculated short-term odds ratios (aOR) (within 1 month) and long-term hazard rates (aHR) (after 1 month) adjusted for age, sex, diabetes, pre-existing heart failure, and kidney disease.

Results: Compared with the population controls, individuals tested for Bb antibodies, regardless of the test result, had increased short-term risk of heart failure, cardiomyopathy, and myocarditis (aOR 8.3, 95 %CI: 6.7-10.2), and both increased short- and long-term risk of redemption of cardiovascular medicine (aOR 4.3, 95 %CI: 3.8-4.8, aHR 1.13, 95 % CI: 1.11-1.15). The Bb seropositive individuals had no increased short- or long-term risk of any outcome compared with Bb seronegative comparison cohort members.

Conclusions: In conclusion, Bb antibody tests seemed to be performed in the diagnostic work-up of heart failure, but Bb seropositivity was not associated with heart failure.

Keywords: Borrelia burgdorferi; Borrelia infections; Cohort studies; Heart failure; Myocarditis; Serologic tests.