Association of Influenza Vaccination With Cardiovascular Risk

Behrouzi, Bahar; Bhatt, Deepak L.; Cannon, Christopher P.; Vardeny, Orly; Lee, Douglas S.; Solomon, Scott D.; Udell, Jacob A.

doi:10.1001/jamanetworkopen.2022.8873

Cited by 80 publications

(57 citation statements)

References 22 publications

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“…Following the IAMI trial (but before IVVE was presented), another meta-analysis was recently conducted in 2022, which included 6 RCTs including IAMI with a total of 9001 patients, 53% of whom had prior CVD [ 58 •]. Influenza vaccination reduced the composite CV outcome by 34% (HR 0.66 (0.53–0.83)), with a greater benefit seen among patients with recent ACS who experienced a 45% reduction in CV outcomes with influenza vaccination.…”

Section: Updated Meta-analysismentioning

confidence: 99%

Influenza Vaccination for Cardiovascular Prevention: Further Insights from the IAMI Trial and an Updated Meta-analysis

2022

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Purpose of Review Influenza infection is a significant, well-established cause of cardiovascular disease (CVD) and CV mortality. Influenza vaccination has been shown to reduce major adverse cardiovascular events (MACE) and CV mortality. Therefore, major society guidelines have given a strong recommendation for its use in patients with established CVD or high risk for CVD. Nevertheless, influenza vaccination remains underutilized. Historically, influenza vaccination is administered to stable outpatients. Until recently, the safety and efficacy of influenza vaccination among patients with acute myocardial infarction (MI) had not been established. Recent Findings The recently published Influenza Vaccination after Myocardial Infarction (IAMI) trial showed that influenza vaccination within 72 h of hospitalization for MI led to a significant 28% reduction in MACE and a 41% reduction in CV mortality, without any excess in serious adverse events. Additionally, we newly performed an updated meta-analysis of randomized clinical trials (RCTs) including IAMI and the recent Influenza Vaccine to Prevent Adverse Vascular Events (IVVE) trial. In pooled analysis of 8 RCTs with a total of 14,420 patients, influenza vaccine, as compared with control/placebo, was associated with significantly lower risk of MACE at follow-up [RR 0.75 (95%CI 0.57–0.97), I 2 56%]. Summary The recent IAMI trial showed that influenza vaccination in patients with recent MI is safe and efficacious at reducing CV morbidity and mortality. Our updated meta-analysis confirms a 25% reduction in MACE. The influenza vaccine should be strongly encouraged in all patients with CVD and incorporated as an essential facet of post-MI care and secondary CVD prevention.

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Section: Updated Meta-analysismentioning

confidence: 99%

Influenza Vaccination for Cardiovascular Prevention: Further Insights from the IAMI Trial and an Updated Meta-analysis

2022

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“…Cardiovascular disease is a major complication of diabetes and a serious complication of influenza [ 33 , 34 ]. A recent meta-analysis demonstrated that influenza vaccination could reduce 34% risk of major cardiovascular events [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Metformin Use before Influenza Vaccination May Lower the Risks of Influenza and Related Complications

Yen¹,

Wei

Shih

et al. 2022

Vaccines

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Older adults are more likely to have influenza and respond less well to the flu vaccine. We conducted this study to investigate whether pre-influenza vaccination metformin use had an effect on influenza and relevant complications in older adults with type 2 diabetes mellitus. Propensity score matching was used to identify 28,169 pairs of metformin users and nonusers from Taiwan’s National Health Insurance Research Database from 1 January 2000 to 31 December 2018. We used Cox proportional hazards models to calculate the risks of hospitalization for influenza, pneumonia, cardiovascular disease, ventilation, and mortality between metformin users and nonusers. Compared with metformin nonusers, the aHRs (95% CI) for metformin users at risk of hospitalization for influenza, pneumonia, cardiovascular disease, invasive mechanical ventilation, death due to cardiovascular disease, and all-cause mortality were 0.60 (0.34, 1.060), 0.63 (0.53, 0.76), 0.41 (0.36, 0.47), 0.56 (0.45, 0.71), 0.49 (0.33, 0.73), and 0.44 (0.39, 0.51), respectively. Higher cumulative duration of metformin use was associated with lower risks of these outcomes than no use of metformin. This cohort study demonstrated that pre-influenza vaccination metformin use was associated with lower risks of hospitalizations for influenza, pneumonia, cardiovascular disease, mechanical ventilation, and mortality compared to metformin nonusers.

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“…Another randomized trial, which was published in 2011 and included 439 patients admitted to acute coronary syndromes (ACS) within 8 weeks, also found that the influenza vaccine reduced the number of major cardiovascular events in patients with ACS after a 1-year follow-up (unadjusted HR = 0.70, 95% CI: 0.57–0.86, P = 0.004) ( 23 ). A meta-analysis based on six randomized controlled studies published in 2022 also found that the influenza vaccine was associated with reduced cardiovascular risk ( 24 ), and two meta-analyses also published in 2022 further suggested that the influenza vaccine was associated with reduced cardiovascular risk in patients with heart failure ( 25 ) or coronary artery disease ( 26 ). This review shows an expanded effect of influenza vaccination on the risk of arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Influenza vaccination is associated with a decreased risk of atrial fibrillation: A systematic review and meta-analysis

Liu

Lin

Song

et al. 2022

Front. Cardiovasc. Med.

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BackgroundEvidence from longitudinal studies has shown that influenza infection is linked to an increased risk of arrhythmia. Therefore, we aimed to assess the role of influenza vaccination in arrhythmia prevention.Materials and methodsThe PubMed, Embase, and Cochrane Library databases were searched to identify studies that investigated the potential effects of the influenza vaccine on arrhythmia risk published until October 25th, 2021. The study was registered with PROSPERO (CRD42022300815).ResultsOne RCT with 2,532 patients and six observational studies with 3,167,445 patients were included. One RCT demonstrated a non-significant benefit of the influenza vaccine against arrhythmias [odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.11–1.64; P = 0.20] in patients after myocardial infarction or those with high-risk stable coronary heart disease. A meta-analysis based on observational studies showed that vaccination was associated with a significantly lower risk of arrhythmia (OR: 0.82, 95% CI: 0.70–0.97; P = 0.02; I2 = 76%). Additionally, subgroup analysis showed a decreased risk of atrial fibrillation (AF) (OR: 0.94, 95% CI: 0.90–0.98; P = 0.006; I2 = 0%) and a non-significant but positive trend concerning ventricular arrhythmias (VAs) (OR: 0.68, 95% CI: 0.42–1.11; P = 0.12; I2 = 85%) after influenza vaccination.ConclusionBased on the current evidence, influenza vaccination may be associated with a reduced risk of arrhythmia, especially AF. Influenza vaccination may be an effective tool for the prevention of arrhythmias. The effect of influenza vaccination on the risk of VAs and arrhythmias in patients at low risk for cardiovascular diseases should be further studied.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022300815].

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Association of Influenza Vaccination With Cardiovascular Risk

Cited by 80 publications

References 22 publications

Influenza Vaccination for Cardiovascular Prevention: Further Insights from the IAMI Trial and an Updated Meta-analysis

Influenza Vaccination for Cardiovascular Prevention: Further Insights from the IAMI Trial and an Updated Meta-analysis

Metformin Use before Influenza Vaccination May Lower the Risks of Influenza and Related Complications

Influenza vaccination is associated with a decreased risk of atrial fibrillation: A systematic review and meta-analysis

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