The protective effect of pneumococcal vaccination on cardiovascular disease in adults: A systematic review and meta-analysis

Abstract

Background: Epidemiological studies suggest that there is a link between pneumococcal infection and adverse cardiovascular outcomes such as myocardial infarction. Multiple studies have evaluated the protective effect of the 23-valent polysaccharide pneumococcal vaccination (PPV23), but results have varied. Therefore, a meta-analysis was conducted to summarize available evidence on the impact of PPV23 on cardiovascular disease. Methods: A literature search from January 1946 to September 2019 was conducted across Embase, Medline and Cochrane. All studies were included that evaluated PPV23 compared with a control (placebo, no vaccine or another vaccine) for any cardiovascular events, including: myocardial infarction (MI), heart failure and cerebrovascular events. Risk ratios (RRs) were pooled using random effects models. Results: Eighteen studies were included, with a total of 716,108 participants. Vaccination with PPV23 was associated with decreased risk of any cardiovascular event (RR: 0.91; 95% CI: 0.84À0.99), and MI (RR: 0.88; 95% CI: 0.79À0.98) in all age groups, with a significant effect in those aged !65 years, but not in the younger age group. Similarly, PPV23 vaccine was associated with significant risk reduction in all-cause mortality in all ages (RR: 0.78; 95% CI: 0.68À0.88), specifically in those aged !65 years (RR: 0.71; 95% CI: 0.60À0.84). A significant risk reduction in cerebrovascular disease was not observed following pneumococcal vaccination. Conclusions: Polysaccharide pneumococcal vaccination decreased the risk for some adverse cardiovascular events, specifically acute MI in the vaccinated population, particularly for those individuals aged !65 years. It would be highly beneficial to vaccinate the population who is at greater risk of cardiovascular diseases.

Vaccination for Respiratory Infections in Patients with Heart Failure

“…A recent meta-analysis (18 studies; 716,108 participants) evaluated the protective effect of 23-valent polysaccharide pneumococcal vaccination (PPV23) in the general adult population for any cardiovascular event (myocardial infarction, HF, and cerebrovascular events) [ 34 ]. Vaccination was associated with a decreased risk of any cardiovascular event (RR 0.91; 95% CI 0.84–0.99) and myocardial infarction (RR 0.88; 95% CI 0.79–0.98) in all age groups; the effect was significant in patients aged ≥65 years but not in the <65 years age group.…”

Hospitalisation for lower respiratory tract infection is associated with an increased incidence of acute myocardial infarction and stroke in tropical Northern Australia

“…Influenza vaccination appears to reduce mortality due to ACS 26 . Pneumococcal vaccination has also been associated with reduced risk of acute coronary syndromes and associated mortality 27 .…”

Infections as Novel Risk Factors of Atherosclerotic Cardiovascular Diseases: Pathophysiological Links and Therapeutic Implications

“…However, the risk associated with macrolide use was substantially attenuated after adjustment for clinical variables, and the risk associated with fluoroquinolones was no longer significant [83]. Concurrently, measures to prevent pneumonia such as polysaccharide pneumococcal vaccination (PPV23) decreased the risk of ASCVD, especially in individuals aged >65 years, supporting the vaccination benefits among the elderly population at high risk of pneumonia [84].…”