Potential protective effects of the influenza vaccine on cardiovascular outcomes in high-risk populations

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Influenza A and B viruses are the cause of 3 to 5 million infections, and 250,000 to 50,000 deaths each year worldwide.¹ Particular groups of the population are at higher risk of infection, including the elderly, immunocompromised, and infants.¹ A seasonal influenza vaccine is developed each year that contains two strains of the Influenza A virus, and one or two strains of the Influenza B virus.² However, research has shown that vaccine uptake is low – less than 50% of the expected coverage in some years – and similarly low in high-risk groups.³

The results from a large prospective cohort study presented on 27 July 2020 during the virtual American Heart Association (AHA) Basic Cardiovascular Sciences 2020 Scientific Sessions indicates that those who do receive a flu vaccination have a significantly lower risk for cardiovascular events.⁴ Using data from the 2014 National Inpatient Sample, the rate at which the flu vaccine was administered to patients at Centers for Disease and Control (CDC)-designated high-risk sites was assessed.⁴ The impact of the flu vaccine on cardiovascular outcomes was examined between patients who were vaccinated during hospitalisation and those who were not.⁴ High-risk patients included adults aged ≥50, those with obesity, those with chronic medical conditions, those who are positive for human immunodeficiency virus (HIV), American Indians, and Alaskan natives.⁴

Of the 7,056,314 high-risk patients identified in the database, 168,325 (2.4%) received the influenza vaccine.⁴ Only 1.8% of patients aged ≥50 had been vaccinated, in contrast with 15.3% in the general population. Vaccinated patients had a 28% lower risk of myocardial infarction (MI), a 47% lower risk of transient ischaemic attack (TIA), and 73% lower all-cause mortality the year following their vaccination.⁴ In the HIV-positive population, 2.2% had been vaccinated, compared with 8.2% of the non-HIV infected population, and flu vaccination was associated with a 24%, 23% and 78% reduction in MI, TIA, and all-cause mortality, respectively.⁴ Of patients with obesity 2.4% were vaccinated vs 9% in those with a healthy weight, and flu vaccination was associated with a 41%, 55%, and 76% reduction in MI, TIA, and all-cause mortality, respectively.⁴

While the results are limited to patients who received the vaccine while hospitalised, and it could be possible that individuals received the influenza vaccine in an outpatient setting, these results highlight the low vaccine uptake in high-risk populations, and the impact the vaccine has on cardiovascular outcomes.⁴ More efforts should be undertaken to educate the public, particularly these high-risk groups, on the need for yearly vaccination, and remove the barriers to access.

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Reference

Zhu W et al. Int J Mol Sci. 2017;18(7).

Agor JK et al. Hum Vaccines Immunother. 2018;14(3):678-683.

Mayer KH et al. Adv Ther. 2020;37(5):1778-1811.

Mandania RA. Presentation 398 presented at the: American Heart Association Basic Cardiovascular Sciences 2020 Scientific Sessions; July 27.

Disclaimer

This article is not medical advice. Patients should seek personal assessment by a licenced specialist. Physicians are recommended to read the full publication(s) as cited in the article before making medical decisions. This article does not supersede nor replace the published article(s).