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Influenza vaccination for patients with cardiovascular disease is underutilized as a method of coronary prevention, according to a review published in Heart.1
The authors noted there is “compelling evidence” linking influenza infection and the occurrence of acute myocardial infarction (MI)—in some cases, as early as within the first 3 days of an influenza respiratory illness and lasting up to 1 year.
Influenza vaccine has demonstrated protective effectiveness against acute MI between 19% and 45%, according to several observational studies.2-4 Furthermore, a randomized controlled trial published in 2011 found a 10% reduction in major cardiovascular events in patients with acute coronary syndromes who received the vaccine during a 12-month follow-up period.5
Among the efficacy/effectiveness rates of other secondary prevention methods for MI, the influenza vaccine is within a similar range. Smoking cessation is associated with reductions in MI between 32% and 43%, statins between 19% and 30%, and antihypertensive drugs between 17% and 25%.
Given the costs spent on both acute treatment of MI and long-term management of coronary heart disease (CHD), the authors posit that implementing an influenza vaccination strategy would be relatively inexpensive, safe, and evidence-based public health measure. Vaccination has already demonstrated cost-effectiveness in the prevention of flu-like illnesses and hospitalization for pneumonia and influenza, even without consideration of its efficacy in acute MI prevention.6
Current guidelines recommend vaccinating patients with coronary artery disease, but vaccination rates are low in risk groups aged 65 years and younger.7 In addition, this recommendation is viewed solely as a means to prevent influenza rather than to reduce acute MI risk.
“A paradigm change may be required to encourage clinicians to see influenza vaccine as a cheap, safe, and effective additional prevention strategy for patients with CHD,” the authors concluded.
Disclosures: Dr MacIntyre has received in-kind support and funding for investigator-driven research from GlaxoSmithKline, Pfizer, Merck, and bioCSL; and has served on advisory boards for GlaxoSmithKline, Pfizer, and Merck.
References
- MacIntyre CR, Mahimbo A, Moa AM, Barnes M. Influenza vaccine as a coronary intervention for prevention of myocardial infarction. Heart. 2016 Sept 29; doi:10.1136/heartjnl-2016-309983 [Epub ahead of print].
- MacIntyre CR, Heywood AE, Kovoor P, et al. Ischemic heart disease, influenza, and influenza vaccination: a prospective case control study. Heart. 2013;99:1843-1848.
- Hsu SY, Chen FL, Liaw YP, et al. A matched influenza vaccine strain was effective in reducing the risk of acute myocardial infarction in elderly persons: a population-based study. Medicine (Baltimore). 2016;95:e2869.
- Siriwardena AN, Gwini SM, Coupland CAC. Influenza vaccination, pnemococcal vaccination and risk of acute myocardial infarction: matched case-control study. CMAJ. 2010;182:1617-1623.
- Phrommintikul A, Kuanprasert S, Wongcharoen W, et al. Influenza vaccination reduces cardiovascular events in patients with acute coronary syndrome. Eur Heart J. 2011;32:1730-1735.
- Newall AT, Scufffham PA, Kelly H, et al. The cost-effectiveness of a universal influenza vaccination program for adult aged 50-64 years in Australia. Vaccine. 2008;26:2142-2153.
- AIHW. Australian Institute of Health and Welfare 2011. 2009 Adult Vaccination Survey: summary results. Cat. No. PHE 135. Canberra; March 3, 2011. http://www.aihw.gov.au/publication-detail/?id=10737418409. Accessed October 21, 2016.
