Vaccination with the BNT162b2 or CoronaVac vaccine is associated with a decreased risk for myocardial infarction (MI) or stroke after SARS-CoV-2 infection in patients with cardiovascular disease (CVD). These findings were published in the Journal of the American Heart Association.
The population-based case-control study assessed the association between BNT162b2 or CoronaVac vaccinations and risk for MI and stroke after SARS-CoV-2 infection in patients with CVD. Data were from electronic health records in Hong Kong.
Cases were patients with CVD who had an MI or stroke within 28 days after SARS-CoV-2 infection between January 1, 2022, and August 15, 2022. Control individuals were defined as all other patients with CVD who attended any health services and were not cases. Ten control patients were randomly matched with each case.
The final cohort included 808 cases matched with 7771 control patients. Each group had a mean age of 81.73 years and 54.3% were men.
BNT162b2 and CoronaVac vaccination was associated with a significantly decreased risk for MI or stroke, and higher effectiveness occurred with an increasing number of doses. For patients that received BNT162b2, risk for stroke or MI decreased from an adjusted odds ratio (aOR) of 0.49 (95% CI, 0.29-0.84) to 0.30 (95% CI, 0.20-0.44) in patients that received 1 dose and 0.17 (95% CI, 0.08-0.34) in patients that received 3 doses. CoronaVac had similar results, with aOR decreasing from 0.69 (95% CI, 0.57-0.85) to 0.42 (95% CI, 0.34-0.52) in patients that received 1 dose and 0.32 (95% CI, 0.21-0.49) in patients that received 3 doses.
Patients who had 2 doses of CoronaVac and a third dose of BNT162b2 had decreased risk for MI and stroke (aOR, 0.09; 95% CI, 0.02-0.40) compared with patients who were unvaccinated.
BNT162b2 was associated with risk for MI within 28 days after SARS-CoV-2 infection (aOR, 0.47; 95% CI, 0.28-0.81) following 1 dose, and the risk was 0.12 (95% CI, 0.06-0.24) for 3 doses. For CoronaVac, the risk for MI within 28 days after SARS-CoV-2 infection was 0.73 (95% CI, 0.58-0.92) for 1 dose and 0.19 (95% CI, 0.12-0.30) for 3 doses.
A single dose of BNT162b2 or CoronaVac had no statistically significant association with the risk for stroke within 28 days after SARS-CoV-2 infection, with ORs of 0.75 (95% CI, 0.43-1.30) and 1.01 (95% CI, 0.79-1.29), respectively. After 3 doses of each vaccine, the risk decreased to 0.13 (95% CI, 0.07-0.25) and 0.19 (95% CI, 0.13-0.30), respectively.
Two doses of CoronaVac and a third dose of BNT162b2 also were associated with a low risk for MI (OR, 0.16; 95% CI, 0.04-0.53) and stroke (OR, 0.28; 95% CI, 0.11-0.72) within 28 days post-SARS-CoV-2 infection.
Limitations of the study include potential lack of generalizability and that information on patients who used private medical services is not included. Other limitations include difficulty in distinguishing whether MI or stroke was directly caused by the infection or from other causes.
“Vaccination of BNT162b2 or CoronaVac can reduce the risk of MI or stroke after SARS-CoV-2 infection among patients with CVD, and the risk decreased with additional vaccine doses,” wrote the investigators. “Therefore, it is important for patients with CVD to receive vaccination to prevent the potential severe CVD complications if infected.”
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Ye X, Yan VKC, Yiu HHE, et al. BNT162b2 or CoronaVac vaccinations are associated with a lower risk of myocardial infarction and stroke after SARS-CoV-2 infection among patients with cardiovascular disease. J Am Heart Assoc. Published online April 29, 2023. doi: 10.1161/JAHA.122.029291