Association Between Influenza Vaccination and Cardiovascular Outcomes in High-Risk Patients
Open Access
- 23 October 2013
- journal article
- research article
- Published by American Medical Association (AMA) in JAMA
- Vol. 310 (16), 1711-1720
- https://doi.org/10.1001/jama.2013.279206
Abstract
Among nontraditional cardiovascular risk factors, there remains interest in a potential association between respiratory tract infections, of which influenza and influenzalike illnesses are common causes,1,2 and subsequent cardiovascular events.3-9 Prior studies suggest that seasonal influenzalike illnesses may explain a major determinant of the timing of acute thrombotic vascular events in patients with previously stable coronary artery disease (CAD) and cerebrovascular disease.3 Further supporting this hypothesis, several epidemiological studies have suggested a strong inverse longitudinal relationship between influenza vaccination and the risk of fatal and nonfatal cardiovascular events.4,10-19 A few small randomized clinical trials (RCTs) have explicitly tested whether influenza vaccination may reduce the risk of cardiovascular events with large treatment effects.20-24 Based largely on observational findings, medical association guidelines recommend universal vaccination in patients with, or at risk of, cardiovascular disease for protection from general influenza complications.25-27 Cardiovascular associations specifically recommended influenza vaccination for the secondary prevention of ischemic heart disease in 2006 based on the earliest reported RCT.28-31 Because of the potential for confounding in an observational study of this subject32-34 and because prior meta-analyses included observational studies but omitted a systematic review of all influenza vaccination randomized trials,7,35,36 we set out to perform a systematic review and meta-analysis of all randomized clinical trials of influenza vaccine that studied cardiovascular events as efficacy or safety outcomes.Keywords
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