#332 A Jab for Your CAD: Influenza vaccination for the prevention of cardiovascular events

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- Five meta-analyses1-5 compared the effect of influenza vaccination to placebo/no vaccination on cardiovascular events (5-8 randomized controlled trials [RCTs], 4,211-12,029 patients, follow-up 1.5-12 months). Focusing on the most complete (results statistically significant unless otherwise stated):
- Secondary prevention:
- Influenza vaccination reduced the risk of all-cause mortality (relative risk reduction [RRR] 42%) and cardiovascular events (RRR 37%).1
- Largest, highest-quality, multi-country (mostly European) RCT6 compared one-time influenza vaccination to placebo in 2,532 participants ≤3 days after myocardial infarction. At 1 year:
- Death: 2.9% versus 4.9% with placebo.
- Cardiovascular events (death, myocardial infarction, stent thrombosis): 5.3% versus 7.2% with placebo.
- Local injection site reactions: ~5% absolute increase.
- Limitations: Cardiovascular benefit only seen in patients within <2 months of acute coronary syndrome (unclear benefit in chronic coronary artery disease) in subgroup analysis.2
- Largest, highest-quality, multi-country (mostly European) RCT6 compared one-time influenza vaccination to placebo in 2,532 participants ≤3 days after myocardial infarction. At 1 year:
- Other cardiovascular disease:7
- Influenza vaccine did not reduce death or cardiovascular events in 2-year RCT of 5,129 patients with heart failure when compared to placebo but reduced overall hospitalization (15% versus 18% with placebo).
- Primary prevention:3
- No difference in cardiovascular deaths based on 12 events in 2 RCTs.
- No other cardiovascular events reported.
- No difference in cardiovascular events between: Different vaccine types/dose;8 or timing (administration during myocardial infarction hospitalization or within 30 days of discharge).9
- Influenza vaccination reduced the risk of all-cause mortality (relative risk reduction [RRR] 42%) and cardiovascular events (RRR 37%).1
- Recent respiratory tract infections/influenza are associated with increased risk of cardiovascular events.10-11
- Guidelines recommend influenza vaccination for people with coronary disease.12
- ~40% of Canadian adults with a chronic condition receive influenza vaccination each year.13
- Influenza vaccine efficacy for secondary cardiovascular prevention is comparable to other preventive therapies in reducing recurrent cardiovascular events [examples: Acetylsalicylic acid and statins (RRR ~25%)].14,15