Flu Shots and Heart Attacks

If you are a person with an existing heart condition or you're at risk to develop one (read that almost everyone as we age since as we know, cardiovascular disease remains the number one killer) you should get a flu shot, Rick and I opine on PodMed this week, based on a study examining the relationship between flu vaccination status and acute cardiovascular events in JAMA.  We freely admit that this is nothing new; we've been on the soapbox about the flu vaccine for many years now, but this study attempts to quantify risk reduction, and for the doubting Thomases out there may be just what's needed to change behavior.

This study was a meta-analysis of randomized clinical trials comprising almost 7000 patients (more than half of whom were women!) comparing influenza vaccine versus placebo in folks at high risk for cardiovascular events. Almost 40% of subjects had a previous history of cardiac problems. Mean follow-up time was almost eight months. The analysis found that indeed, influenza vaccination was associated with a reduced risk of an acute cardiac event, and that the benefit was greatest in the highest risk patients! Unquestionably an eloquent argument for obtaining the influenza vaccine.

Rick and I speculate on the mechanism by which vaccination would provide such a benefit, and devolve with much company to the inflammation hypothesis.  While a persuasive case can be made that subsequent to the actual administration of the vaccine a low level of acute inflammation often results, it seems clear that this arm of the immune response and possible small risk to folks with existing cardiovascular disease is overcome by the significant benefit seen in avoiding a much greater degree of inflammation when someone develops influenza infection. Indeed, in this study no risk of acute cardiac events was seen immediately after use of the vaccine, and the authors call for larger prospective studies to examine this very question.

The American Heart Association is clearly convinced by the existing data on risk reduction with influenza vaccination for folks at risk such that they recommend annual immunization as one means of risk reduction for cardiac events. Also very recently a new type of flu vaccine with double the amount of antigen was introduced specifically with older people in mind, whose immune responses are not as robust as younger folks and therefore may not be protective.  Finally, we also need to reiterate the fact that the Centers for Disease Control and Prevention has expanded recommendations for who should receive the flu vaccine to almost everyone, pregnant women included. It's worth noting that when you get the vaccine you're not just protecting yourself but everyone around you.  Okay, rant over.

Other topics this week include giving the pertussis vaccine (!) to teenagers and it's impact on whooping cough in infants in Pediatrics, a disappointing result for use of statins to prevent ventilator associated pneumonia in JAMA, and in Annals of Internal Medicine a look at why screening for cognitive impairment isn't helpful and likely shouldn't be done.  Until next week, y'all live well.

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Flu Shots and Heart Attacks | jhublogs
November 1, 2013 at 9:36 am

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come ritardare l eiaculazione February 11, 2014 at 3:01 pm

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