Flu Vaccines May Reduce Heart Failure Risks

SEPTEMBER 30, 2016
W. Todd Penberthy,PhD
cardiology, cardiologists, heart failure, influenza, influenza vaccine, vaccines, internal medicine, hospital medicine“The reason we are talking about vaccinations is that they are some of the simplest interventions we can provide our patients to reduce heart failure (HF) hospitalizations and HF exacerbations,” says Dr. Orly Vardeny, PharmD, at the beginning of her presentation on analysis of influenza and pneumococcal vaccinations as related to cardiovascular disease.
She pointed out that influenza causes approximately 36,000 deaths per flu season and greater than 200,000 influenza-associated hospitalizations. Moreover, many cardiologists attending the 2016 Heart Failure Society of America meeting have treated influenza patients that developed acute decompensated HF. Analysis of influenza reveals an approximate 3-to-5-fold increase in risk of acute cardiovascular events or stroke following infection.
Dr. Vardeny also described a more recent meta-analysis of patients that revealed that the use of influenza vaccine was associated with a lower risk of major adverse cardiovascular events.
Everyone above the age of 6 months should be vaccinated, including pregnant women, according to the CDC recommendations. Contrary to previous beliefs, timing is such that vaccination should be done as soon as possible. There is no preferred season for vaccination. Several types of vaccines are available, including an intradermal formulation for the needle averse and a higher dosage formulation for >65y. Data from as early as 1979 clearly shows a direct correlation between antibody titer and decreased infection: a titer less than 10 results in approximately 74% infection, while only 4% infection for titers ≥160.
Recent randomized trials performed with over 36,000 subjects >65 years of age compared a standard dose to a double dose (high dose). A clear statistically significant reduction in influenza, pneumonia, and cardiorespiratory illness was observed. Approximately 3% of vaccinated patients had cardiorespiratory illness, while 5% had cardiorespiratory illness with the unvaccinated. The safety profile was generally well tolerated, with no differences for all serious adverse events.
Today, they are doing a randomized trial in post-MI or post-HF hospitalization patients that compares trivalent high dose vaccine to standard quadrivalent dose to determine whether this affects cardiorespiratory illness. It will take about four flu seasons to reach a conclusion.

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