Effects of influenza vaccine on mortality and cardiovascular outcomes in patients with cardiovascular disease: A systematic review and meta-analysis

Siva H. Yedlapati, Safi U. Khan, Swapna Talluri, Ahmed N. Lone, Muhammad Zia Khan, Muhammad Shahzeb Khan, Ann M. Navar, Martha Gulati, Heather Johnson, Seth Baum, Erin D. Michos

Research output: Contribution to journalReview articlepeer-review

Abstract

BACKGROUND: Influenza infection causes considerable morbidity and mortality in patients with cardiovascular disease. We as-sessed the effects of the influenza vaccine on mortality and cardiovascular outcomes in patients with cardiovascular disease. METHODS AND RESULTS: We searched PubMed, Embase, and the Cochrane Library through January 2020 for randomized controlled trials and observational studies assessing the effects of influenza vaccine on mortality and cardiovascular outcomes in patients with cardiovascular disease. Estimates were reported as random effects risk ratios (RRs) with 95% CIs. Analyses were stratified by study design into randomized controlled trials and observational studies. A total of 16 studies (n=237 058), including 4 randomized controlled trials (n=1667) and 12 observational studies (n=235 391), were identified. Participants’ mean age was 69.2±7.01 years, 36.6% were women, 65.1% had hypertension, 31.1% had diabetes mellitus, and 23.4% were smok-ers. At a median follow-up duration of 19.5 months, influenza vaccine was associated with a lower risk of all-cause mortality (RR, 0.75; 95% CI, 0.60–0.93 [P=0.01]), cardiovascular mortality (RR, 0.82; 95% CI, 0.80–0.84 [P<0.001]), and major adverse cardiovascular events (RR, 0.87; 95% CI, 0.80–0.94 [P<0.001]) compared with control. The use of the influenza vaccine was not associated with a statistically significant reduction of myocardial infarction (RR, 0.73; 95% CI, 0.49–1.09 [P=0.12]) compared with control. CONCLUSIONS: Data from both randomized controlled trials and observational studies support the use of the influenza vaccine in adults with cardiovascular disease to reduce mortality and cardiovascular events, as currently supported by clinical guide-lines. Clinicians and health systems should continue to promote the influenza vaccine as part of comprehensive secondary prevention.

Original languageEnglish (US)
Article numbere019636
JournalJournal of the American Heart Association
Volume10
Issue number6
DOIs
StatePublished - 2021

Keywords

  • Cardiovascular disease
  • Influenza vaccine
  • Meta-analysis
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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