Abstract
AIMS: Previous studies show a reduced incidence of first myocardial infarction and stroke 1-3 months after influenza vaccination, but it is unclear how underlying cardiovascular risk impacts the association.
METHODS AND RESULTS: The study used linked Clinical Practice Research Datalink, Hospital Episode Statistics Admitted Patient Care and Office for National Statistics mortality data from England between 1 September 2008 and 31 August 2019. From the data, individuals aged 40-84 years with a first acute cardiovascular event and influenza vaccination occurring within 12 months of each September were selected. Using a self-controlled case series analysis, season-adjusted cardiovascular risk stratified incidence ratios (IRs) for cardiovascular events after vaccination compared with baseline time before and >120 days after vaccination were generated. 193 900 individuals with a first acute cardiovascular event and influenza vaccine were included. 105 539 had hypertension and 172 050 had a QRISK2 score ≥10%. In main analysis, acute cardiovascular event risk was reduced in the 15-28 days after vaccination [IR 0.72 (95% CI 0.70-0.74)] and, while the effect size tapered, remained reduced to 91-120 days after vaccination [0.83 (0.81-0.88)]. Reduced cardiovascular events were seen after vaccination among individuals of all age groups and with raised and low cardiovascular risk.
CONCLUSIONS: Influenza vaccine may offer cardiovascular benefit among individuals at varying cardiovascular risk. Further studies are needed to characterize the populations who could derive the most cardiovascular benefits from vaccination.
| Original language | English |
|---|---|
| Pages (from-to) | 610-620 |
| Number of pages | 11 |
| Journal | European Heart Journal |
| Volume | 44 |
| Issue number | 7 |
| Early online date | 20 Dec 2022 |
| DOIs | |
| Publication status | Published - 14 Feb 2023 |
| Externally published | Yes |
Bibliographical note
Funding Information:This study is based on anonymized data from the Clinical Practice Research Datalink (CPRD) obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data is provided by patients and collected by the National Health Service as part of their care and support. This work was supported in whole, or in part, by the Wellcome Trust (201440/Z/16/Z to C.W.-G). For the purpose of Open Access, the author has applied a CC-BY public copyright licence to any Author Accepted Manuscript version arising from this submission. This work was also supported by the British Heart Foundation (FS/18/71/33938 to J.A.D.). A.B. has received grants from Astra Zeneca, UK Research and Innovation (UKRI), British Medical Association and the NIHR. C.W.-G. has received speaker fees from Sanofi Pasteur and participated in a Data Safety Monitoring Board for an investigator-led trial of the effect of influenza vaccination after heart attack on future cardiovascular prognosis (NCT02831608) from January 2019 to April 2020. H.I.M is funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation was an invited expert to the Commission on Human Medicines (CHM) COVID-19 Vaccine Safety Surveillance Methodologies Expert Working Group. I.D. has received unrestricted research grants from Glaxo Smith Kline. C.L. has received lecturer fees from Astra Zeneca and participated in a Data Safety Monitoring Board for the Université de Clermont-Ferrand (NCT03892148). J.A.D is funded by the British Heart Foundation through the grant received by C.W.-G. E.H. is funded by a NIHR postdoctoral fellowship. All other authors declare no competing interests.
Funding Information:
Conflict of interest: A.B. has received grants from Astra Zeneca, UK Research and Innovation (UKRI), British Medical Association and the NIHR. C.W.-G. has received speaker fees from Sanofi Pasteur and participated in a Data Safety Monitoring Board for an investigator-led trial of the effect of influenza vaccination after heart attack on future cardiovascular prognosis (NCT02831608) from January 2019 to April 2020. H.I.M is funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation was an invited expert to the Commission on Human Medicines (CHM) COVID-19 Vaccine Safety Surveillance Methodologies Expert Working Group. I.D. has received unrestricted research grants from Glaxo Smith Kline. C.L. has received lecturer fees from Astra Zeneca and participated in a Data Safety Monitoring Board for the Université de Clermont-Ferrand (NCT03892148). J.A.D is funded by the British Heart Foundation through the grant received by C.W.-G. E.H. is funded by a NIHR postdoctoral fellowship. All other authors declare no competing interests.
Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
Keywords
- Cardiovascular complications
- Influenza vaccine
- QRISK
- hypertension
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
