Respiratory infections increase the risk of cardiovascular complications, especially in older patients. The association between influenza and cardiovascular events is significant. Vice versa, patients with manifest cardiovascular disease increasingly fall ill with influenza. What especially interested the two BREATH scientists was the significance of vaccinations in this context. Prospective studies and meta-analyses show the effect of influenza and pneumococcal vaccines on the cardiovascular outcome in the total population.  Particularly extensive is the data situation for the „flu“ vaccination, and it is clear: „The influenza vaccination seems to have a favourable effect in the primary and secondary prevention of cardiovascular events“, according to Dr. Rademacher. This results in about a halving of the risk for CVD (cardiovascular disease)-associated events and hospitalisations. The vaccine against pneumococci (PPSV23) has been proven to reduce the danger of MACE (major adverse cardiac events) in male and female patients over 65 years of age. 

„Less clear is the situation with COVID-19 infections“, said Prof. Welte. The connection between vaccination and cardiovascular outcome has only been insufficiently investigated. The largest US-American patient cohort, which observed the association between vaccination and MACE, revealed however a reduction in myocardial infarction and ischemic stroke after complete immunization. Unfavourable cardiovascular (cv) effects after vaccination against SARS-CoV2, such as myocarditis or pericarditis, are known, but seldom occur. RSV (respiratory synctial virus) vaccines for older people are currently still in clinical Phase III studies or the approval process. 

Lead author Dr. Rademacher and Professor Welte took stock from the results of the review. They generally emphasized vaccinations as a highly effective preventive measure, particularly also for cv risk patients. „All patients with an underlying cardiovascular disease should, in addition to the usual standard vaccinations, also be vaccinated against influenza, pneumococci, SARS-CoV2 and, if possible, RSV“. Their specific recommendation is

• a high-dose or adjuvanted quadrivalent influenza vaccine once a year
• a single dose of PCV20
• a basic immunization including booster against SARS-CoV2 with an mRNA vaccine 
• an RSV vaccination, as soon as the Standing Committee on Vaccination (STIKO) makes a recommendation.

Furthermore, it is necessary to raise the awareness of cardiologists and cardiovascular risk patients of the importance of the vaccinations. „The prevention of infections by immunization is a cornerstone in the prophylaxis of cardiovascular complications and deaths“,  Dr. Rademacher points out the importance of immunization of this risk group. Despite scientific evidence of effectiveness, safety and benefit for the patients, the immunization rates in this population are rather „suboptimal“. Acceptance by patients and doctors must finally also be clearly improved by concrete recommendations.

J. RADEMACHER ET AL EUR J PREV CARDIOL. 2024; ZWAE016 
Please find the original publication here: https://doi.org/10.1093/eurjpc/zwae016
 
Text: Beate Fessler / BREATH
Photo: BREATH