Primary prevention of acute cardiovascular events by influenza vaccination: an observational study

Author:

Davidson Jennifer A1ORCID,Banerjee Amitava2ORCID,Douglas Ian1,Leyrat Clémence13ORCID,Pebody Richard4,McDonald Helen I56,Herrett Emily1,Forbes Harriet7,Smeeth Liam1,Warren-Gash Charlotte1

Affiliation:

1. Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel Street, London WC1E 7HT , UK

2. Institute of Health Informatics, University College London , 222 Euston Road, London NW1 2DA , UK

3. Department of Medical Statistics, London School of Hygiene and Tropical Medicine , Keppel Street, London WC1E 7HT , UK

4. Institute of Epidemiology and Health Care, University College London , 1-19 Torrington Place, London NW1 2DA , UK

5. National Institute for Health Research Health Protection Research Unit in Immunisation, London School of Hygiene and Tropical Medicine in partnership with the UK Health Security Agency , Keppel Street, London WC1E 7HT , UK

6. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel Street, London WC1E 7HT , UK

7. Population Health Sciences, Bristol Medical School, University of Bristol , Queens Road, Bristol BS8 1QU , UK

Abstract

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.

Funder

Wellcome Trust

British Heart Foundation

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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