Department of Research and Evaluation, Southern California Permanente Medical Group, Kaiser Permanente, 100 S Los Robles Ave, Second Floor, Pasadena, CA 91101, USA.
JAMA. 2010 May 5;303(17):1699-706. doi: 10.1001/jama.2010.529.
Multiple studies have shown that preventing influenza by vaccination reduces the risk of vascular events. However, the effect of pneumococcal polysaccharide vaccine on vascular events remains controversial.
To examine the association between pneumococcal vaccination and risk of acute myocardial infarction (MI) and stroke among men.
DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study of Kaiser Permanente Northern and Southern California health plans with 84 170 participants aged 45 to 69 years from the California Men's Health Study who were recruited between January 2002 and December 2003, and followed up until December 31, 2007. The cohort was similar to the population of health plan members and men who responded to a general health survey in California on important demographic and clinical characteristics. Demographic and detailed lifestyle characteristics were collected from surveys. Vaccination records were obtained from the Kaiser Immunization Tracking System.
Incidence of acute MI and stroke during the follow-up period in men who had no history of such conditions.
During follow-up, there were 1211 first MIs in 112,837 vaccinated person-years (10.73 per 1000 person-years) compared with 1494 first MI events in 246,170 unvaccinated person-years (6.07 per 1000 person-years). For stroke, there were 651 events in 122,821 vaccinated person-years (5.30 per 1000 person-years) compared with 483 events in 254,541 unvaccinated person-years (1.90 per 1000 person-years). With propensity score adjustment, we found no evidence for an association between pneumococcal vaccination and reduced risk of acute MI (adjusted hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.98-1.21) or stroke (adjusted HR, 1.14; 95% CI, 1.00-1.31). An inverse association was also not found in men of different age and risk groups. The results appeared to be consistent, because using more specific International Classification of Diseases, Ninth Revision codes for the outcome definition did not change the estimations.
Among a cohort of men aged 45 years or older, receipt of pneumococcal vaccine was not associated with subsequent reduced risk of acute MI and stroke.
多项研究表明，通过接种疫苗预防流感可降低血管事件的风险。然而，肺炎球菌多糖疫苗对血管事件的影响仍存在争议。
研究肺炎球菌疫苗接种与男性急性心肌梗死（MI）和中风风险之间的关联。
设计、地点和参与者：这是一项前瞻性队列研究，纳入了来自加利福尼亚男性健康研究的 84170 名年龄在 45 至 69 岁的 Kaiser Permanente 北加州和南加州健康计划参与者，这些参与者于 2002 年 1 月至 2003 年 12 月之间招募，并随访至 2007 年 12 月 31 日。该队列与健康计划成员和在加利福尼亚接受一般健康调查的男性人群相似，具有重要的人口统计学和临床特征。从调查中收集了人口统计学和详细的生活方式特征。从 Kaiser 免疫追踪系统获得了疫苗接种记录。
在没有此类疾病史的男性中，随访期间急性 MI 和中风的发生率。
在随访期间，在 112837 人年的接种疫苗人群中发生了 1211 例首次 MI（每 1000 人年 10.73 例），而在 246170 人年的未接种疫苗人群中发生了 1494 例首次 MI 事件（每 1000 人年 6.07 例）。对于中风，在 122821 人年的接种疫苗人群中发生了 651 例事件（每 1000 人年 5.30 例），而在 254541 人年的未接种疫苗人群中发生了 483 例事件（每 1000 人年 1.90 例）。通过倾向评分调整，我们没有发现肺炎球菌疫苗接种与急性 MI 风险降低（调整后的危害比 [HR]，1.09；95%置信区间 [CI]，0.98-1.21）或中风（调整后的 HR，1.14；95% CI，1.00-1.31）之间存在关联。在不同年龄和风险组的男性中也没有发现相反的关联。结果似乎是一致的，因为使用更具体的国际疾病分类，第九修订版的疾病定义并没有改变这些估计值。
在年龄在 45 岁或以上的男性队列中，接种肺炎球菌疫苗与随后急性 MI 和中风风险降低无关。
