Peripheral Vessels Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
Peripheral Vessels Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.
Eur J Prev Cardiol. 2015 Sep;22(9):1185-99. doi: 10.1177/2047487314549512. Epub 2014 Sep 24.
Streptococcus pneumoniae is the most common cause of community-acquired pneumonia (CAP) and CAP-related mortality in adults. Pneumococcal vaccination (PV) could protect subjects from cardiovascular events by reducing pneumonia severity or even preventing it. We sought to determine the ability of PV to protect from the risk of cardiovascular events.
A comprehensive search of electronic databases was conducted up to March 2014. Cohort studies that reported relative risk (RR) estimates with 95% confidence intervals (CI) were included. Eleven studies were included (332,267 participants, mean follow-up 20.1 months). The pooled RRs for cardiovascular events and cardiovascular mortality were 0.86 (95% CI: 0.76-0.97) and 0.92 (95% CI: 0.86-0.98; fixed-effects), respectively, for subjects with PV versus without PV. Protective ability was more prominent in high cardiovascular risk populations and with older age. The protective role of PV was attenuated after 1 year (RR: 0.72; 95% CI: 0.59-0.88 vs RR: 1.03; 95% CI: 0.93-1.14; p = 0.002, for follow-up >1 year vs ≤1 year, respectively). It also increased as the presence of cardiovascular and pulmonary disease increased. Regarding myocardial infarction (MI) and cerebrovascular events, the protective role of PV was statistically significant only in the elderly (RR: 0.90; 95% CI: 0.817-0.999; fixed-effects and RR: 0.86; 95% CI: 0.75-0.99, respectively).
PV is associated with decreased risk of cardiovascular events and mortality. This protective effect increases at older age and in high cardiovascular risk subjects and decreases as the time elapses from PV. PV decreases the risk of MI and cerebrovascular events in the elderly.
肺炎链球菌是导致社区获得性肺炎（CAP）和成人肺炎相关死亡率的最常见原因。肺炎球菌疫苗（PV）通过减轻肺炎严重程度甚至预防肺炎，可保护患者免受心血管事件的影响。我们旨在确定 PV 预防心血管事件风险的能力。
对电子数据库进行了全面检索，检索截至 2014 年 3 月。纳入报告相对风险（RR）估计值和 95%置信区间（CI）的队列研究。共纳入 11 项研究（332267 名参与者，平均随访 20.1 个月）。接种 PV 与未接种 PV 的患者发生心血管事件和心血管死亡的汇总 RR 分别为 0.86（95%CI：0.76-0.97）和 0.92（95%CI：0.86-0.98；固定效应）。在高心血管风险人群和老年人群中，保护作用更为明显。PV 的保护作用在接种 1 年后减弱（RR：0.72；95%CI：0.59-0.88 与 RR：1.03；95%CI：0.93-1.14；p=0.002，分别为随访>1 年与≤1 年）。随着心血管和肺部疾病的存在增加，保护作用也随之增加。关于心肌梗死（MI）和脑血管事件，PV 的保护作用仅在老年人中具有统计学意义（RR：0.90；95%CI：0.817-0.999；固定效应和 RR：0.86；95%CI：0.75-0.99）。
PV 与心血管事件和死亡率风险降低相关。这种保护作用在年龄较大、心血管风险较高的患者中增加，并随着接种 PV 后时间的推移而减少。PV 降低了老年人发生 MI 和脑血管事件的风险。
