Chiang Ming-Hsien, Wu Hau-Hsin, Shih Chia-Jen, Chen Yung-Tai, Kuo Shu-Chen, Chen Te-Li
Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
Northern Regional Center, Centers for Disease Control, Taipei, Taiwan.
Am Heart J. 2017 Nov;193:1-7. doi: 10.1016/j.ahj.2017.07.020. Epub 2017 Aug 2.
This study was conducted to determine the protective effect of influenza vaccine against primary major adverse cardiovascular events (MACEs) in elderly patients, especially those with influenza-like illness (ILI).
This retrospective, population-based case-control study of an elderly population (age≥65 years) was conducted using Taiwan's National Health Insurance Research Database (2000-2013). One control was selected for each MACE case (n=80,363 each), matched according to age, year of study entry, and predisposing factors for MACEs. ILI and MACEs (myocardial infarction [MI] and ischemic stroke) were defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Odds ratios (ORs) were calculated for the association between MACEs and vaccination.
Influenza vaccination received in the previous year was associated with reduced risks of primary MACEs overall (adjusted OR [aOR] 0.80, 95% CI 0.78-0.82, P<.001), MI (aOR 0.80, 95% CI 0.76-0.84, P<.001), and ischemic stroke (aOR 0.80, 95% CI 0.77-0.82, P<.001). ILI diagnosed in the previous year was associated with increased risks of MACEs (aOR 1.24, 95% CI 1.18-1.29, P<.001), MI (aOR 1.46, 95% CI 1.34-1.59, P<.001), and ischemic stroke (aOR 1.16, 95% CI 1.10-1.22, P<.001). Vaccination attenuated the heightened risks associated with ILI (MACEs: aOR 0.99, 95% CI 0.92-1.07, P=.834; MI: aOR 1.05, 95% CI 0.92-1.21, P=.440; ischemic stroke: aOR 0.96, 95% CI 0.89-1.05, P=.398).
Results of this study suggest that influenza vaccination is associated with reduced primary MACE risks in the elderly population, including those with ILI.
本研究旨在确定流感疫苗对老年患者，尤其是患有流感样疾病（ILI）的患者原发性主要不良心血管事件（MACE）的保护作用。
本研究利用台湾全民健康保险研究数据库（2000 - 2013年），对老年人群（年龄≥65岁）进行了一项基于人群的回顾性病例对照研究。为每例MACE病例选取一名对照（各80363例），根据年龄、研究入组年份和MACE的易感因素进行匹配。ILI和MACE（心肌梗死[MI]和缺血性中风）根据《国际疾病分类，第九次修订本，临床修订版》进行定义。计算MACE与疫苗接种之间关联的比值比（OR）。
前一年接种流感疫苗与总体原发性MACE风险降低相关（校正OR[aOR]0.80，95%CI 0.78 - 0.82，P<0.001），与MI（aOR 0.80，95%CI 0.76 - 0.84，P<0.001）和缺血性中风（aOR 0.80，95%CI 0.77 - 0.82，P<0.001）风险降低相关。前一年诊断为ILI与MACE风险增加相关（aOR 1.24，95%CI 1.18 - 1.29，P<0.001），与MI（aOR 1.46，95%CI 1.34 - 1.59，P<0.001）和缺血性中风（aOR 1.16，95%CI 1.10 - 1.22，P<0.001）风险增加相关。疫苗接种减弱了与ILI相关的风险升高（MACE：aOR 0.99，95%CI 0.92 - 1.07，P = 0.834；MI：aOR 1.05，95%CI 0.92 - 1.21，P = 0.440；缺血性中风：aOR 0.96，95%CI 0.89 - 1.05，P = 0.398）。
本研究结果表明，流感疫苗接种与老年人群，包括患有ILI的人群原发性MACE风险降低相关。
