Modin Daniel, Claggett Brian, Køber Lars, Schou Morten, Jensen Jens Ulrik Stæhr, Solomon Scott D, Vardeny Orly, Knop Filip Krag, Nielsen Susanne Dam, Fralick Michael, Torp-Pedersen Christian, Gislason Gunnar, Biering-Sørensen Tor
Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Diabetes Care. 2020 Sep;43(9):2226-2233. doi: 10.2337/dc20-0229. Epub 2020 Jul 9.
Recent influenza infection is associated with an increased risk of atherothrombotic events, including acute myocardial infarction (AMI) and stroke. Little is known about the association between influenza vaccination and cardiovascular outcomes in patients with diabetes.
We used nationwide register data to identify patients with diabetes in Denmark during nine consecutive influenza seasons in the period 2007-2016. Diabetes was defined as use of glucose-lowering medication. Patients who were not 18-100 years old or had ischemic heart disease, heart failure, chronic obstructive lung disease, cancer, or cerebrovascular disease were excluded. Patient exposure to influenza vaccination was assessed before each influenza season. We considered the outcomes of death from all causes, death from cardiovascular causes, and death from AMI or stroke. For each season, patients were monitored from December 1 until April 1 the next year.
A total of 241,551 patients were monitored for a median of four seasons (interquartile range two to eight seasons) for a total follow-up of 425,318 person-years. The vaccine coverage during study seasons ranged from 24% to 36%. During follow-up, 8,207 patients died of all causes (3.4%), 4,127 patients died of cardiovascular causes (1.7%), and 1,439 patients died of AMI/stroke (0.6%). After adjustment for confounders, vaccination was significantly associated with reduced risks of all-cause death (hazard ratio [HR] 0.83, < 0.001), cardiovascular death (HR 0.84, < 0.001), and death from AMI or stroke (HR 0.85, = 0.028) and a reduced risk of being admitted to hospital with acute complications associated with diabetes (diabetic ketoacidosis, hypoglycemia, or coma) (HR 0.89, = 0.006).
In patients with diabetes, influenza vaccination was associated with a reduced risk of all-cause death, cardiovascular death, and death from AMI or stroke. Influenza vaccination may improve outcome in patients with diabetes.
近期流感感染与动脉粥样硬化血栓形成事件风险增加相关，包括急性心肌梗死（AMI）和中风。关于糖尿病患者流感疫苗接种与心血管结局之间的关联，人们了解甚少。
我们使用全国登记数据，确定了2007 - 2016年连续九个流感季节丹麦的糖尿病患者。糖尿病定义为使用降糖药物。排除年龄不在18 - 100岁之间或患有缺血性心脏病、心力衰竭、慢性阻塞性肺疾病、癌症或脑血管疾病的患者。在每个流感季节之前评估患者的流感疫苗接种情况。我们考虑了全因死亡、心血管原因死亡以及AMI或中风死亡的结局。对于每个季节，从12月1日至次年4月1日对患者进行监测。
总共对241,551名患者进行了中位时间为四个季节（四分位间距为两个至八个季节）的监测，总随访时间为425,318人年。研究季节期间的疫苗接种覆盖率在24%至36%之间。在随访期间，8,207名患者死于各种原因（3.4%），4,127名患者死于心血管原因（1.7%），1,439名患者死于AMI/中风（0.6%）。在对混杂因素进行调整后，接种疫苗与全因死亡风险降低（风险比[HR] 0.83，<0.001）、心血管死亡风险降低（HR 0.84，<0.001）以及AMI或中风死亡风险降低（HR 0.85，=0.028）显著相关，并且与因糖尿病相关急性并发症（糖尿病酮症酸中毒、低血糖或昏迷）住院的风险降低（HR 0.89，=0.006）相关。
在糖尿病患者中，流感疫苗接种与全因死亡、心血管死亡以及AMI或中风死亡风险降低相关。流感疫苗接种可能改善糖尿病患者的结局。
