Institute of Health Policy, Management, and Evaluation and Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
ICES, Toronto, Canada.
JAMA Netw Open. 2022 Apr 1;5(4):e228873. doi: 10.1001/jamanetworkopen.2022.8873.
Influenza infection is associated with increased cardiovascular hospitalization and mortality. Our prior systematic review and meta-analysis hypothesized that influenza vaccination was associated with a lower risk of cardiovascular events.
To evaluate, via an updated meta-analysis, if seasonal influenza vaccination is associated with a lower risk of fatal and nonfatal cardiovascular events and assess whether the newest cardiovascular outcome trial results are consistent with prior findings.
A previously published meta-analysis of randomized controlled trials (RCTs) and a large 2021 cardiovascular outcome trial.
Studies with RCTs published between 2000 and 2021 that randomized participants to either influenza vaccine or placebo/control. Eligible participants were inpatients and outpatients recruited for international multicenter RCTs and randomized to receive either influenza vaccine or placebo/control.
PRISMA guidelines were followed in the extraction of study details, and risk of bias was assessed using the Cochrane Collaboration tool. Trial quality was evaluated using Cochrane criteria. Data were analyzed January 2020 and December 2021.
Random-effects Mantel-Haenszel risk ratios (RRs) and 95% CIs were derived for a composite of major adverse cardiovascular events and cardiovascular mortality within 12 months of follow-up. Where available, analyses were stratified by patients with and without recent acute coronary syndrome (ACS) within 1 year of randomization.
Six published RCTs comprising a total of 9001 patients were included (mean age, 65.5 years; 42.5% women; 52.3% with a cardiac history). Overall, influenza vaccine was associated with a lower risk of composite cardiovascular events (3.6% vs 5.4%; RR, 0.66; 95% CI, 0.53-0.83; P < .001). A treatment interaction was detected between patients with recent ACS (RR, 0.55; 95% CI, 0.41-0.75) and without recent ACS (RR, 1.00; 95% CI, 0.68-1.47) (P for interaction = .02). For cardiovascular mortality, a treatment interaction was also detected between patients with recent ACS (RR, 0.44; 95% CI, 0.23-0.85) and without recent ACS (RR, 1.45; 95% CI, 0.84-2.50) (P for interaction = .006), while 1.7% of vaccine recipients died of cardiovascular causes compared with 2.5% of placebo or control recipients (RR, 0.74; 95% CI, 0.42-1.30; P = .29).
In this study, receipt of influenza vaccination was associated with a 34% lower risk of major adverse cardiovascular events, and individuals with recent ACS had a 45% lower risk. Given influenza poses a threat to population health during the COVID-19 pandemic, it is integral to counsel high-risk patients on the cardiovascular benefits of influenza vaccination.
流感感染与心血管住院和死亡率增加有关。我们之前的系统评价和荟萃分析假设流感疫苗接种与心血管事件风险降低有关。
通过更新的荟萃分析评估季节性流感疫苗接种是否与致命和非致命心血管事件风险降低相关，并评估最新的心血管结局试验结果是否与之前的发现一致。
先前发表的随机对照试验 (RCT) 的荟萃分析和 2021 年的一项大型心血管结局试验。
在 2000 年至 2021 年期间发表的 RCT 中进行随机分组的研究，将参与者随机分配到流感疫苗或安慰剂/对照。合格的参与者是国际多中心 RCT 招募的住院和门诊患者，并随机分配接受流感疫苗或安慰剂/对照。
按照 PRISMA 指南提取研究细节，并使用 Cochrane 合作工具评估偏倚风险。使用 Cochrane 标准评估试验质量。数据于 2020 年 1 月和 2021 年 12 月进行分析。
对于随访 12 个月内主要不良心血管事件和心血管死亡率的综合结果，采用随机效应曼-惠特尼风险比 (RR) 和 95%置信区间 (CI) 进行推导。在可用的情况下，根据随机分组后 1 年内最近发生急性冠状动脉综合征 (ACS) 的患者进行分层分析。
纳入了 6 项已发表的 RCT，共纳入了 9001 名患者（平均年龄 65.5 岁；42.5%为女性；52.3%有心脏病史）。总体而言，流感疫苗与复合心血管事件风险降低相关（3.6%比 5.4%；RR，0.66；95%CI，0.53-0.83；P<0.001）。检测到最近发生 ACS 的患者（RR，0.55；95%CI，0.41-0.75）和未发生 ACS 的患者（RR，1.00；95%CI，0.68-1.47）之间存在治疗相互作用（P 交互值=0.02）。对于心血管死亡率，也检测到最近发生 ACS 的患者（RR，0.44；95%CI，0.23-0.85）和未发生 ACS 的患者（RR，1.45；95%CI，0.84-2.50）之间存在治疗相互作用（P 交互值=0.006），而疫苗接种者中有 1.7%死于心血管原因，安慰剂或对照组中有 2.5%（RR，0.74；95%CI，0.42-1.30；P=0.29）。
在这项研究中，接受流感疫苗接种与主要不良心血管事件风险降低 34%相关，最近发生 ACS 的患者风险降低 45%。鉴于流感在 COVID-19 大流行期间对人群健康构成威胁，向高风险患者提供流感疫苗接种的心血管益处至关重要。
