Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study
Abstract Background US and European guidelines diverge on whether to vaccinate adults who are not at high risk for cardiovascular events against influenza. Here, we investigated the associations between influenza vaccination and risk for acute myocardial infarction, stroke and pulmonary embolism dur...
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| Format: | Article |
| Language: | English |
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BMC
2021-01-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-020-01836-z |
| _version_ | 1818383323441922048 |
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| author | Abhijit Sen Inger Johanne Bakken Ragna Elise Støre Govatsmark Torunn Varmdal Kaare Harald Bønaa Kenneth Jay Mukamal Siri Eldevik Håberg Imre Janszky |
| author_facet | Abhijit Sen Inger Johanne Bakken Ragna Elise Støre Govatsmark Torunn Varmdal Kaare Harald Bønaa Kenneth Jay Mukamal Siri Eldevik Håberg Imre Janszky |
| author_sort | Abhijit Sen |
| collection | DOAJ |
| description | Abstract Background US and European guidelines diverge on whether to vaccinate adults who are not at high risk for cardiovascular events against influenza. Here, we investigated the associations between influenza vaccination and risk for acute myocardial infarction, stroke and pulmonary embolism during the 2009 pandemic in Norway, when vaccination was recommended to all adults. Methods Using national registers, we studied all vaccinated Norwegian individuals who suffered AMI, stroke, or pulmonary embolism from May 1, 2009 through September 30, 2010. We defined higher-risk individuals as those using anti-diabetic, anti-obesity, anti-thrombotic, pulmonary or cardiovascular medications (i.e. individuals to whom vaccination was routinely recommended); all other individuals were regarded as having lower-risk. We estimated incidence rate ratios with 95% CI using conditional Poisson regression in the pre-defined risk periods up to 180 days following vaccination compared to an unexposed time-period, with adjustment for season or daily temperature. Results Overall, we observed lower risk for cardiovascular events following influenza vaccination. When stratified by baseline risk, we observed lower risk across all three outcomes in association with vaccination among higher-risk individuals. In this subgroup, relative risks were 0.72 (0.59–0.88) for AMI, 0.77 (0.59–0.99) for stroke, and 0.73 (0.45–1.19) for pulmonary embolism in the period 1–14 days following vaccination when compared to the background period. These associations remained essentially the same up to 180 days after vaccination. In contrast, the corresponding relative risks among subjects not using medications were 4.19 (2.69–6.52), 1.73 (0.91–3.31) and 2.35 (0.78–7.06). Conclusion In this nationwide study, influenza vaccination was associated with overall cardiovascular benefit. This benefit was concentrated among those at higher cardiovascular risk as defined by medication use. In contrast, our results demonstrate no comparable inverse association with thrombosis-related cardiovascular events following vaccination among those free of cardiovascular medications at baseline. These results may inform the risk–benefit balance for universal influenza vaccination. |
| first_indexed | 2024-12-14T03:04:32Z |
| format | Article |
| id | doaj.art-3fa4d701b95f48c58015935bfa276cb7 |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-12-14T03:04:32Z |
| publishDate | 2021-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-3fa4d701b95f48c58015935bfa276cb72022-12-21T23:19:25ZengBMCBMC Cardiovascular Disorders1471-22612021-01-0121111110.1186/s12872-020-01836-zInfluenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series studyAbhijit Sen0Inger Johanne Bakken1Ragna Elise Støre Govatsmark2Torunn Varmdal3Kaare Harald Bønaa4Kenneth Jay Mukamal5Siri Eldevik Håberg6Imre Janszky7Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and TechnologyCentre for Fertility and Health (CeFH), Norwegian Institute of Public HealthDepartment of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and TechnologyDepartment of Medical Quality Registries, St. Olav’s University HospitalDepartment of Circulation and Medical Imaging, Norwegian University of Science and TechnologyDepartment of Medicine, Beth Israel Deaconess Medical CenterCentre for Fertility and Health (CeFH), Norwegian Institute of Public HealthDepartment of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and TechnologyAbstract Background US and European guidelines diverge on whether to vaccinate adults who are not at high risk for cardiovascular events against influenza. Here, we investigated the associations between influenza vaccination and risk for acute myocardial infarction, stroke and pulmonary embolism during the 2009 pandemic in Norway, when vaccination was recommended to all adults. Methods Using national registers, we studied all vaccinated Norwegian individuals who suffered AMI, stroke, or pulmonary embolism from May 1, 2009 through September 30, 2010. We defined higher-risk individuals as those using anti-diabetic, anti-obesity, anti-thrombotic, pulmonary or cardiovascular medications (i.e. individuals to whom vaccination was routinely recommended); all other individuals were regarded as having lower-risk. We estimated incidence rate ratios with 95% CI using conditional Poisson regression in the pre-defined risk periods up to 180 days following vaccination compared to an unexposed time-period, with adjustment for season or daily temperature. Results Overall, we observed lower risk for cardiovascular events following influenza vaccination. When stratified by baseline risk, we observed lower risk across all three outcomes in association with vaccination among higher-risk individuals. In this subgroup, relative risks were 0.72 (0.59–0.88) for AMI, 0.77 (0.59–0.99) for stroke, and 0.73 (0.45–1.19) for pulmonary embolism in the period 1–14 days following vaccination when compared to the background period. These associations remained essentially the same up to 180 days after vaccination. In contrast, the corresponding relative risks among subjects not using medications were 4.19 (2.69–6.52), 1.73 (0.91–3.31) and 2.35 (0.78–7.06). Conclusion In this nationwide study, influenza vaccination was associated with overall cardiovascular benefit. This benefit was concentrated among those at higher cardiovascular risk as defined by medication use. In contrast, our results demonstrate no comparable inverse association with thrombosis-related cardiovascular events following vaccination among those free of cardiovascular medications at baseline. These results may inform the risk–benefit balance for universal influenza vaccination.https://doi.org/10.1186/s12872-020-01836-zInfluenzaVaccinationPandemicMyocardial infarctionStrokePulmonary embolism |
| spellingShingle | Abhijit Sen Inger Johanne Bakken Ragna Elise Støre Govatsmark Torunn Varmdal Kaare Harald Bønaa Kenneth Jay Mukamal Siri Eldevik Håberg Imre Janszky Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study BMC Cardiovascular Disorders Influenza Vaccination Pandemic Myocardial infarction Stroke Pulmonary embolism |
| title | Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study |
| title_full | Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study |
| title_fullStr | Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study |
| title_full_unstemmed | Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study |
| title_short | Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study |
| title_sort | influenza vaccination and risk for cardiovascular events a nationwide self controlled case series study |
| topic | Influenza Vaccination Pandemic Myocardial infarction Stroke Pulmonary embolism |
| url | https://doi.org/10.1186/s12872-020-01836-z |
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