Flu Vaccine and Mortality in Hypertension: A Nationwide Cohort Study
Background Influenza infection may increase the risk of stroke and acute myocardial infarction (AMI). Whether influenza vaccination may reduce mortality in patients with hypertension is currently unknown. Methods and Results We performed a nationwide cohort study including all patients with hyperten...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.021715 |
| _version_ | 1797859045879578624 |
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| author | Daniel Modin Brian Claggett Mads Emil Jørgensen Lars Køber Thomas Benfield Morten Schou Jens‐Ulrik Stæhr Jensen Scott D. Solomon Ramona Trebbien Michael Fralick Orly Vardeny Marc A. Pfeffer Christian Torp‐Pedersen Gunnar Gislason Tor Biering‐Sørensen |
| author_facet | Daniel Modin Brian Claggett Mads Emil Jørgensen Lars Køber Thomas Benfield Morten Schou Jens‐Ulrik Stæhr Jensen Scott D. Solomon Ramona Trebbien Michael Fralick Orly Vardeny Marc A. Pfeffer Christian Torp‐Pedersen Gunnar Gislason Tor Biering‐Sørensen |
| author_sort | Daniel Modin |
| collection | DOAJ |
| description | Background Influenza infection may increase the risk of stroke and acute myocardial infarction (AMI). Whether influenza vaccination may reduce mortality in patients with hypertension is currently unknown. Methods and Results We performed a nationwide cohort study including all patients with hypertension in Denmark during 9 consecutive influenza seasons in the period 2007 to 2016 who were prescribed at least 2 different classes of antihypertensive medication (renin‐angiotensin system inhibitors, diuretics, calcium antagonists, or beta‐blockers). We excluded patients who were aged <18 years, >100 years, had ischemic heart disease, heart failure, chronic obstructive lung disease, cancer, or cerebrovascular disease. The exposure to influenza vaccination was assessed before each influenza season. The end points were defined as death from all‐causes, from cardiovascular causes, or from stroke or AMI. For each influenza season, patients were followed from December 1 until April 1 the next year. We included a total of 608 452 patients. The median follow‐up was 5 seasons (interquartile range, 2–8 seasons) resulting in a total follow‐up time of 975 902 person‐years. Vaccine coverage ranged from 26% to 36% during the study seasons. During follow‐up 21 571 patients died of all‐causes (3.5%), 12 270 patients died of cardiovascular causes (2.0%), and 3846 patients died of AMI/stroke (0.6%). After adjusting for confounders, vaccination was significantly associated with reduced risks of all‐cause death (HR, 0.82; P<0.001), cardiovascular death (HR, 0.84; P<0.001), and death from AMI/stroke (HR, 0.90; P=0.017). Conclusions Influenza vaccination was significantly associated with reduced risks of death from all‐causes, cardiovascular causes, and AMI/stroke in patients with hypertension. Influenza vaccination might improve outcome in hypertension. |
| first_indexed | 2024-04-09T21:23:08Z |
| format | Article |
| id | doaj.art-d3e36accebca47b685b2d8a2ac2d112c |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T21:23:08Z |
| publishDate | 2022-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-d3e36accebca47b685b2d8a2ac2d112c2023-03-28T04:20:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-03-0111610.1161/JAHA.121.021715Flu Vaccine and Mortality in Hypertension: A Nationwide Cohort StudyDaniel Modin0Brian Claggett1Mads Emil Jørgensen2Lars Køber3Thomas Benfield4Morten Schou5Jens‐Ulrik Stæhr Jensen6Scott D. Solomon7Ramona Trebbien8Michael Fralick9Orly Vardeny10Marc A. Pfeffer11Christian Torp‐Pedersen12Gunnar Gislason13Tor Biering‐Sørensen14Department of Cardiology Herlev & Gentofte Hospital University of Copenhagen DenmarkDepartment of Medicine Cardiovascular Medicine Division Brigham and Women’s Hospital Harvard Medical School Boston MADepartment of Cardiology Herlev & Gentofte Hospital University of Copenhagen DenmarkFaculty of Health Sciences Institute of Clinical MedicineUniversity of Copenhagen DenmarkFaculty of Health Sciences Institute of Clinical MedicineUniversity of Copenhagen DenmarkDepartment of Cardiology Herlev & Gentofte Hospital University of Copenhagen DenmarkFaculty of Health Sciences Institute of Clinical MedicineUniversity of Copenhagen DenmarkDepartment of Medicine Cardiovascular Medicine Division Brigham and Women’s Hospital Harvard Medical School Boston MADepartment of Virus and Microbiological Special Diagnostics National Influenza CenterStatens Serum Institut Copenhagen DenmarkDepartment of Medicine Eliot Phillipson Clinician Scientist Training ProgramUniversity of Toronto Ontario CanadaCenter for Chronic Disease Outcomes Research Minneapolis VA Health Care System Minneapolis MNDepartment of Medicine Cardiovascular Medicine Division Brigham and Women’s Hospital Harvard Medical School Boston MADepartment of Cardiology and Clinical Research Nordsjaellands Hospital Hillerød DenmarkDepartment of Cardiology Herlev & Gentofte Hospital University of Copenhagen DenmarkDepartment of Cardiology Herlev & Gentofte Hospital University of Copenhagen DenmarkBackground Influenza infection may increase the risk of stroke and acute myocardial infarction (AMI). Whether influenza vaccination may reduce mortality in patients with hypertension is currently unknown. Methods and Results We performed a nationwide cohort study including all patients with hypertension in Denmark during 9 consecutive influenza seasons in the period 2007 to 2016 who were prescribed at least 2 different classes of antihypertensive medication (renin‐angiotensin system inhibitors, diuretics, calcium antagonists, or beta‐blockers). We excluded patients who were aged <18 years, >100 years, had ischemic heart disease, heart failure, chronic obstructive lung disease, cancer, or cerebrovascular disease. The exposure to influenza vaccination was assessed before each influenza season. The end points were defined as death from all‐causes, from cardiovascular causes, or from stroke or AMI. For each influenza season, patients were followed from December 1 until April 1 the next year. We included a total of 608 452 patients. The median follow‐up was 5 seasons (interquartile range, 2–8 seasons) resulting in a total follow‐up time of 975 902 person‐years. Vaccine coverage ranged from 26% to 36% during the study seasons. During follow‐up 21 571 patients died of all‐causes (3.5%), 12 270 patients died of cardiovascular causes (2.0%), and 3846 patients died of AMI/stroke (0.6%). After adjusting for confounders, vaccination was significantly associated with reduced risks of all‐cause death (HR, 0.82; P<0.001), cardiovascular death (HR, 0.84; P<0.001), and death from AMI/stroke (HR, 0.90; P=0.017). Conclusions Influenza vaccination was significantly associated with reduced risks of death from all‐causes, cardiovascular causes, and AMI/stroke in patients with hypertension. Influenza vaccination might improve outcome in hypertension.https://www.ahajournals.org/doi/10.1161/JAHA.121.021715acute myocardial infarctionall‐cause deathhypertensioninfluenzainfluenza vaccinationstroke |
| spellingShingle | Daniel Modin Brian Claggett Mads Emil Jørgensen Lars Køber Thomas Benfield Morten Schou Jens‐Ulrik Stæhr Jensen Scott D. Solomon Ramona Trebbien Michael Fralick Orly Vardeny Marc A. Pfeffer Christian Torp‐Pedersen Gunnar Gislason Tor Biering‐Sørensen Flu Vaccine and Mortality in Hypertension: A Nationwide Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute myocardial infarction all‐cause death hypertension influenza influenza vaccination stroke |
| title | Flu Vaccine and Mortality in Hypertension: A Nationwide Cohort Study |
| title_full | Flu Vaccine and Mortality in Hypertension: A Nationwide Cohort Study |
| title_fullStr | Flu Vaccine and Mortality in Hypertension: A Nationwide Cohort Study |
| title_full_unstemmed | Flu Vaccine and Mortality in Hypertension: A Nationwide Cohort Study |
| title_short | Flu Vaccine and Mortality in Hypertension: A Nationwide Cohort Study |
| title_sort | flu vaccine and mortality in hypertension a nationwide cohort study |
| topic | acute myocardial infarction all‐cause death hypertension influenza influenza vaccination stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.021715 |
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