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Meta-Analysis
. 2015 May 5;2015(5):CD005050.
doi: 10.1002/14651858.CD005050.pub3.

Influenza vaccines for preventing cardiovascular disease

Christine Clar  1 , Zainab Oseni, Nadine Flowers, Maryam Keshtkar-Jahromi, Karen Rees
Affiliations
Meta-Analysis

Influenza vaccines for preventing cardiovascular disease

Christine Clar et al. Cochrane Database Syst Rev. .

Abstract

Background: This is an update of the original review published in 2008. The risk of adverse cardiovascular outcomes is increased with influenza-like infection, and vaccination against influenza may improve cardiovascular outcomes.

Objectives: To assess the potential benefits of influenza vaccination for primary and secondary prevention of cardiovascular disease.

Search methods: We searched the following electronic databases on 18 October 2013: The Cochrane Library (including Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Economic Evaluation Database (EED) and Health Technology Assessment database (HTA)), MEDLINE, EMBASE, Science Citation Index Expanded, Conference Proceedings Citation Index - Science and ongoing trials registers (www.controlled-trials.com/ and www.clinicaltrials.gov). We examined reference lists of relevant primary studies and systematic reviews. We performed a limited PubMed search on 20 February 2015, just before publication.

Selection criteria: Randomised controlled trials (RCTs) of influenza vaccination compared with placebo or no treatment in participants with or without cardiovascular disease, assessing cardiovascular death or non-fatal cardiovascular events.

Data collection and analysis: We used standard methodological procedures as expected by The Cochrane Collaboration. We carried out meta-analyses only for cardiovascular death, as other outcomes were reported too infrequently. We expressed effect sizes as risk ratios (RRs), and we used random-effects models.

Main results: We included eight trials of influenza vaccination compared with placebo or no vaccination, with 12,029 participants receiving at least one vaccination or control treatment. We included six new studies (n = 11,251), in addition to the two included in the previous version of the review. Four of these trials (n = 10,347) focused on prevention of influenza in the general or elderly population and reported cardiovascular outcomes among their safety analyses; four trials (n = 1682) focused on prevention of cardiovascular events in patients with established coronary heart disease. These populations were analysed separately. Follow-up continued between 42 days and one year. Five RCTs showed deficits in at least three of the risk of bias criteria assessed. When reported (seven studies), vaccination provided adequate immunogenicity or protection against influenza. Cardiovascular mortality was reported by four secondary prevention trials and was significantly reduced by influenza vaccination overall (risk ratio (RR) 0.45, 95% confidence interval (CI) 0.26 to 0.76; P value 0.003) with no significant heterogeneity between studies, and by three trials reporting cardiovascular mortality as part of their safety analyses when the numbers of events were too small to permit conclusions. In studies of patients with coronary heart disease, composite outcomes of cardiovascular events tended to be decreased with influenza vaccination compared with placebo. Generally no significant difference was found between comparison groups regarding individual outcomes such as myocardial infarction.

Authors' conclusions: In patients with cardiovascular disease, influenza vaccination may reduce cardiovascular mortality and combined cardiovascular events. However, studies had some risk of bias, and results were not always consistent, so additional higher-quality evidence is necessary to confirm these findings. Not enough evidence was available to establish whether influenza vaccination has a role to play in the primary prevention of cardiovascular disease.

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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Vaccine versus placebo, Outcome 1 All‐cause mortality.
1.2
1.2. Analysis
Comparison 1 Vaccine versus placebo, Outcome 2 Cardiovascular death.
1.3
1.3. Analysis
Comparison 1 Vaccine versus placebo, Outcome 3 Major adverse coronary events (MACE).
1.4
1.4. Analysis
Comparison 1 Vaccine versus placebo, Outcome 4 Coronary ischaemic event (MACE or hospitalisation for myocardial ischaemia).
1.5
1.5. Analysis
Comparison 1 Vaccine versus placebo, Outcome 5 Double endpoint (CV death, non‐fatal MI or severe recurrent ischaemia).
1.6
1.6. Analysis
Comparison 1 Vaccine versus placebo, Outcome 6 Triple endpoint (CV death, non‐fatal MI or severe recurrent ischaemia).
1.7
1.7. Analysis
Comparison 1 Vaccine versus placebo, Outcome 7 At least 1 cardiovascular event.
1.8
1.8. Analysis
Comparison 1 Vaccine versus placebo, Outcome 8 Coronary artery bypass graft (CABG).
1.9
1.9. Analysis
Comparison 1 Vaccine versus placebo, Outcome 9 Percutaneous coronary intervention (PCI).
1.10
1.10. Analysis
Comparison 1 Vaccine versus placebo, Outcome 10 Myocardial infarction.
1.11
1.11. Analysis
Comparison 1 Vaccine versus placebo, Outcome 11 Stroke/hospitalisation for acute stroke.
1.12
1.12. Analysis
Comparison 1 Vaccine versus placebo, Outcome 12 Hospitalisation for heart failure.
1.13
1.13. Analysis
Comparison 1 Vaccine versus placebo, Outcome 13 Angina/unstable angina.
1.14
1.14. Analysis
Comparison 1 Vaccine versus placebo, Outcome 14 Hospitalisation for acute coronary syndrome/myocardial ischaemia.
1.15
1.15. Analysis
Comparison 1 Vaccine versus placebo, Outcome 15 Coronary revascularisation (PCI/CABG).
See this image and copyright information in PMC

Update of

Comment in

References

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