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Flu Vaccine for Cardiovascular Prevention in the Elderly

Mounting evidence suggests that vaccinating the elderly should be part of any preventive-cardiology program.

Influenza is linked with increased risk for adverse cardiovascular events. In a small, unblinded, randomized trial, predischarge influenza vaccination was associated with reduced risk for subsequent ischemic events in MI patients and in patients who underwent angioplasty with stenting (Journal Watch Cardiology Jul 26 2002). Now, researchers have reviewed data from patients at least 65 years old enrolled in 1 of 3 managed care organizations for at least a year up to and including 1 of 2 influenza seasons: 1998-1999 (140,055 patients) and 1999-2000 (146,328 patients).

Vaccination rates were 55.5% in 1998-1999 and 59.7% in 1999-2000. Vaccinated patients were older and had a greater burden of comorbid disease than unvaccinated patients. To account for these baseline differences between vaccinated and unvaccinated patients, a multivariable logistic-regression model was used. According to this model, vaccinated patients experienced significantly less hospitalization for cardiac disease (19% less in both flu seasons) and for cerebrovascular disease (16% less in 1998-1999, 23% less in 1999-2000), and significantly lower mortality (48% less in 1998-1999, 50% less in 1999-2000). The number of vaccinated patients needed to prevent a hospitalization or death was 61 in 1998-1999 and 68 in 1999-2000. In the summer months, vaccinated patients were not hospitalized less than unvaccinated patients.

Comment: Although these results are observational, taken together with prior findings they provide strong evidence for the importance of influenza vaccination in preventing adverse cardiovascular events in the elderly. Vaccination of appropriate individuals should be considered an important part of any preventive-cardiology program.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology May 9, 2003

Citation(s):

Nichol KL et al. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med 2003 Apr 3; 348:1322-32.

• Medline abstract (Free)

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