Discover How Vaccines Can Protect Not Only Your Health, But Also Your Heart!

Dr. Catia Cilloniz, PhD, FERS

When we think about vaccines, the first thing that usually comes to mind is their ability to protect us from infectious diseases like measles, polio, the flu, or pneumonia. However, what many people don't know is that vaccines can also play a crucial role in protecting our cardiovascular health. Just before the COVID-19 pandemic, Dr. Daniel Musher led a pivotal review published in the New England Journal of Medicine, which explored the relationship between acute infections and the risk of myocardial infarction (1). This study revealed three key points that changed our understanding of how infections can impact heart health:

1.- A significant increase in the short-term risk of myocardial infarction was observed in individuals with various infections, such as the flu, pneumonia, bronchitis, bacteremia, or urinary tract infections. However, the highest risk is seen with respiratory infections like the flu and pneumonia. Surprisingly, this relationship doesn't only occur at the onset of the infection: in severe cases, such as pneumonia or sepsis, the risk of myocardial infarction can remain elevated for up to 10 years after the infection has been resolved.

2.- The main reasons for this association between acute infections and myocardial infarction are the deterioration and blockage of the heart arteries caused by the complex inflammatory process triggered during an acute infection.

3.- The good news is that vaccination against the flu and pneumococcus helps reduce the risk of cardiovascular events by 36% and 17%, respectively, offering additional protection not only against infections but also against potential heart complications.

What is most interesting about knowing these data on the relationship between acute infections and the risk of myocardial infarction is that a key study on cardiovascular effects in pneumonia patients was published back in 2012. In this study, Dr. Vicente Corrales-Medina analyzed data from 2,287 pneumonia-diagnosed patients, of whom 1,343 (58.7%) were hospitalized and 944 (41.2%) received outpatient treatment. The results were surprising: among outpatient-treated patients, 2% experienced cardiac complications related to pneumonia, whereas 26.7% of hospitalized patients had cardiac complications (2). This finding highlights the importance of the severity of the infection in increasing cardiovascular risk.

After more than a decade of new studies and greater scientific evidence, we now have a clearer understanding of which pneumonia patients are at higher risk of cardiac complications, both short-term (within the first 30 days) and long-term (up to one year after the onset of pneumonia). The factors that increase this risk include: being 65 years or older, having chronic heart disease, the severity of pneumonia, and especially when pneumonia is caused by Streptococcus pneumoniae (pneumococcus). These findings emphasize the importance of closely monitoring certain patients to prevent severe heart complications (3).

Respiratory virus

Cardiac complications has also been documented in cases of pneumonia caused by viruses, such as the flu virus or respiratory syncytial virus. A study published in 2021, analyzing data from 1,191 patients hospitalized for influenza virus-induced pneumonia, revealed that 24.6% of patients developed cardiac complications, and the mortality rate in this group was 45%, compared to only 12% in patients without heart damage. This finding reinforces the severity of respiratory viral infections (4).

Even more revealing is that, prior to this study, another investigation had already confirmed the association between laboratory-confirmed flu and the risk of acute myocardial infarction. In this study, individuals infected with the flu virus were six times more likely to suffer a heart attack in the week following diagnosis. And not only the flu virus increases this risk: the authors also observed a similar association in patients infected with respiratory syncytial virus (RSV), highlighting the potential impact of these viral infections on cardiovascular health (5).

Recently, the results of a study investigating the prevalence and severity of cardiac events in 6,248 adults aged 50 or older, hospitalized due to RSV infection, were published. The findings showed that 22% of these patients experienced a heart event, with acute heart failure being the most common (15.8%). Patients with pre-existing cardiovascular disease had a higher risk of experiencing these events. Furthermore, patients who had heart events had significantly higher rates of ICU admissions (25.8% vs. 16.5%) and higher mortality rates during their hospitalization (8.1% vs. 4%) (6).

Unfortunately, the observations on the relationship between acute infections and the risk of myocardial infarction described above have also been confirmed during the COVID-19 pandemic, particularly in patients with severe forms of the disease. We now know that individuals with severe COVID-19 are more likely to suffer a myocardial infarction and experience a stroke. These data highlight the significant impact that COVID-19 has not only on the respiratory system but also on cardiovascular health, raising concerns about the long-term effects of the pandemic on the population (7,8).

Get vacccinated

All of these scientific observations emphasize the crucial role of vaccines in protecting our heart, especially if we already suffer from chronic heart disease, have multiple health conditions, or are simply at risk of developing a severe infection like pneumonia.

The good news is that effective vaccines exist for the main microorganisms responsible for these acute infections, such as the flu vaccine, the pneumococcal vaccine (the bacterium that most commonly causes pneumonia), the COVID-19 vaccine, and the respiratory syncytial virus vaccine, which particularly affects children under 5 years old and older adults.

Getting vaccinated not only reduces the risk of severe illness but also helps prevent possible cardiovascular complications associated with the viruses or bacteria that cause them. Taking care of your heart is in your hands, and today you have the opportunity to make a decision that could make a difference for your health (9-11).

Referencias

1. ??????? Musher Daniel M., Abers Michael S., Corrales-Medina Vicente F. Acute Infection and Myocardial Infarction. New England Journal of Medicine 2019;380(2):171–176.

2. ??????? Corrales-Medina VF, Musher DM, Wells GA, Chirinos JA, Chen L, Fine MJ. Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation 2012;125(6):773–781.

3. ??????? Aldás I, Menéndez R, Méndez R, et al. Early and late cardiovascular events in patients hospitalized for community-acquired pneumonia. Arch Bronconeumol 2020;56(9):551–558.

4. ??????? Chen L, Han X, Li Y, Zhang C, Xing X. Complications of Cardiovascular Events in Patients Hospitalized with Influenza-Related Pneumonia. Infect Drug Resist 2021;14:1363–1373.

5. ??????? Kwong Jeffrey C., Schwartz Kevin L., Campitelli Michael A., et al. Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection. New England Journal of Medicine 2018;378(4):345–353.

6. ??????? Woodruff RC, Melgar M, Pham H, et al. Acute Cardiac Events in Hospitalized Older Adults With Respiratory Syncytial Virus Infection. JAMA Intern Med 2024;184(6):602–611.

7. ??????? Eberhardt N, Noval MG, Kaur R, et al. SARS-CoV-2 infection triggers pro-atherogenic inflammatory responses in human coronary vessels. Nat Cardiovasc Res 2023;2(10):899–916.

8. ??????? Nannoni S, Groot R de, Bell S, Markus HS. Stroke in COVID-19: A systematic review and meta-analysis. Int J Stroke 2021;16(2):137–149.

9. ??????? Cezard GI, Denholm RE, Knight R, et al. Impact of vaccination on the association of COVID-19 with cardiovascular diseases: An OpenSAFELY cohort study. Nat Commun 2024;15(1):2173.

10. ????? Omidi F, Zangiabadian M, Shahidi Bonjar AH, Nasiri MJ, Sarmastzadeh T. Influenza vaccination and major cardiovascular risk: a systematic review and meta-analysis of clinical trials studies. Sci Rep 2023;13(1):1–7.

11. ????? Ciszewski A. Cardioprotective effect of influenza and pneumococcal vaccination in patients with cardiovascular diseases. Vaccine 2018;36(2):202–206.

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