Vaccines Now Seen as Key to Heart Health

European cardiology group urges proactive use of immunizations

Beyond their direct protection against infectious diseases, vaccines are now recognized for their significant impact on cardiovascular health. The European Society of Cardiology (ESC) has released a consensus statement advocating for routine vaccinations as a critical component of managing cardiovascular risk.

New Pillar of Prevention

The ESC statement boldly asserts that “vaccinations have profound effects on the CV [cardiovascular] risk and as such should be considered the fourth pillar of medical CV prevention besides antihypertensives, lipid-lowering drugs, and medications that treat diabetes.”

This recommendation builds upon earlier guidelines. For example, in 2021, the ESC recommended influenza and pneumococcal vaccines to prevent heart failure-related hospitalizations. Similarly, the American Heart Association (AHA) and American College of Cardiology (ACC) advised annual flu shots for those with chronic coronary disease.

According to Dr. Thomas F. Lüscher, a corresponding author of the ESC document, this new statement emphasizes the extensive evidence linking infectious diseases to cardiovascular issues. Lüscher is the current president of the ESC and a consultant cardiologist at King’s College and Imperial College in London.

Growing Evidence Base

Dr. Lüscher suggests the timing of this statement is crucial, owing to increased research into vaccines for diseases such as SARS-CoV-2 and RSV. He stated that vaccinations for influenza, pneumococcus, and SARS-CoV-2 can be recommended to lower cardiovascular event risk based on “reasonably solid evidence.”

Infectious diseases raise myocardial oxygen consumption and trigger inflammatory pathways. Dr. Lüscher and his coauthors anticipate that vaccinations for other infectious diseases may soon be recommended as well. The ongoing And-RSV trial in Denmark, involving 130,000 participants, may offer more insight, especially for RSV.

While vaccines must demonstrate a favorable risk-benefit ratio for approval, the ESC statement stresses that people with coronary artery disease gain an additional health benefit from certain vaccines via reduced cardiovascular risk. According to KFF, about 27% of adults in the U.S. have some type of cardiovascular disease (KFF).

Weighing Risks and Benefits

Major complications from approved vaccines occur in fewer than 10 per 100,000 patients, according to the ESC. Milder adverse events, such as injection site reactions, are generally tolerable given the benefit of lowering cardiovascular event risk.

Myocarditis has been reported as a rare side effect of the SARS-CoV-2 vaccine, mainly in younger men, but usually resolves spontaneously and is rarely severe. The risk of myocarditis from untreated COVID-19 is estimated to be six times higher than from vaccination, the statement notes.

Key Studies Highlight Benefits

Trials with influenza and pneumococcal vaccines have provided the strongest evidence for cardiovascular benefits.

The IAMI trial, a multicenter study, found that influenza vaccination after an acute myocardial infarction was associated with a 41% reduction in cardiovascular death over 12 months.

A meta-analysis of pneumococcal polysaccharide vaccine studies showed a 10% reduction in any cardiovascular event, including acute myocardial infarction, among those aged 65 years or older.

Observational data supports a cardiovascular benefit from the SARS-CoV-2 vaccine, primarily due to protection from severe COVID-19 and long COVID.

While the AHA/ACC guidelines recommend annual influenza vaccination for reducing major cardiovascular events, Suzanne Grant, an AHA spokesperson, acknowledged that “infections can trigger or worsen CV events in people with existing heart disease.” Therefore, vaccinations, at least for influenza, should be administered for cardiac risk reduction.

Dr. Lüscher emphasizes that the ESC consensus statement aims to guide clinicians with an intensive review of evidence, particularly given “the conspiracy theories on vaccination.” He said, “Here, we provide solid evidence that vaccination is more than just prevention or reducing the severity of infection but, indeed, has long-term benefits.”