Vaccines for the Heart — How Preventing Infections Protects Against Heart Attacks and Stroke
Vaccines for the Heart — How Preventing Infections Protects Against Heart Attacks and Stroke
Source:
From discussions and Zoom inputs during the Heart Failure & Prevention, Public Health and National Campaigns, and Heart Transplant & Advanced Heart Failure Roundtable sessions — First Regional Arab Protocols Conference (Amman, Oct 16–17, 2025, based on AHA -ESC preventive protocols
Keynotes:
1. Acute infections increase risk of cardiovascular (CV) events, and patients with heart disease are more vulnerable to such infections.
2. Infection → systemic inflammation (cytokine surge, oxidative/immune activation, endothelial dysfunction) → supports atherogenesis and plaque vulnerability.
3. Infection → hypercoagulability (↑ fibrinogen, thrombin activity, platelet binding) → increased thrombosis risk, triggering acute coronary events.
4. Physiologic stress during infection (fever/hypoxia/↑ metabolic demand/hypotension/sympathetic activation) → demand ischemia or arrhythmia → Type-2 MI, atrial fibrillation etc.
5. Some pathogens directly damage the myocardium (viral myocarditis) → heart failure or sudden death.
6. Epidemiological evidence: e.g., laboratory-confirmed influenza markedly increases risk of acute myocardial infarction in the first week (incidence ratio ~6.05).
7. There is a bidirectional relationship: existing CVD ↑ risk of severe infection, and infection ↑ risk of CV events → vaccination as a cardioprotective strategy.
8. Vaccination acts upstream by preventing infection-triggered inflammation and thereby reducing acute CV events in both high-risk and healthy populations.
9. For influenza vaccine: meta-analysis in ischemic heart disease/heart failure showed ~26% relative reduction in major CV events (HR ~0.74).
10. Real-world data: large English study (n≈193,900) aged 40-84 found 28% lower risk of first acute CV event in days 15-28 after influenza vaccination.
11. Greater baseline CV risk → greater absolute vaccine benefit (e.g., early post-MI patients).
12. Other vaccinations with CV associations:
a) COVID-19 full vaccination → substantially lower early CV events after SARS-CoV-2 infection.
b) Pneumococcal vaccine in elderly → ~12% reduction in CV outcomes.
c) Herpes zoster (HZ) vaccine in diabetics → HR 0.76 for major adverse CV events (MACE), HR 0.73 for coronary disease, HR 0.79 for stroke, HR 0.54 for all‐cause mortality.
13. Mechanistic rationale: preventing infection => avoiding inflammation/endothelial injury/plaque destabilization/thrombosis.
14. Clinical guidelines/consensus: e.g., European Society of Cardiology endorses vaccination as part of CV prevention for high-risk groups.
15. Implementation challenges and research gaps: optimal vaccine dose (standard vs high), timing/boosters, combination vaccines (e.g., influenza + RSV), new platforms — ongoing trials.