Influenza Vaccination is Associated with Lower Risk of Acute Coronary Syndrome in Elderly Patients with Chronic Kidney Disease

Abstract

Elderly patients with chronic kidney disease (CKD) are at a higher risk of hospitalization for cardiovascular diseases (CVD). Previous studies have showed that influenza vaccination could reduce the risk of recurrent major cardiovascular events in patients with CVD. However, the effects of influenza vaccination on the reduction of first hospitalizations for acute coronary syndrome (ACS) in elderly patients with CKD remain unknown.We conducted a cohort study using data from the Taiwan Longitudinal Health Insurance Database 1997 to 2008. This cohort study comprised elderly patients (ages ≥55 years) with a recorded diagnosis of CKD (n = 4406) between January 1, 1999, and December 31, 2007. Each patient was followed up until the end of 2008. To minimize the selection bias of vaccine therapy, a propensity score adjustment was applied. The hazard ratio (HR) and 95% confidence interval (CI) for the association between the influenza vaccination and the occurrence of first hospitalization for ACS was evaluated by Cox proportional hazards regression. We further categorized the patients into 4 groups according to their vaccination status (unvaccinated, and total number of vaccinations: 1, 2–3, and ≥4).We found that elderly CKD patients without prior CVD history receiving influenza vaccination exhibited a lower risk of hospitalization for ACS (adjusted HR = 0.35, 95% CI 0.30–0.42; P < 0.001). We observed consistent protective effects regardless of age groups (55–64, 65–74, and ≥75), gender, and seasonality of influenza. When the patients were stratified according to the total number of vaccinations, the adjusted HRs for first ACS hospitalization were 0.62 (95% CI 0.52–0.81), 0.35 (95% CI 0.28–0.45), and 0.13 (95% CI 0.09–0.19) for patients who received 1, 2 to 3, and ≥4 vaccinations. There was a significant trend of decreasing risk of ACS hospitalization with an increasing number of vaccinations.The results of our observational study could strengthen the annual vaccination policy and physicians should be aware of missed opportunities to vaccinate elderly patients with CKD against influenza. The potential public health impact of influenza vaccination, particularly in the elderly CKD patients without a history of CVD, who are at risk for ACS, should be further explored.

Precision Medicine and Vaccination of Older Adults: From Reactive to Proactive (A Mini-Review)

“…In addition, such costs need to be set against the substantial direct saving that will potentially be achieved. Some vaccination studies have already reported a reduction in hospitalization rates greatly exceeding 50% in older patients with comorbidities [15,16].…”

“…Over the 18-month study period, participants receiving both vaccines saw significant reductions in coronary and intensive care admissions of 41 and 55%, respectively [14]. Population-based cohort studies on older adults (> 55 years) with comorbidities that put them at risk for cardiovascular disease found a clear association Gerontology 2020;66:238-248 DOI: 10.1159/000503141 between decreased risk of acute coronary syndrome hospitalization and influenza vaccination [15,16]. The vaccine caused an overall reduction in hospital admissions of 56% for acute coronary syndromes for patients with chronic obstructive pulmonary disease, and 65% for patients with chronic kidney disease (CKD) [15,16].…”

“…However, a growing body of clinical evidence suggests that this perception is misguided, as some vaccine-preventable diseases (VPDs) are clearly implicated in the poor outcomes associated with major NCDs such as ischaemic heart disease, stroke, and some forms of dementia [10][11][12][13]. Supporting these findings, controlled trials have shown that vaccination against VPDs such as influenza can reduce the overall risk of hospitalization and death by 30-50% in older populations with chronic comorbid NCDs, making vaccination a potent tool for improving the overall health of older adults [14][15][16] (Table 1: summary). In this review, we indicate some of the ways that current health policies undervalue adult vaccination as a preventive tool and argue that a more personalized, risk-based approach to vaccination ("P4 Medicine" or "predictive, preventive, personalized, and participatory medicine" [17]) may be a useful complement to traditional public health campaigns.…”

Challenges in adult vaccination

“…In addition, there is the risk that acutebut treatableinfections may have more sequelae in older patients. These include loss of function, and increasing risk of frailty (itself a risk factor for subsequent infections) which is associated with elevated risk for CVD and diabetes [91][92][93]. The goal of life-course immunization, and of the healthy aging agenda in general, is to prevent this downward spiral in older individuals.…”

“…A number of recent studies have shown influenza infection to be a potential trigger for cardiovascular conditions including acute coronary syndromes [95][96][97], and atrial fibrillation [98], with some studies showing that influenza vaccination can lower risk of acute cardiovascular events and mortality in patients with medical co-morbidities [89,92,[98][99][100][101], and others demonstrating an association between influenza vaccination and a reduction in hospitalisations and deaths due to heart failure [102][103][104][105]. In their study evaluating the benefits of influenza and pneumococcal vaccination in individuals aged !65 years, Hung et al found that while both vaccines reduced the risk of ischemic stroke, myocardial infarction and coronary care admissions, benefit was greatest in those receiving both vaccines [106].…”