Abstract
The COVID-19 pandemic has spurred clinical and scientific interest in the cardiology community because of the significantly enhanced vulnerability of patients with underlying cardiac diseases. COVID-19 vaccination is therefore of vital importance to the patients we see in our clinics and hospitals every day and should be promoted by the medical community, especially cardiologists. In view of vaccine-preventable diseases, the association between influenza and cardiovascular complications has been widely investigated. Several studies have found a substantially elevated risk of hospital admission for acute myocardial infarction in the first 7 days after laboratory-confirmed influenza, with incidence ratios ranging from 6.05–8.89. The effectiveness of the influenza vaccine to protect against acute myocardial infarction is about 29%. This effectiveness is comparable to or even better than that of existing secondary preventive therapies, such as statins (prevention rate approximately 36%), antihypertensives (prevention rate approximately 15–18%), and smoking cessation (prevention rate approximately 26%). As the influenza season is rapidly approaching, this Point of View article serves as a call to action: Cardiologists should promote influenza vaccination and actively advice their patients to get the seasonal influenza vaccination.
Highlights
The COVID-19 pandemic has spurred clinical and scientific interest in the cardiology community because of the significantly enhanced vulnerability of patients with underlying cardiac diseases
One proposed mechanism of this increased vulnerability is the fact that the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) enters the cells by binding to the angiotensinconverting enzyme 2 receptor, which is abundantly present in heart and blood vessels [2, 3]
Annual epidemics are caused by influenza A and B viruses, whereas pandemics are caused by influenza A virus
Summary
Besides its involvement in respiratory tract infections, the burden of influenza carries broader consequences, including the effects on cardiovascular diseases (myocarditis, ischaemic heart disease, stroke) [13], chronic respiratory conditions (e.g. asthma exacerbation), diabetes mellitus (e.g. aggravating diabetic ketoacidosis or influenza complications due to chronic hyperglycaemia), neurologic complications (e.g. febrile seizures, influenza-associated encephalitis or encephalopathy, Guillain-Barré syndrome, exacerbations in patients with epilepsy), co-infections and secondary infections [6]. Several hypotheses exist that explain the ways influenza can trigger cardiovascular events, mainly through the activation of inflammatory and coagulation pathways [18,19,20] This theory has been substantiated by a recent study, which showed that patients with elevated white blood cell and platelet counts are at higher risk of developing acute MI [16]. Influenza virus infection could lead to destabilisation of already susceptible atherosclerotic plaques, which could eventually result in coronary artery occlusion and acute MI Another mechanism describes features of infection, which cause inadequate coronary perfusion through increased metabolic demand with fever, tachycardia and hypoxia [20, 21]. Length of stay is increased in patients with acute MI and influenza compared with acute MI alone [22]
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