Abstract
Concern has been raised about the effectiveness of the coronavirus disease 2019 (COVID-19) vaccine in the population of patients with various comorbidities such as heart disease. We investigated the humoral response to the BNT162b2 mRNA COVID-19 vaccine in patients with cardiovascular disease (CVD). We measured IgG against severe acute respiratory syndrome coronavirus 2 spike receptor-binding domain (RBD-IgG) in 85 CVD patients and 179 healthcare workers (HCWs). Blood samples were collected from patients and HCWs three times: (1) before the first dose of vaccination, (2) two weeks after the first dose of vaccination, and (3) two weeks after the second dose of vaccination. Patients with CVD showed a significantly inferior serological response to the BNT162b2 mRNA COVID-19 vaccine at 14 days after the prime dose compared to HCWs (21% vs. 95%, p < 0.001). Median RBD-IgG titers of patients with CVD at 14 days after the second dose were significantly lower than those of HCWs (137.2 U/mL (80.6–200.4 U/mL) vs. 176.2 U/mL (123.9–260.0 U/mL), p < 0.001). In multivariable analyses, CVD is significantly associated with seropositivity after first vaccination and RBD-IgG titers after second vaccination. CVD patients may have a poor humoral response to the BNT162b2 mRNA COVID-19 vaccine, need to be closely monitored, and require earlier revaccination to ensure stronger immunity and protection against infection.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a widespread impact on health, including a substantial mortality among patients with various pre-existing health conditions [1]
No data are available regarding the vaccine effectiveness in patients with cardiovascular disease (CVD) alone. This prompted us to investigate the humoral response of patients with CVD to the BNT162b2 mRNA COVID-19 vaccine compared to that in healthcare workers (HCWs)
Patients who had the following characteristics were excluded from the study: (1) suspected current SARS-CoV-2 infection, such as those with fever and/or respiratory symptoms, (2) a previous diagnosis of COVID-19, (3) clinical or electrocardiographic evidence suggestive of an acute coronary syndrome (ACS) or coronary revascularization during the previous 6 months, (4) symptomatic heart failure, (5) having an active malignant disease being treated with chemotherapy or radiation, and (6) having any autoimmune diseases
Summary
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a widespread impact on health, including a substantial mortality among patients with various pre-existing health conditions [1]. Vaccination against SARS-CoV-2 is generally recommended in patients with CVD, as is vaccination against other infectious agents. A nationwide mass vaccination study focused on the estimated vaccine effectiveness of patients with various comorbidities such as heart disease [6]. No data are available regarding the vaccine effectiveness in patients with CVD alone. This prompted us to investigate the humoral response of patients with CVD to the BNT162b2 mRNA COVID-19 vaccine compared to that in healthcare workers (HCWs)
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