Myocardial infarction vaccine? Evidence supporting the influenza vaccine for secondary prevention

Abstract

This editorial refers to ‘Influenza vaccination reduces cardiovascular events in patients with acute coronary syndrome’, by A. Phrommintikul et al. doi:10.1093/eurheartj/ehr004 Coronary heart disease (CHD) is one of the leading causes of morbidity and mortality worldwide. Both primary and secondary prevention strategies thus far substantially reduce the risk of acute cardiovascular events, but still a substantial number of patients have outcomes. As a result, there has been a call for newer avenues for risk reduction. The complex interplay between infection and atherosclerosis has been under scientific scrutiny for years. Many organisms have been implicated, including herpesviruses, Chlamydia pneumoniae , Mycoplasma pneumoniae , periodontal pathogens, and many others.1 There was much excitement regarding C. pneumoniae given its association with CHD and animal models suggesting a direct involvement in the pathogenesis of atherosclerosis, but trials using suppressive antibiotic therapy failed to show a reduction in clinical events.2,3 Although the evidence for chronic infections of intracellular pathogens and atherosclerosis exists, it was speculated that infection in CHD had begun the process of atherosclerosis decades before, thereby limiting the ability to employ antibiotic treatment so late in the evolution of CHD. However, the paradigm of inflammation significantly contributing to atherosclerosis and triggering acute cardiovascular events is firmly established, and as such there has been a continued interest in the role of infection as a contributor to this inflammatory response. Of acute infectious organisms, the influence of the influenza virus has been closely examined since it is one of the most severe respiratory viral pathogens and essentially the only one with …