Influenza vaccination: Simple, safe, and effective for patients with ischaemic heart disease and heart failure.

Influenza vaccination and cardiovascular events in patients with ischaemic heart disease and heart failure: A meta-analysis. B This article refers to 'Influenza vaccination and cardiovascular events in patients with ischaemic heart disease and heart failure: A meta-analysis' by D. Modin I et al i ., published in this issue on pages 1685-1692. b Annual influenza epidemics are estimated to cause between 290 000-650 000 respiratory deaths per year - however, this estimate does not include cardiovascular (CV) deaths.[1] Influenza infection is associated with increased risk of CV events, particularly among individuals at high CV risk.[2] Multiple pathophysiological mechanisms have been proposed to explain the associated increase in CV outcomes in individuals with influenza infection, such as atherosclerotic plaque rupture and an increased risk of atherothrombosis (secondary to the release of pro-inflammatory cytokines resulting in a pro-thrombotic milieu, influx of inflammatory cells, plaque destabilization, and endothelial dysfunction), increased metabolic demand due to sympathetic activation (leading to tachycardia and hypoxaemia, exacerbating supply-demand mismatch), or by direct viral effect or triggering of myocarditis.[[3]] Influenza vaccination (IV) is widely acknowledged as the most effective way to prevent seasonal influenza, reduce disease severity, and lower the incidence of complications and deaths.[1] It is, therefore, intuitive that IV might reduce the risk of CV events in at-risk patients, although until recently randomized controlled trials (RCTs) specifically addressing this hypothesis were small and varied in quality. Five of the six trials included patients with IHD, while the recently published Influenza Vaccine to Prevent Adverse Vascular Events (IVVE) trial included patients with HF.[6] The follow-up duration ranged from 10 to 36 months. [Extracted from the article]