Influenza Vaccination to Reduce Cardiovascular Morbidity and Mortality in Patients With COVID-19: JACC State-of-the-Art Review

Abstract

Viral respiratory infections are risk factors for cardiovascular disease (CVD). Underlying CVD is also associated with an increased risk of complications following viral respiratory infections, including increased morbidity, mortality, and health care utilization. Globally, these phenomena are observed with seasonal influenza and with the current coronavirus disease 2019 (COVID-19) pandemic. Persons with CVD represent an important target population for respiratory virus vaccines, with capacity developed within 3 large ongoing influenza vaccine cardiovascular outcomes trials to determine the potential cardioprotective effects of influenza vaccines. In the context of COVID-19, these international trial networks may be uniquely positioned to redeploy infrastructure to study therapies for primary and secondary prevention of COVID-19. Here, we describe mechanistic links between influenza and COVID-19 infection and the risk of acute cardiovascular events, summarize the data to date on the potential cardioprotective effects of influenza vaccines, and describe the ongoing influenza vaccine cardiovascular outcomes trials, highlighting important lessons learned that are applicable to COVID-19.

Keywords: acute myocardial infarction; cardioprotection; heart failure; influenza vaccination.

Graphical abstract

Figure 1

Comparison of Seasonal Influenza Vaccine Effectiveness Between 2015 and 2019 There has been a modest decrease in overall influenza vaccine effectiveness between 2015 and 2019 among individuals of all ages and those age ≥65 years, with the largest reduction in vaccine effectiveness seen against H3N2. Zero-valued columns are included to denote cases of missing data from the Centers for Disease Control and Prevention (CDC) Influenza Effectiveness National Report (132). BV = B/Victoria lineage; BY = B/Yamagata lineage.

Central Illustration

Leveraging Influenza Vaccine Cardiovascular Outcome Trials for Coronavirus Disease 2019 Lessons learned from seasonal influenza vaccine development and mass production as well as 3 international influenza vaccine cardiovascular outcome trials assessing its cardioprotective effects in high-risk patients (INVESTED [INfluenza Vaccine to Effectively Stop cardioThoracic Events and Decompensated heart failure], IAMI [Influenza Vaccination After Myocardial Infarction], and IVVE [Influenza Vaccine to Prevent Adverse Vascular Events]) can inform future efforts geared at developing and evaluating novel therapies, including vaccine strategies, for coronavirus disease 2019 (COVID-19). On the world map, regions in dark blue, teal, and light blue represent countries involved in the INVESTED, IVVE, and IAMI trials, respectively.