EDITORIAL Year : 2023  |  Volume : 14  |  Issue : 2  |  Page : 67-68

Cardiovascular effects of adult vaccines

Nitin Sethi1, Ashwani Kumar1, Nirupam Prakash2
1 Department of Cardiology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
2 Consultant Physician, CHS, Lucknow, Uttar Pradesh, India

Date of Submission15-May-2023Date of Decision16-Jun-2023Date of Acceptance16-Jun-2023Date of Web Publication04-Jul-2023

Correspondence Address:
Dr. Nitin Sethi
Department of Cardiology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injms.injms_47_23

How to cite this article:
Sethi N, Kumar A, Prakash N. Cardiovascular effects of adult vaccines. Indian J Med Spec 2023;14:67-8
  Introduction 

Vaccines have played a crucial role in preventing infectious diseases and reducing their associated morbidity and mortality. While the primary focus of vaccination has traditionally been on infectious diseases, recent research suggests that certain adult vaccines may have additional benefits for cardiovascular health. Infections are known to trigger acute cardiovascular including cerebrovascular events.[1] COVID-19 disease was also associated with adverse cardiovascular events. In fact, some controversy exists even with COVID-19 vaccines, the administration of which has been linked to an increase in cardiovascular morbidity and mortality. However, exploring the cardiovascular effects of adult vaccines can provide valuable insights into their potential in preventing cardiovascular diseases, which are a leading cause of global mortality.

  Influenza Vaccine and Cardiovascular Health 

Epidemiological studies have established a link between influenza infection and an increased risk of cardiovascular events, including myocardial infarction and stroke. The influenza vaccine has been associated with reduced cardiovascular morbidity and mortality. For example, a study by Udell et al.[2] demonstrated that influenza vaccination was associated with a 36% reduction in the risk of major adverse cardiovascular events.

The cardiovascular benefits of the influenza vaccine may be attributed to several mechanisms. The vaccine can modulate systemic inflammation, which plays a crucial role in the pathogenesis of atherosclerosis and plaque rupture. It can also improve endothelial function, enhance the stability of atherosclerotic plaques, and reduce the risk of thrombotic events. For instance, a study by Vardeny et al.[3] showed that influenza vaccination improved endothelial function in patients with heart failure. Influenza vaccine also appears to have a role in secondary prevention of acute myocardial events in patients of coronary artery disease.[4]

  Pneumococcal Vaccine and Cardiovascular Health 

Pneumococcal infection has been associated with an increased risk of cardiovascular events, such as myocardial infarction and stroke. The pneumococcal vaccine has demonstrated cardiovascular benefits by reducing the incidence of these events. A meta-analysis by Phung et al.[5] revealed a significant reduction in the risk of cardiovascular events among individuals who received the pneumococcal vaccine.

The cardioprotective effects of the pneumococcal vaccine may be mediated through various mechanisms. The vaccine can reduce systemic inflammation and endothelial dysfunction, which are key factors in the development and progression of cardiovascular diseases. By preventing pneumococcal infection, the vaccine may indirectly protect against cardiovascular events. In addition, the choice of pneumococcal vaccine formulation may impact its effectiveness in preventing cardiovascular events. For instance, a study by Moberley et al.[6] found that the pneumococcal conjugate vaccine was more effective than the pneumococcal polysaccharide vaccine in preventing invasive pneumococcal disease, including cardiovascular complications.

  Herpes Zoster Vaccine and Cardiovascular Health 

Herpes zoster (shingles) infection has been associated with an increased risk of cardiovascular events, including stroke and myocardial infarction. The herpes zoster vaccine has shown efficacy in preventing shingles and related complications, and emerging evidence suggest potential cardiovascular benefits. A study by Asghar Z, et al.[7] demonstrated that herpes zoster vaccination was associated with a reduced risk of stroke in older adults.

The cardiovascular benefits of herpes zoster vaccine may be attributed to various mechanisms. The vaccine can modulate inflammation and prevent vascular damage, thereby reducing the risk of cardiovascular events. By preventing herpes zoster infection, the vaccine may indirectly protect against associated cardiovascular complications.

  Shared Mechanisms Underlying Cardiovascular Benefits 

Several shared mechanisms contribute to the cardiovascular benefits observed with adult vaccines. Immunomodulation plays a vital role, as vaccines can reduce systemic inflammation, attenuate the inflammatory response to infections, and modulate the immune system's reaction to cardiovascular stressors. This immunomodulatory effect can help reduce the risk of atherosclerosis, plaque rupture, and subsequent cardiovascular events.

Vaccines can have direct and indirect effects on endothelial function. Direct effects involve improving endothelial health and function, which is crucial for maintaining vascular integrity and reducing the risk of cardiovascular diseases. For instance, the influenza vaccine has been shown to improve endothelial function in patients with heart failure, as demonstrated by a study conducted by Vardeny et al.[3]

Indirect effects of vaccines on endothelial function involve their ability to prevent infections that can trigger endothelial dysfunction and subsequent cardiovascular events. By reducing the incidence of infectious diseases, vaccines indirectly contribute to maintaining endothelial health and preventing cardiovascular complications associated with infections.

Furthermore, vaccines can modulate autonomic tone and cardiovascular regulation. The immune system and autonomic nervous system are interconnected, and vaccines can influence autonomic regulation, including sympathetic and parasympathetic activity, which can have implications for cardiovascular health. For example, the influenza vaccine has been shown to improve autonomic function and reduce sympathetic overactivity, as reported in a study by Frasure-Smith et al.[8]

Coagulation and thrombosis pathways are also impacted by vaccines, potentially reducing the risk of thrombotic events. Vaccines can influence the balance between procoagulant and anticoagulant factors, leading to a more favorable coagulation profile. This can help prevent the formation of blood clots and reduce the risk of cardiovascular events associated with thrombosis.

It is important to note that the mechanisms discussed above are not exclusive to a specific vaccine but rather represent shared pathways through which various adult vaccines may exert their cardiovascular benefits. However, the specific mechanisms and magnitude of effects may vary depending on the vaccine and the individual's characteristics.

  Clinical Implications and Future Directions 

The observed cardiovascular benefits of adult vaccines have significant clinical implications. Integrating adult vaccines, such as influenza, pneumococcal, and herpes zoster vaccines, into cardiovascular disease prevention strategies can provide an additional layer of protection against cardiovascular events.

Health-care professionals should consider the incorporation of adult vaccines into routine cardiovascular care, particularly for high-risk populations, including individuals with preexisting cardiovascular conditions. Vaccination should be viewed as an integral part of comprehensive cardiovascular risk management.

Further research is warranted to better understand the mechanisms underlying the cardiovascular effects of adult vaccines and their long-term implications. Future studies should explore the potential development of novel vaccines specifically targeting cardiovascular pathways, with the aim of optimizing cardiovascular disease prevention strategies and improving public health outcomes.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med 2004;351:2611-8.  
    2.Udell JA, Zawi R, Bhatt DL, Keshtkar-Jahromi M, Gaughran F, Phrommintikul A, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: A meta-analysis. JAMA 2013;310:1711-20.  
    3.Vardeny O, Sweitzer NK, Detry MA, Moran JM, Johnson MR, Hayney MS. Decreased immune responses to influenza vaccination in patients with heart failure. J Card Fail 2009;15:368-73.  
    4.Ciszewski A, Bilinska ZT, Brydak LB, Kepka C, Kruk M, Romanowska M, et al. Influenza vaccination in secondary prevention from coronary ischaemic events in coronary artery disease: FLUCAD study. Eur Heart J 2008;29:1350-8.  
    5.Phung DT, Wang Z, Rutherford S, Huang C, Chu C, Wang X. Pneumococcal vaccination prevents acute myocardial infarction in adults: A systematic review and meta-analysis. Vaccine 2015;33:6235-40.  
    6.Moberley S, Holden J, Tatham DP, Andrews RM. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev 2013;2013:CD000422.  
    7.Asghar Z, Coupland C, Siriwardena N. Influenza vaccination and risk of stroke: Self-controlled case-series study. Vaccine 2015;33:5458-63.  
    8.Frasure-Smith N, Lespérance F, Irwin MR, Talajic M, Pollock BG. The relationships among heart rate variability, inflammatory markers and depression in coronary heart disease patients. Brain Behav Immun 2009;23:1140-7.