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Flu Vaccination May Provide Surprise Benefit
If you're one of the millions with coronary artery disease, avoiding the flu may turn out to be one of the best things you can do for your heart. Acute respiratory infection, such as commonly occurs with influenza, is being suggested as a possible trigger for myocardial infarctions (MI), more commonly known as heart attacks.
Presenting for his team of researchers at the 49th Annual Scientific Session of the American College of Cardiology being held in Anaheim, California, Morteza Naghavi, M.D. from the University of Texas Houston Health Science Center, investigated if getting a flu shot reduced the risk of having a recurrent heart attack for people with chronic coronary artery disease (atherosclerosis).
At least 50 studies since the 1980s show that infection with certain microorganisms, such as Chlamydia pneumoniae or cytomegalovirus, may lead to the inflammation of the coronary vessels, atherosclerosis and eventual heart attack. If this theory is correct, asks Dr. Naghavi, then would preventing influenza by vaccination reduce the risk of heart attack?
In Dr. Naghavi's study of 233 participants, those that received a flu shot reduced their risk of suffering an additional heart attack by 67 percent.
Participants for the study were chosen from a group of people with a history of a heart attack and who were seen during flu season for their regular follow up visit. Researchers tracked a number of variables to determine what factors, if any, affected the risk of having another MI.
Four factors were shown to have a significant effect on the risk of a MI recurrence:
~ Current hypertension (increase)
~ Current high cholesterol (increase)
~ Current smoking (increase)
~ Influenza vaccination (decrease)
The connection between influenza and heart disease dates back to the severe influenza epidemics in the early 1900s, which culminated in 1918. While some influenza strains were virulent enough to kill people in a matter of hours, half of the deaths were attributed to causes other than flu, such as heart disease.
Should the flu vaccine prove to be protective against MI, Dr. Naghavi urges that both consumers and physicians be further educated in order to increase the number of people who are immunized. Currently, less that 65 percent of the population receives a flu shot.
In addition, he also recommends investigating the pneumococcal vaccine, which protects against some types of pneumonia, to see if it too may also protect against a heart attack.
Editorial comment: Many physicians continue to question the validity of trials such as the one reported here for PTMR. The basic logic for the procedure, developed 3-4 years ago, was that new vascular channels would be created by the laser to feed ischemic tissue. This clearly does not occur as the new channels are closed within days as demonstrated in animal studies and in those individuals who have died. The procedure is not risk free as there have been many reported deaths.
The validity of the data supporting its efficacy has to be carefully scrutinized. It is well known that all procedures have a placebo effect. Clearly, more studies are needed with objective endpoints before this procedure can be considered an option for angina patients. It is likely that these patients will have other treatment options soon: gene therapy and angiogenic growth factor therapy trials have been extremely promising.
Editorial comment: There are two important things to consider from this study. First, there may be an association between bacterial infection and the development of plaques. There is now an impressive body of literature supporting such a possibility. Antibiotics may serve as protective agents against plaque rupture but this remains to be proven in a large-scale prospective study.
The second possibility is that flu increases stress on a person who has heart disease and thereby increases heart attack risk. Influenza may not cause plaque rupture but may induce heart attacks, because the heart rate is increased during fever. And increases in heart rate place heavier demands on the heart. Doctors and patients with heart disease should consider vaccinations against pneumonia and influenza yearly. Furthermore, fever should be lowered in people with heart disease (especially the elderly) because it induces chest pain and heart attacks.