Nirali Thakkar: Influenza and Myocardial Infarction An Unexpected Cardiovascular Connection
Nirali Thakkar, Associate Consultant at KIMS Hospitals, shared a post on LinkedIn:
“Can influenza trigger a myocardial infarction?
The evidence behind an unexpected cardiovascular connection.
A respiratory infection may be more than just a respiratory event.
A landmark study published in the New England Journal of Medicine in 2018, ‘Acute Myocardial Infarction after Laboratory Confirmed Influenza Infection’ by Kwong et al., reported a sixfold increase in the incidence of acute myocardial infarction during the first 7 days after laboratory confirmed influenza infection.
What could explain this association?
Systemic inflammation and endothelial dysfunction
Increased prothrombotic activity
Plaque destabilization
Increased myocardial oxygen demand during acute illness
But here is where influenza vaccination becomes particularly interesting.
The IAMI trial (Influenza Vaccination After Myocardial Infarction), published in Circulation in 2021, evaluated influenza vaccination in patients with recent myocardial infarction or high risk coronary disease.
At 12 months, the primary composite outcome of all-cause death, myocardial infarction or stent thrombosis occurred in:
5.3 percent of the influenza vaccine group
7.2 percent of the placebo group
Cardiovascular mortality was also lower in the vaccinated group (2.7 percent vs. 4.5 percent).
The trial was stopped early during the COVID 19 pandemic, and the findings need to be interpreted in that context.
The clinical takeaway:
Influenza vaccination is not merely about preventing seasonal respiratory illness.
It may also have an important role in cardiovascular risk reduction, particularly in patients with established coronary artery disease.
An important question for clinical practice:
Should influenza vaccination become a more routinely discussed component of secondary cardiovascular prevention?”
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