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Impact of Influenza Vaccination on Mortality and Major Cardiovascular Events in Adults with Cardiovascular Disease: A
Sitah Alotaibi1, Mazen Bostaji2, Anas Alharbi3
1Faculty of Nursing, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia.
Insights
Influenza vaccination significantly reduces cardiovascular events and cardiovascular mortality in adults with established cardiovascular disease (CVD). However, it does not significantly lower all-cause mortality, indicating its role in secondary CVD prevention.
Area of Science:
- Cardiology
- Immunology
- Public Health
Background:
- Cardiovascular disease (CVD) is a major global health burden.
- Seasonal influenza outbreaks are known triggers for acute cardiovascular events.
- The role of influenza vaccination in secondary CVD prevention requires clarification.
Purpose of the Study:
- To evaluate the efficacy of influenza vaccination in reducing mortality and major cardiovascular events in adults with established CVD.
- To synthesize evidence from randomized controlled trials (RCTs) on influenza vaccination's impact on cardiovascular outcomes.
Main Methods:
- Systematic review and meta-analysis of RCTs.
- Searched PubMed, Google Scholar, and CENTRAL up to November 2025.
- Included RCTs comparing influenza vaccine to placebo or standard care in adults with established CVD.
- Assessed study quality using the Cochrane Risk of Bias tool 2.
Main Results:
- Eight RCTs met inclusion criteria.
- Influenza vaccination significantly reduced a composite outcome of all-cause mortality, acute myocardial infarction, and stent thrombosis (OR 0.71).
- Major adverse cardiovascular events were significantly decreased (OR 0.44).
- Cardiovascular mortality was significantly lower in vaccinated individuals (OR 0.64).
- All-cause mortality was not significantly reduced (OR 1.13).
Conclusions:
- Influenza vaccination is associated with reduced cardiovascular events and cardiovascular mortality in adults with established CVD.
- The vaccine's effect on all-cause mortality remains inconclusive.
- Supports routine influenza vaccination as an adjunctive strategy for secondary CVD prevention.
Abstract:
Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide, and seasonal influenza is a recognized trigger of acute cardiovascular events. The influenza vaccine has been proposed as a secondary preventative measure, though the benefits regarding mortality and cardiovascular events are unclear. Objective: This study aimed to establish the efficacy of influenza vaccination in lowering mortality and major cardiovascular events in adults suffering from established CVD. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Eligible studies were identified from PubMed, Google Scholar, and The Cochrane Central Register of Controlled Trials (CENTRAL) through November 2025. RCTs involving adults with established CVD evaluating influenza vaccine impact in comparison to placebo or standard care were included. The Cochrane Risk of Bias tool 2 was used to evaluate study quality. Results: A total of eight RCTs met the inclusion criteria. Influenza vaccination was associated with a statistically significant decrease in the composite outcome (of all-cause mortality, acute myocardial infarction, and stent thrombosis) (OR 0.71, 95% CI 0.57-0.90; p = 0.004; I2 = 0%) and major adverse cardiovascular events (OR 0.44, 95% CI 0.26-0.74; p = 0.002; I2 = 0%). Cardiovascular mortality was found to be significantly lower in the vaccination group (OR 0.64, 95% CI 0.47-0.86; p = 0.003). However, all-cause mortality was not significantly reduced (OR 1.13, 95% CI 0.79-1.62; p = 0.50; I2 = 88%). Conclusions: Influenza vaccination was associated with a reduction in combined cardiovascular events and mortality due to cardiovascular causes in adults diagnosed with established CVD. In contrast, all-cause mortality was not significantly reduced, and the evidence for this outcome was inconclusive. This supports the routine use of the vaccine as an adjunctive measure in the secondary prevention of CVD.
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