[流感疫苗作为心血管疾病的二次预防]
Albert M Vollaard1,2, Edwin N E Slok1, Paul R M van Dijkman3
1RIVM, Centrum Infectieziektebestrijding, Bilthoven.
Nederlands tijdschrift voor geneeskunde
|October 12, 2023
概括
流感疫苗接种在心脏病患者中显著减少心血管死亡和主要心血管不良事件 (MACE),包括心肌梗塞后和心力衰竭患者. 这种安全的二次预防策略未得到充分利用,应该得到更广泛的采用.
科学领域:
- 心脏病学 心脏病学
- 传染性疾病 传染性疾病
- 预防医学 预防医学
背景情况:
- 流感感染在患有先前心脏病的患者中,对心血管并发症和死亡的风险很大.
- 虽然观察性研究表明有好处,但缺乏高质量的证据证明流感疫苗接种对心脏病患者心血管结果的影响.
- 以前的研究表明,冠状动脉疾病患者的潜在益处,但需要强有力的数据.
研究的目的:
- 评估流感疫苗在降低心血管重大不良事件 (MACE) 和心血管疾病患者心血管死亡率方面的疗效.
- 从随机对照试验 (RCT) 提供高质量的证据,证明流感疫苗接种对心血管的益处.
- 评估流感疫苗接种对特定心脏病患者群体的临床益处,包括心肌梗塞后和心力衰竭患者.
主要方法:
- 在心肌梗塞发生后不久的患者中进行了一项随机对照试验 (RCT).
- 在心力衰竭患者中进行了第一个发表的RCT,将流感疫苗接种与安慰剂进行了比较.
- 使用元分析来综合数据并估计MACE的整体风险降低.
主要成果:
- 接种流感疫苗显著降低了心肌梗塞后患者的MACE和心血管死亡风险.
- 心力衰竭患者的RCT表明,在流感季节接种流感疫苗的临床益处.
- 分析表明,在心脏病患者接种流感疫苗后,MACE的潜在风险降低至少25%.
结论:
- 流感疫苗接种是心脏病患者的有效和安全的二次预防策略.
- 这些发现证实了先前的观察性研究中观察到的临床益处.
- 建议在心脏病患者中增加流感疫苗的使用,以减轻心血管风险.
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