The arrival at the hospital as soon as possible. The care of the case. And then, as soon as the situation has stabilized, the vaccine to protect against the flu. After a heart attack, or in any case a high-risk coronary artery disease that required hospitalization, the flu vaccine appears to be able to limit the risk of death in those who have had a heart attack or a serious impairment of the circulation of the heart. . A few days after the start of the vaccination campaign for the most classic of seasonal infections, with the proposal to immunize those in hospital for heart problems without waiting too long, is a research presented at the congress of the European Society of Cardiology, the study Iami (Influenza Vaccination and Myocardial Infarction), developed specifically to assess whether influenza vaccination improves outcomes after myocardial infarction or percutaneous coronary intervention in high-risk patients with coronary artery disease
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The study was conducted in 30 hospitals in eight countries (Sweden, Denmark, Norway, Latvia, United Kingdom, Czech Republic, Bangladesh and Australia) for four flu seasons from October 2016 to February 2020, thus in the pre-Covid era. The principal investigator is Ole Fröbert dell’University of Örebro, in Sweden. The research examined over 2570 people, with an average age of 60: in more than four out of five cases they were men. The subjects considered were divided into two groups, randomly: in the first the vaccine was administered after a procedure on the coronary arteries, such as stent placement, or after a heart attack, within three days of hospitalization, in the second a simple placebo . Then they went to check for deaths from all causes, myocardial infarction or stent thrombosis one year after admission.
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At twelve months death occurred in 5.3% of vaccinated subjects, compared to 7.2% in people who had not received the vaccine. In particular, death from any cause was more than doubled in the unvaccinated, while no significant differences were found for deaths directly linked to heart attacks. All this, it must be said, without particular differences for the side effects even if in the case of vaccination small local disturbances were more frequent in the area where the injection was made. According to Fröbert, “the IAMI study found that in patients with high-risk myocardial infarction or coronary artery disease, early flu vaccination resulted in a lower risk of all-cause death, myocardial infarction or stent thrombosis at 12 months compared to placebo. ”
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Direct consequence in health terms? Influenza vaccination could also be considered as part of treatment strategies for the person who has survived a heart attack. It is not for nothing that the European Society of Cardiology itself has long included the vaccination in measures with level of protection 1, such as drugs to lower cholesterol, for the “heart” risk linked to viral infection. In fact, there are already several studies that show that the attack of the flu virus can be particularly harmful to the heart, especially in those with already serious circulatory problems. The most credited hypothesis to explain the relationship correlates influenza virus infection with the inflammation it induces in the body. Inflammation, which is fundamental for the body that has to react to the virus, in fact induces a series of phenomena that in some way turn out to be harmful to the heart: first of all tachycardia, since fever increases the frequency of the heartbeat, and hence the stress to which the heart wall is exposed. But also the possible lack of oxygen, the release of cytokines (substances that induce inflammation), the excessive response of the sympathetic nervous system and the consequent “stress” which is also reflected on the musculature of the arteries also count.
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The end result is simple: if there is a plaque along a coronary artery it can become more “unstable” and rupture. The substances that compose it, such as fats or materials that are released and what happens to heal the “wound” on the arterial wall can lead to thrombosis, with occlusion of the vessel itself and the appearance of ischemia. As if that were not enough, sometimes the flu virus also finds space in “territories” where it should not replicate itself, outside the respiratory system. When this happens, myocarditis can occur, i.e. inflammation of the myocardium with the consequent possible onset of decompensation and even serious arrhythmias.
Cardiovascular prevention, an appeal for heart health
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