Influenza vaccine and risk of acute myocardial infarction in a population-based case-control study
Authors
Abajo Iglesias, Francisco José de; Rodríguez Martín, Sara; Barreira Hernández, Diana; Rodríguez Miguel, Antonio; Fernández Antón, Encarnación; [et al.]Identifiers
Permanent link (URI): http://hdl.handle.net/10017/60151DOI: 10.1136/heartjnl-2021-319754
ISSN: 1355-6037
Date
2021-09-17Funders
Instituto de Salud Carlos III
Ministerio de Ciencia e Innovación
Hospital Universitario Príncipe de Asturias
Bibliographic citation
Heart, 2021, v. 108, n. 13, p. 1039-1045
Keywords
myocardial infarction
epidemiology
Document type
info:eu-repo/semantics/article
Version
info:eu-repo/semantics/publishedVersion
Rights
© Author(s) (or their employer(s)) 2021.
Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
Access rights
info:eu-repo/semantics/openAccess
Abstract
Objective To assess the relationship between influenza vaccination and risk of a first acute myocardial infarction (AMI) in the general population by different epidemic periods. Methods This is a population-based case?control study carried out in BIFAP (Base de datos para la investigación farmacoepidemiológica en atención primaria), over 2001?2015, in patients aged 40?99 years. Per each incident AMI case, five controls were randomly selected, individually matched for exact age, sex and index date (AMI diagnosis). A patient was considered vaccinated when he/she had a recorded influenza vaccination at least 14 days before the index date within the same season. The association between influenza vaccination and AMI risk was assessed through a conditional logistic regression, computing adjusted ORs (AOR) and their respective 95% CIs. The analysis was performed overall and by each of the three time epidemic periods per study year (pre-epidemic, epidemic and postepidemic). Results We identified 24 155 AMI cases and 120 775 matched controls. Of them, 31.4% and 31.2%, respectively, were vaccinated, yielding an AOR of 0.85 (95% CI 0.82 to 0.88). No effect modification by sex, age and background cardiovascular risk was observed. The reduced risk of AMI was observed shortly after vaccination and persisted over time. Similar results were obtained during the pre-epidemic (AOR=0.87; 95% CI 0.79 to 0.95), epidemic (AOR=0.89; 95% CI 0.82 to 0.96) and postepidemic (AOR=0.83; 95% CI 0.79 to 0.87) periods. No association was found with pneumococcal vaccine (AOR=1.10; 95% CI 1.06 to 1.15). Conclusions Results are compatible with a moderate protective effect of influenza vaccine on AMI in the general population, mostly in primary prevention, although bias due to unmeasured confounders may partly account for the results.
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