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Dagens #fsvoversigt:
Influenza vaccines for preventing cardiovascular disease.
Cochrane Database Syst Rev. 2015;5:CD005050
Authors: Clar C, Oseni Z, Flowers N, Keshtkar-Jahromi M, Rees K
Abstract
BACKGROUND: This is an update of the original review published in 2008. The
risk of adverse cardiovascular outcomes is increased with influenza-like
infection, and vaccination against influenza may improve cardiovascular
outcomes.
OBJECTIVES: To assess the potential benefits of influenza vaccination for
primary and secondary prevention of cardiovascular disease.
SEARCH METHODS: We searched the following electronic databases on 18 October
2013: The Cochrane Library (including Cochrane Central Register of Controlled
Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Economic
Evaluation Database (EED) and Health Technology Assessment database (HTA)),
MEDLINE, EMBASE, Science Citation Index Expanded, Conference Proceedings
Citation Index - Science and ongoing trials registers
(www.controlled-trials.com/ and www.clinicaltrials.gov). We examined reference
lists of relevant primary studies and systematic reviews. We performed a
limited PubMed search on 20 February 2015, just before publication.
SELECTION CRITERIA: Randomised controlled trials (RCTs) of influenza
vaccination compared with placebo or no treatment in participants with or
without cardiovascular disease, assessing cardiovascular death or non-fatal
cardiovascular events.
DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as
expected by The Cochrane Collaboration. We carried out meta-analyses only for
cardiovascular death, as other outcomes were reported too infrequently. We
expressed effect sizes as risk ratios (RRs), and we used random-effects models.
MAIN RESULTS: We included eight trials of influenza vaccination compared with
placebo or no vaccination, with 12,029 participants receiving at least one
vaccination or control treatment. We included six new studies (n = 11,251), in
addition to the two included in the previous version of the review. Four of
these trials (n = 10,347) focused on prevention of influenza in the general or
elderly population and reported cardiovascular outcomes among their safety
analyses; four trials (n = 1682) focused on prevention of cardiovascular events
in patients with established coronary heart disease. These populations were
analysed separately. Follow-up continued between 42 days and one year. Five
RCTs showed deficits in at least three of the risk of bias criteria assessed.
When reported (seven studies), vaccination provided adequate immunogenicity or
protection against influenza. Cardiovascular mortality was reported by four
secondary prevention trials and was significantly reduced by in
fluenza vaccination overall (risk ratio (RR) 0.45, 95% confidence interval
(CI) 0.26 to 0.76; P value 0.003) with no significant heterogeneity between
studies, and by three trials reporting cardiovascular mortality as part of
their safety analyses when the numbers of events were too small to permit
conclusions. In studies of patients with coronary heart disease, composite
outcomes of cardiovascular events tended to be decreased with influenza
vaccination compared with placebo. Generally no significant difference was
found between comparison groups regarding individual outcomes such as
myocardial infarction.
AUTHORS' CONCLUSIONS: In patients with cardiovascular disease, influenza
vaccination may reduce cardiovascular mortality and combined cardiovascular
events. However, studies had some risk of bias, and results were not always
consistent, so additional higher-quality evidence is necessary to confirm these
findings. Not enough evidence was available to establish whether influenza
vaccination has a role to play in the primary prevention of cardiovascular
disease.
PMID: 25940444 [PubMed - indexed for MEDLINE]
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Dette abstract er hentet via PubMed fra National Library of Medicine, USA
(http://www.ncbi.nlm.nih.gov/About/disclaimer.html).
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