Association Between Influenza Vaccination and Cardiovascular Outcomes in High-Risk Patients A Meta-analysis
Association Between Influenza Vaccination and Cardiovascular Outcomes in High-Risk Patients A Meta-analysis
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DOI：
10.1001/jama.2013.279206
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发表时间：
2013-10-23
影响因子：
120.7
通讯作者：
Cannon, Christopher P.
中科院分区：
文献类型：
--
作者：
Udell, Jacob A.;Zawi, Rami;Cannon, Christopher P.
重要性在非传统的心血管危险因素中，近期流感样感染与致命性和非致命性动脉粥样硬化血栓形成事件相关。（1946- 2013年8月），EMBASE（1947年-2013年8月），和科克伦图书馆对照试验中心登记处（2013年8月开始）随机临床试验（RCT）在心血管疾病高危患者中比较流感疫苗与安慰剂或对照，将心血管结果报告为有效性或安全性事件。数据提取和综合两名研究者独立地提取试验设计的数据，已发表手稿和未发表补充数据的基线特征、结局和安全性事件。高质量的研究被认为是那些描述了一个适当的方法随机化，分配隐藏，盲法，和follow-up.Main结局和MEASURES完整性随机效应Mantel-Haenszel风险比（RR）和95%CI的复合心血管事件，心血管死亡率，全因死亡率，和个人的心血管事件。分析分层的患者和无急性冠状动脉综合征（ACS）的历史在1年内randomization.Results五个发表和1个未发表的随机临床试验的6735例患者（平均年龄，67岁，51.3%的女性，36.2%的心脏病史，平均随访时间，7.9个月）。在已发表的试验中，流感疫苗与复合心血管事件的风险较低相关（2.9% vs 4.7%; RR，0.64 [95%CI，0.48-0.86]，P = .003）。在近期ACS患者（RR，0.45 [95% CI，0.32-0.63]）和无近期ACS患者（RR，0.94 [95% CI，0.55-1.61]）之间检测到治疗相互作用（相互作用P = 0.02）。结果是相似的，除了未发表的data.Conclusions和相关性在一项荟萃分析的随机对照试验，流感疫苗的使用与主要不良心血管事件的风险较低。最大的治疗效果出现在冠状动脉疾病更活跃的高危患者中。一个大的，充分的把握度，多中心试验是必要的，以解决这些发现和评估个人的心血管终点。
IMPORTANCE Among nontraditional cardiovascular risk factors, recent influenzalike infection is associated with fatal and nonfatal atherothrombotic events.OBJECTIVES To determine if influenza vaccination is associated with prevention of cardiovascular events.DATA SOURCES AND STUDY SELECTION A systematic review and meta-analysis of MEDLINE (1946-August 2013), EMBASE (1947-August 2013), and the Cochrane Library Central Register of Controlled Trials (inception-August 2013) for randomized clinical trials (RCTs) comparing influenza vaccine vs placebo or control in patients at high risk of cardiovascular disease, reporting cardiovascular outcomes either as efficacy or safety events.DATA EXTRACTION AND SYNTHESIS Two investigators extracted data independently on trial design, baseline characteristics, outcomes, and safety events from published manuscripts and unpublished supplemental data. High-quality studies were considered those that described an appropriate method of randomization, allocation concealment, blinding, and completeness of follow-up.MAIN OUTCOMES AND MEASURES Random-effects Mantel-Haenszel risk ratios (RRs) and 95% CIs were derived for composite cardiovascular events, cardiovascular mortality, all-cause mortality, and individual cardiovascular events. Analyses were stratified by subgroups of patients with and without a history of acute coronary syndrome (ACS) within 1 year of randomization.RESULTS Five published and 1 unpublished randomized clinical trials of 6735 patients (mean age, 67 years; 51.3% women; 36.2% with a cardiac history; mean follow-up time, 7.9 months) were included. Influenza vaccine was associated with a lower risk of composite cardiovascular events (2.9% vs 4.7%; RR, 0.64 [95% CI, 0.48-0.86], P = .003) in published trials. A treatment interaction was detected between patients with (RR, 0.45 [95% CI, 0.32-0.63]) and without (RR, 0.94 [95% CI, 0.55-1.61]) recent ACS (P for interaction = .02). Results were similar with the addition of unpublished data.CONCLUSIONS AND RELEVANCE In a meta-analysis of RCTs, the use of influenza vaccine was associated with a lower risk of major adverse cardiovascular events. The greatest treatment effect was seen among the highest-risk patients with more active coronary disease. A large, adequately powered, multicenter trial is warranted to address these findings and assess individual cardiovascular end points.