Date of Graduation

Summer 8-8-2015

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Saje Davis-Risen, MS, PA-C

Second Advisor

Annjanette Sommers, PA-C, MS

Abstract

Background: Cardiovascular disease is the leading cause of death worldwide with coronary artery disease (CAD) making up a majority of those deaths. Coronary artery diseases are atherosclerotic or thrombotic in nature leading to a disparity of blood in the coronary arteries and subsequent infarction of heart muscle. Influenza has been established as a pro-inflammatory agent that has been implicated in increased death rates from cardiovascular disease. With the establishment of this causal relationship, several trials were run to assess the effect of the influenza vaccine on major cardiovascular risk factors, myocardial infarctions (MI), and strokes. This review focuses on the effect of the influenza vaccine on major adverse cardiovascular events (MACE) in patients with CAD.

Methods: An exhaustive search of available medical literature was performed using Medline-Ovid, Medline-Pubmed, CINAHL and Web of science using the following keywords: influenza vaccine, heart diseases, cardiovascular events, acute coronary syndrome, myocardial infarction, stroke, and angina pectoris. Relevant studies were assessed for quality using GRADE.

Results: A 164 studies were reviewed for relevancy. Three studies met the inclusion criteria and were included in this systematic review. All three of these randomized controlled trials (RCT) demonstrate a decrease in major adverse cardiovascular events (MACE) in patients with CAD or acute coronary syndrome (ACS) with the administration of the influenza vaccine: adjusted HR 0.67 (0.51-0.86), HR 0.54 (0.24-1.21), and RR 0.51 (0.30-0.86) respectively.

Conclusion: The influenza vaccine has shown a decrease in cardiovascular death, MI, unstable angina, hospitalization, and ischemia in patients with already existing heart problems. This decrease in MACE has been demonstrated for up to a year in all three studies with a two year follow up study showing a similar result. The high quality of evidence presented from these studies, the low side effect profile of the influenza vaccine as well as its low cost lead to a strong recommendation for the use of influenza vaccine in secondary prevention of cardiovascular events in patients with CAD.

Keywords: Influenza vaccine, heart diseases, cardiovascular events, acute coronary syndrome, myocardial infarction, stroke, angina pectoris

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