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Influenza vaccines for preventing cardiovascular disease

机译：预防心血管疾病的流感疫苗

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ABSTRACTBACKGROUND: 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.METHODS: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 influenza 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.
机译：摘要：这是对2008年发表的原始评论的更新。类似流感的感染会增加不良心血管结果的风险，针对流感的疫苗接种可能会改善心血管结果。目的：评估流感疫苗对于原发性和潜在流感的潜在益处方法：我们在2013年10月18日搜索了以下电子数据库：Cochrane图书馆（包括Cochrane对照试验中央注册簿（CENTRAL），效果评价摘要数据库（DARE），经济评估）数据库（EED）和卫生技术评估数据库（HTA）），MEDLINE，EMBASE，科学引文索引扩展，会议论文引文索引-科学和进行中的试验注册簿（www.control-trials.com/和www.clinicaltrials.gov）。我们检查了相关基础研究和系统评价的参考文献清单。我们在2015年2月20日（即发表之前）进行了一次有限的PubMed搜索。选择标准：在有或没有心血管疾病的受试者中，与安慰剂或不进行治疗相比，对流感疫苗进行随机对照试验（RCT），评估心血管死亡或非致命性心血管事件数据收集和分析：我们采用了Cochrane协作所期望的标准方法程序。我们仅针对心血管死亡进行了荟萃分析，因为其他结局的报道也很少。主要结果：我们纳入了8项流感疫苗接种与安慰剂或无疫苗接种的试验，其中1,029例参与者接受了至少一种疫苗接种或对照治疗。除了先前版本的评价中的两项研究，我们还纳入了六项新研究（n = 11,251）。其中有四项试验（n = 10,347）的重点是预防普通人群或老年人的流感，并在其安全性分析中报告了心血管疾病的预后。四项试验（n = 1682）的重点是预防已确定的冠心病患者的心血管事件。这些人群分别进行了分析。随访持续了42天至一年。五个RCT显示至少有3个评估的偏倚标准风险不足。报道（七个研究）时，疫苗接种提供了足够的免疫原性或针对流感的保护作用。在四项二级预防试验中报告了心血管疾病的死亡率，并通过总体流感疫苗接种（风险比（RR）0.45，95％置信区间（CI）0.26至0.76; P值0.003）显着降低，且研究之间无显着异质性，而三项研究之间当事件的数量太少而无法得出结论时，这些试验报告了心血管疾病死亡率是其安全性分析的一部分。在对冠心病患者的研究中，与安慰剂相比，接种流感疫苗后心血管事件的综合结果趋于降低。一般而言，对照组之间在诸如心肌梗塞等单个结局方面没有发现显着差异。作者的结论：在患有心血管疾病的患者中，接种流感疫苗可能会降低心血管疾病的死亡率和合并的心血管事件。但是，研究存在偏见的风险，结果并不总是一致的，因此需要更多高质量的证据来证实这些发现。没有足够的证据来确定流感疫苗接种是否在心血管疾病的一级预防中发挥作用。

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