A new scientific advisory from the American Heart Association and American College of Cardiology recommends that patients with cardiovascular disease receive influenza vaccinations, although not the nasal-spray formulation.
Patients with cardiovascular disease are more likely to die from influenza than patients with any other chronic condition, according to the new advisory. Studies have found that annual flu vaccinations can prevent death in adults and children with chronic conditions of the cardiovascular system, yet only one in three American adults with cardiovascular disease were vaccinated in 2005.

“If we vaccinated at least 60 percent of the 13.2 million people with coronary heart disease in the United States against influenza, we could prevent hundreds of deaths and thousands of cases of flu each year,” said Matthew M. Davis, MD, lead author of the advisory and associate professor of pediatrics, internal medicine, and public policy at the University of Michigan in Ann Arbor.

Overall, influenza is responsible for 36,000 deaths and 225,000 hospitalizations in the United States each year. People with cardiovascular disease are particularly vulnerable because flu can exacerbate heart disease symptoms directly and can also lead to conditions like viral or bacterial pneumonia that cause flare-ups of cardiovascular disease.

“Influenza vaccination is now recommended with the same enthusiasm as cholesterol and blood pressure control and other modifiable risk factors for cardiovascular disease,” the advisory noted.

The strongest evidence of a protective effect comes from the FLUVACS trial. In that trial, 301 people hospitalized for either myocardial infarction or angioplasty with placement were randomized to receive flu vaccine or remain unvaccinated. Over the next year, 23 percent of the unvaccinated group had died of heart disease, had a nonfatal infarction, or developed severe ischemia compared with only 11 percent of their vaccinated peers.

The advisory specifically noted that patients with cardiovascular disease not receive the live, attenuated vaccine given as a nasal spray because it can cause influenza in this high-risk population.

The advisory is available online at www.americanheart.org and www.acc.org; and will be published in Circulation and the Journal of the American College of Cardiology.