Primary prevention of acute cardiovascular events by influenza vaccination: an observational study

Eur Heart J. 2023 Feb 14;44(7):610-620. doi: 10.1093/eurheartj/ehac737.


Aims: Previous studies show a reduced incidence of first myocardial infarction and stroke 1-3 months after influenza vaccination, but it is unclear how underlying cardiovascular risk impacts the association.

Methods and results: The study used linked Clinical Practice Research Datalink, Hospital Episode Statistics Admitted Patient Care and Office for National Statistics mortality data from England between 1 September 2008 and 31 August 2019. From the data, individuals aged 40-84 years with a first acute cardiovascular event and influenza vaccination occurring within 12 months of each September were selected. Using a self-controlled case series analysis, season-adjusted cardiovascular risk stratified incidence ratios (IRs) for cardiovascular events after vaccination compared with baseline time before and >120 days after vaccination were generated. 193 900 individuals with a first acute cardiovascular event and influenza vaccine were included. 105 539 had hypertension and 172 050 had a QRISK2 score ≥10%. In main analysis, acute cardiovascular event risk was reduced in the 15-28 days after vaccination [IR 0.72 (95% CI 0.70-0.74)] and, while the effect size tapered, remained reduced to 91-120 days after vaccination [0.83 (0.81-0.88)]. Reduced cardiovascular events were seen after vaccination among individuals of all age groups and with raised and low cardiovascular risk.

Conclusions: Influenza vaccine may offer cardiovascular benefit among individuals at varying cardiovascular risk. Further studies are needed to characterize the populations who could derive the most cardiovascular benefits from vaccination.

Keywords: Cardiovascular complications; Influenza vaccine; QRISK; hypertension.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Humans
  • Influenza Vaccines* / therapeutic use
  • Influenza, Human* / epidemiology
  • Influenza, Human* / prevention & control
  • Myocardial Infarction* / complications
  • Myocardial Infarction* / epidemiology
  • Myocardial Infarction* / prevention & control
  • Stroke* / drug therapy
  • Stroke* / epidemiology
  • Stroke* / prevention & control
  • Vaccination / adverse effects


  • Influenza Vaccines