Attention, heart patients: The seasonal flu jab doesn’t just protect you from seasonal flu - it might prevent a heart attack too.
YOU might know heart disease is the number one killer, worldwide. What you might not know is:
·Heart disease is also the number one killer among people with chronic conditions who contract flu (US Mayo Clinic);
·Flu causes up to 92000 deaths a year in the US, purely by triggering fatal heart attacks (Mohammad Madjid et al, Eur Heart J, 2007; according to the American Heart Association, the 2005 total of fatal heart attacks in the US was around 150,000)
Heart Foundation of Malaysia director and consultant cardiologist Datuk Dr. Khoo Kah Lin... We recommend anyone with a heart problem to take the flu vaccine. ·The risk of dying from a heart attack increases when rates of flu infection go up, e.g. during seasonal flu epidemics, by as much as a third, according to the 2007 above, and up to 50%, according to a 2009 British study (Charlotte Warren-Gash et al, Lancet Infectious Diseases, as reported by Reuters on Sept 22)
Fortunately for heart patients, there is a simple way to mitigate this danger - flu vaccination.
We’re used to idea of being vaccinated against an infection like tuberculosis, measles, or chicken pox, but maybe not to the idea of being vaccinated against a condition like heart disease. Even the cervical cancer vaccine targets an infection (by the human papillomavirus.)
However, the safety and cost-effectiveness of influenza vaccination as a method of cardiovascular protection is well documented.
“We recommend anyone with a heart problem to take the flu vaccine,” stresses Heart Foundation of Malaysia director and consultant cardiologist Datuk Dr. Khoo Kah Lin, echoing the recommendations put forth by various studies and issued by the American Heart Association/American College of Cardiology.
The inside story
How does the influenza virus cause cardiovascular events? There are two schools of thought, explains Dr. Khoo.
According to one, the influenza virus triggers an inflammatory response, directing auto-antibodies to artherosclerotic plaques in blood vessels.
In other words, the presence of the virus causes the body’s immune system to overreact and attack the fatty deposits in a heart patient’s arteries.
When attacked, the plaques get “hot, angry, and inflamed,” and may break off. If any of these clog up the patient’s coronary arteries, he experiences a heart attack.
According to the other hypothesis, the virus directly colonises the blood vessel walls and triggers the same auto-immune cascade and/or a thrombotic event (where a blood clot forms and travels to and blocks the coronary arteries.)
Why bother getting vaccinated?
According to Dr. Khoo, studies by Madjid and colleagues in 2004 showed influenza vaccination reduced cardiovascular outcomes by about half (the study reviewed various studies, which showed heart attack rate reductions ranging from 49% to 67% in different groups.)
Besides being effective, vaccination is relatively cheap (compared to heart medication and/or surgery) and convenient.
Dr. Khoo says: “The cost of the vaccine is less than RM100. Maybe, depending on the brand, RM40-60. It’s such a great thing to have one jab, which lasts 365 days. If I were to give you aspirin, blood pressure pills, cholesterol pills, you would have to swallow them every day for 365 days. This is one jab, and then you don’t have to do anything more.”
Flu vaccine FAQs
What does vaccination entail?
One injection with the current killed-virus formulation. Side effects may include soreness at the site of injection, muscle ache, or fever.
Heart patients should not receive the live, attenuated formulation.
Who should get it?
All those with chronic cardiovascular disease, including coronary artery disease, cardiomyopathy, cerebrovascular disease, high blood pressure, peripheral artery disease, rheumatic heart disease, congenital heart disease, and heart failure.
Who should not get it?
·Those with egg allergies
·Those who have had an allergic reaction to the vaccine in the past
When should you get it?
“Any time will do,” says Dr. Khoo.
Being a tropical country, Malaysia does not experience dramatic flu peaks, barring cases of outbreaks like the recent A(H1N1) pandemic. Instead, cases occur all year around, with a mild peak from March to July.
Unfortunately, this lack of a sharp peak means seasonal flu doesn’t evoke the same preparedness urgency here as it does in temperate countries, where the mass autumn rush to get vaccinated acts as a good reminder to do so.
Is there a difference between the Northern or Southern vaccine formulation?
The World Health Organisation (WHO) makes recommendations for two separate flu vaccine formulations every year - one specific to the prevailing flu strains in the Northern hemisphere and one specific to those in the South.
Dr. Khoo finds the geographic distinction insignificant.
“Do you think you’ll really be protected if your girlfriend from school days visits you from London, and then another girlfriend comes in from New Zealand?” he asks.
“The world is so small with air transport. You’re going to meet anybody and everybody.”
Data is on his side. In 1999, 2002, 2003, 2007, and 2008, the WHO-recommended formulations for North and South were identical.
The upshot: more jabs, please
Besides geriatricians, paediatricians, and general practitioners, Dr. Khoo urges cardiologists, too, to stock and administer the flu vaccine.
“If you don’t have it, how are you going to jab your fellow? Then the chain gets broken,” he laments.
As for heart patients, he suggests getting proactive. If your doctor doesn’t bring the vaccine up, ask him for it. It’s time to take charge of your health.
References:
1. Flu shots: Important if you have heart disease at mayoclinic.com/health/flu-shots/HB00086
2. Influenza epidemics and acute respiratory disease activity are associated with a surge in autopsy-confirmed coronary heart disease death: results from 8 years of autopsies in 34 892 subjects, Madjid et al, European Heart Journal, 2007 (free to view)
3. Heart Disease & Stroke Statistics, 2009 Update At-A-Glance at americanheart.org/presenter.jhtml?identifier=3000090
4. Influenza Surveillance in Malaysia: 1997-2001, Nor Shahidah et al, Malaysian Journal of Public Health Medicine 2003
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