What vaccinations are recommended for patients with coronary artery disease (CAD)?

Recommended Vaccinations for Patients with Coronary Artery Disease

Patients with coronary artery disease (CAD) should receive annual influenza vaccination and the complete SARS-CoV-2 vaccination sequence, including boosters, as part of comprehensive secondary prevention. 1

Influenza Vaccination

Influenza vaccination is a critical component of cardiovascular care for patients with CAD:

• Annual influenza vaccination is recommended as a Class I, Level B intervention for all patients with coronary and other atherosclerotic vascular disease 1
• Influenza vaccination significantly reduces cardiovascular mortality (risk ratio 0.45) and major adverse cardiovascular events in patients with established coronary heart disease 2
• The inactivated influenza vaccine (administered intramuscularly) is the recommended formulation for patients with cardiovascular conditions 1
• The live, attenuated intranasal influenza vaccine is not currently recommended for individuals with cardiovascular conditions 1

Cardiovascular Benefits of Influenza Vaccination

• Recent meta-analyses demonstrate that influenza vaccination reduces:
  • Major adverse cardiovascular events (MACE) by 25-37% 3, 4
  • All-cause mortality by 42% 4
  • Cardiovascular mortality by 47% 4
• The cardioprotective effect is particularly pronounced in patients who have recently experienced coronary events 5

Implementation Considerations

• Despite strong recommendations, vaccination rates among CAD patients remain suboptimal (approximately 34% nationally) 1
• Barriers to vaccination include:
  • Many cardiology practices do not stock influenza vaccine 1
  • Lack of strong provider recommendations 1
• Healthcare providers should:
  • Stock influenza vaccine in practices that care for CAD patients 1
  • Provide strong recommendations for vaccination 1
  • Consider implementing standing orders for vaccination 1

COVID-19 Vaccination

• Patients with CAD should receive the complete SARS-CoV-2 vaccination sequence, including recommended boosters 1
• Observational studies show that patients with cardiovascular comorbidities have higher risk for hospitalization, thrombotic events, and death with SARS-CoV-2 infection 1
• Follow the most current CDC recommendations for SARS-CoV-2 vaccination for adults 1

Mechanism of Cardiovascular Protection

• Vaccination may provide cardiovascular protection through:
  • Prevention of respiratory infections that can trigger cardiovascular events 6
  • Modification of the immune-inflammatory processes involved in atherosclerosis 6, 5
  • Reduction of systemic inflammation that can destabilize atherosclerotic plaques 5

Clinical Implications

• Influenza and COVID-19 vaccinations should be recommended with the same emphasis as other secondary prevention measures like cholesterol and blood pressure control 1
• Vaccination is particularly important for patients with recent myocardial infarction, as the IAMI trial showed a 28% reduction in MACE and 41% reduction in CV mortality when influenza vaccine was administered within 72 hours of hospitalization 3
• Providers should address vaccination status at every visit with CAD patients, especially before influenza season 1