Call is Out for All Heart Patients to Get Immunized This Fall

By: Jean Johnson for Body1 If the American Heart Association (AHA) has its way, considerably more than the one in three adults with cardiovascular disease that got flu shots in 2005 will get immunized for the 2006-2007 flu season.

“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 Mathew M. Davis, M.D., lead author of new guidelines released in tandem by the AHA and American College of Cardiology this past May.

Take Action

The American Heart Association urges: Cardiologists to stock flu vaccine for their patients in their clinics and strongly encourage influenza immunization. Patients with cardiovascular disease to get a flu vaccination (given by injection) every year by the end of November. Receiving a shot in January or even later should still protect against flu, as the flu season in the United States typically peaks in January, February, or March. Patients with cardiovascular disease not receive the live, attenuated vaccine given as a nasal spray. The live vaccine can cause influenza in this high-risk population. The Centers for Disease Control and Prevention also recommend annual influenza vaccination for people age 50 and older, children ages 6 months to 59 months, women who will be pregnant during flu season, and adults and children with other chronic conditions.

“The target goal set by the US Department of Health and Human Services is to vaccinate 60 percent of people with heart disease under the age 65, and 90 percent of everyone 65 and over, many of whom have heart disease,” Davis added. The cardiologist also points out that last year’s vaccine will not protect people from getting the flu this year since the serum “is reformulated each year to respond to these changes as best we can.”

Immediately we thought of Olive Blackwell of Portland, Oregon, whose experiences with heart by-pass surgery last spring were profiled on Heart1 under the title “Grandma’s Unplugged!” When we called Blackwell and told her that not only do heart patients who get flu shots have a one-third better chance of not having a second attack, but that only one in three heart patients got vaccinated in 2005, her immediate response was, “I better get my flu shot!

“Usually my regular doctor’s office calls when the shots come in, but I haven’t heard from them yet this year. Since I’ve been 60,” said the 84-year-old Blackwell, “I’ve gone in for my flu shot every year. So I had one last year, too.

“But it didn’t save me,” she said laughing. “I might not have had the flu, but I got everything else!”

Regarding the two out of three heart patients that didn’t get flu shots last year, Blackwell observed that “it seems odd, because usually you think if you had something you’d want to protect yourself because your body is probably a little bit vulnerable, which mine is.”

Blackwell says she went in for a checkup with her cardiologist a couple of months ago, but has another appointment in the middle of October. “If the heart doctors are going to be carrying flu shots too, maybe I can get mine when I go for that appointment rather than having to make a separate trip in to see my usual doctor,” she said. “That would be nice – and convenient. “I can see why patients who might not think to see their regular doctor for a flu shot might get one if they were at their cardiologist and that doctor recommended it and had it available right then and there. I remember how lousy I felt before my surgery, and I imagine others are in that same boat. When you feel that bad, even getting to one doctor seems like a major chore.

“Also, I can see why some who are dealing with heart problems might think a flu shot is a small thing in comparison. That’s how it is when you think about the flu – it’s sort of like a major cold – like a minor thing. I mean I know all of us know people, especially older folks, can die from the flu, but it’s not like how you can die from a heart attack.

“Anyway, I’ll get mine this year. After going through everything I did last spring, I sure wouldn’t want not getting a flu shot to bring me down. I’m back at my granddaughter’s soccer games now, and it’s great. My daughter drove last week and we went clear down to Boring, a little town south of Portland. Where we sat we had a view of Mt. Hood, too, which is only 100 miles away. As the sun set, the mountain just got pinker and pinker. It was so big and beautiful. I watched it more than I did the game!”

Why Getting the Flu Puts Heart Patients at Extra Risk

Researchers in Houston and Washington State began looking at connections between heart disease and influenza as early as 2000.

“Time and again, we were seeing people in our practice who had had an upper-respiratory infection and then suffered a heart attack,” said S. Ward Casscells, M.D., director of the University of Texas-Houston Medical School, Department of Internal Medicine, Division of Cardiology.

“When we dug into the literature, we saw reports that many heart attacks, as many as 35 percent, were preceded by an upper respiratory infection. We also saw that patients who had received their flu shot were less likely to have a heart attack.”

Various studies ensued over the intervening years, including a New England Journal of Medicine assessment of 280,000 patients in 2003. Another important contribution has been the FLUVACS trial of 301 patients.

According to the AHA, FLUVACS evaluated this particular group of patients because they had been “hospitalized for either a heart attack or an angioplasty and stent procedure to open clogged arteries.” Members of the group “were randomly assigned to receive flu vaccine or remain unvaccinated. Over the next year, among those who did not get vaccinated, 23 percent had died of heart disease, had a nonfatal heart attack, or developed severe ischemia (insufficient blood supply to the heart tissue), compared with only 11 percent of their vaccinated counterparts.”

Combined with research that has accrued over the past decade, researchers theorized that inflammation, or the body’s response to infection, can affect conditions in the walls of the arteries.

For those who are interested in a bit of the science, the University of Texas Health Science Center offers a short, easy-to-follow explanation: “Factors such as oxidized cholesterol along with an infectious agent may attract immune cells. This process contributes to plaque build-up and, in some cases, to plaque rupture and sudden heart attack.”

Translated, that means that general inflammation, such as that caused by the flu, may cause arterial plaque that is otherwise benign to form a clot large enough to block blood flow and lead to a heart attack.

Or as Mohammed Madjiid, M.D., assistant professor of medicine at the UT-Houston Medical School put it, “Influenza begins as a severe and acute inflammation in the body which can also inflame the plaque in the arterial wall. This inflammation can destabilize the plaque, thus leading to stroke or heart attack. It also increases the possibility of clot formation.”

The Flu Shot is a Smart Choice – And Former President Bill Clinton Knows It

“We found that getting a flu shot was associated with a 67 percent reduction in the risk of having a second heart attack for those over the age of 65,” Casscells said.

In AHA parlance, that translates to “patients who had taken a flu shot had only one third the chance of a heart attack or unstable angina as those who did not get the vaccine.”

It didn’t take anything more to convince former President Bill Clinton or the team of cardiologists involved in his case. In September 2004 when Clinton had quadruple by-pass surgery at the age of 58, his cardiology team made sure their patient was immunized against the latest strain of influenza.

As for us at Heart1, we plan to follow the President’s lead. We hope you and your family do too, and that we all move forward into the new year well and protected.

Last updated: 16-Oct-06