Vaccination, the new weapon in cardiovascular prevention

Vaccination was originally designed to prevent infectious diseases by immunizing against the agent that causes them.
However, it is of real interest in cardiology, and a European consensus underlines its crucial, but still underestimated, role in cardiovascular prevention.

Long limited to the prevention of infectious diseases, vaccination is now revealing a much broader potential. Increasingly robust data suggest that it could also reduce the risk of major cardiovascular events such as myocardial infarction, stroke, worsening heart failure or sudden death. Against this backdrop, the European Society of Cardiology (ESC), in collaboration with several specialist associations, recently published a consensus text presenting vaccination as a very important but largely under-exploited element in cardiovascular prevention [1].

A summary of the scientific literature

Based on a rigorous synthesis of available scientific data, the authors report that certain infections such as influenza, COVID-19, pneumococcus and shingles have a direct impact on the cardiovascular system, by promoting inflammation, thrombosis (clot formation) and destabilization of atherosclerotic plaques. In fragile patients, these infections can cause a brutal physiological imbalance: increased oxygen demand, rupture of atheromatous plaques, rhythm disorders, etc. The consequences are potentially serious, especially for the elderly or those already suffering from heart disease.
An old Professor of Medicine used to say: "The evil is in the lung, the danger is in the heart".

Influenza, for example, is responsible for a significant excess of deaths every year among people with coronary artery disease. Even though the flu vaccine is widely available and well tolerated, it remains under-utilized. A study [2] of patients hospitalized for myocardial infarction showed that early vaccination reduced all-cause mortality and recurrence. Similar, though sometimes more nuanced, results were observed with vaccines against COVID-19, pneumococcus or shingles. In heart transplant patients, immunocompromised patients and pregnant women, the benefits of vaccination are also well established, with improved survival and fewer infectious complications.

Benefits far outweigh risks

We must insist on the safety of vaccines, and the controversy surrounding COVID in a French population already rather reluctant to vaccinate has not improved matters... Objective scientific data indicate that serious adverse reactions are very rare, just as the most frequent reactions are mild: pain at the injection site, moderate fever, transient fatigue. Post-COVID-19 myocarditis, often mentioned in the media, remains a rare complication, mostly benign and self-limiting, far less frequent and severe than cardiac damage caused by the virus itself.
The message is therefore clear: the benefits far outweigh the risks, especially in populations at cardiovascular risk.

This European Consensus is a strong incentive to change practices. It is not enough to recommend vaccination during consultations; it must be actively offered, including during hospitalization for acute events. Hospitals must help to improve vaccination coverage, which is still inadequate: Drug treatments and interventions remain fundamental, but vaccination must be added to them, in the same way as other drugs, as part of a more comprehensive prevention program.

In conclusion, the Consensus stresses that vaccination should be recognized as the "fourth pillar" of cardiovascular prevention, alongside treatments for hypertension, hypercholesterolemia and diabetes.
It's a simple, safe, inexpensive and life-saving intervention!

References
[1] Heideker B. et al. Vaccination as a new form of cardiovascular prevention: a European Society of Cardiology clinical consensus statement: With the contribution of the European Association of Preventive Cardiology (EAPC), the Association for Acute CardioVascular Care (ACVC), and the Heart Failure Association (HFA) of the ESC European Heart Journal,2025; 46, (36), 3518-3531.

[2] Loeb M. et al Influenza vaccine to reduce adverse vascular events in patients with heart failure: a multinational randomised, double-blind, placebo-controlled trial. Lancet 2022; 10 (12) E1835-E1844.


Key words: Cardiovascular prevention, vaccination, heart attack, sudden death, heart failure, influenza, covid-19, pneumococcus, shingles.