Cochrane for Clinicians

Putting Evidence into Practice

Influenza Vaccination for the Prevention of Cardiovascular Disease


Am Fam Physician. 2016 Mar 1;93(5):357-358.

  Related POEM: Influenza Vaccine Reduces Risk of Adverse Cardiovascular Events in High-Risk Patients.

Clinical Question

Does influenza vaccination have any benefit for primary or secondary prevention of cardiovascular disease?

Evidence-Based Answer

Influenza vaccination may reduce cardiovascular mortality in patients with established cardiovascular disease. The effect of vaccination is unclear among patients in the general population without known cardiovascular disease. (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

Globally, cardiovascular disease remains the number one cause of death.1 By 2030, it is estimated that the number of annual deaths from cardiovascular disease will increase to 23.3 million.1 Innovative strategies for primary and secondary prevention of cardiovascular disease are important. Observational studies have shown an association between receipt of the influenza vaccine and lower cardiovascular morbidity and mortality, especially among older and vulnerable populations.2,3 Another study found that influenza infection, but not influenza vacc

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Clar C, Oseni Z, Flowers N, Keshtkar-Jahromi M, Rees K. Influenza vaccines for preventing cardiovascular disease. Cochrane Database Syst Rev. 2015;(5):CD005050.

The practice recommendations in this activity are available at


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1. Global Status Report on Noncommunicable Diseases 2010. Geneva, Switzerland: World Health Organization; 2011....

2. Udell JA, Zawi R, Bhatt DL, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA. 2013;310(16):1711–1720.

3. Nichol KL, Nordin JD, Nelson DB, Mullooly JP, Hak E. Effectiveness of influenza vaccine in the community-dwelling elderly. N Engl J Med. 2007;357(14):1373–1381.

4. Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med. 2004;351(25):2611–2618.

5. Grohskopf LA, Sokolow LZ, Olsen SJ, Bresee JS, Broder KR, Karron RA. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices, United States, 2015–16 influenza season. MMWR Morb Mortal Weekly Rep. 2015;64(30):818–825.

6. UK Department of Health. Influenza: the Green Book. Chapter 19. Accessed February 3, 2016.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at


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