Author + information
- Received May 8, 2020
- Revision received July 24, 2020
- Accepted August 7, 2020
- Published online October 5, 2020.
- Bahar Behrouzi, MSca,b,c,∗,
- Maria Viviana Araujo Campoverde, BSca,b,∗,
- Kyle Liang, MScd,
- H. Keipp Talbot, MD, MPHe,
- Isaac I. Bogoch, MDf,
- Allison McGeer, MD, MScb,c,g,
- Ole Fröbert, MD, PhDh,
- Mark Loeb, MD, MSci,j,
- Orly Vardeny, PharmD, MSk,
- Scott D. Solomon, MDl and
- Jacob A. Udell, MD, MPHa,b,c,m,∗ (, )@JayUdell
- aCardiovascular Division, Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada
- bFaculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- cInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- dWomen’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV), Women’s College Hospital, Toronto, Ontario, Canada
- eDepartments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- fDivisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- gDivision of Microbiology, Sinai Health System, Toronto, Ontario, Canada
- hDepartment of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
- iDepartment of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- jDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- kCenter for Care Delivery and Outcomes Research, Minneapolis Veteran Affairs Health Care System, Minneapolis, Minnesota
- lDivision of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
- mPeter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
- ↵∗Address for correspondence:
Dr. Jacob A. Udell, Cardiovascular Division, Toronto General Hospital and Women’s College Hospital, University of Toronto, 76 Grenville Street, Toronto, Ontario M5S 1B1, Canada.
• Viral respiratory infections, such as seasonal influenza and COVID-19, are associated with elevated risks of cardiovascular events.
• Several international CVOTs are investigating whether seasonal influenza vaccine reduces the risk of cardiovascular events among patients with HF or coronary artery disease.
• Existing trial networks may provide an opportunity to assess primary and secondary prevention strategies for patients with CVD at risk of complications from COVID-19.
Viral respiratory infections are risk factors for cardiovascular disease (CVD). Underlying CVD is also associated with an increased risk of complications following viral respiratory infections, including increased morbidity, mortality, and health care utilization. Globally, these phenomena are observed with seasonal influenza and with the current coronavirus disease 2019 (COVID-19) pandemic. Persons with CVD represent an important target population for respiratory virus vaccines, with capacity developed within 3 large ongoing influenza vaccine cardiovascular outcomes trials to determine the potential cardioprotective effects of influenza vaccines. In the context of COVID-19, these international trial networks may be uniquely positioned to redeploy infrastructure to study therapies for primary and secondary prevention of COVID-19. Here, we describe mechanistic links between influenza and COVID-19 infection and the risk of acute cardiovascular events, summarize the data to date on the potential cardioprotective effects of influenza vaccines, and describe the ongoing influenza vaccine cardiovascular outcomes trials, highlighting important lessons learned that are applicable to COVID-19.
↵∗ Ms. Behrouzi and Mrs. Araujo Campoverde contributed equally to this work.
Ms. Behrouzi has been supported in part by a University of Toronto MD/PhD studentship award and a Heart & Stroke/Richard Lewar Centre of Excellence in Cardiovascular Research and CANHEART SPOR Graduate Studentship Award. Mrs. Araujo Campoverde has been supported by Secretaría de Educación Superior, Ciencia, Tecnología e Innovación (SENESCYT) 2018 Programa de Becas Internacionales. Dr. Talbot has served on the Data Safety and Monitoring Board for Seqirus. Dr. Bogoch has consulted for BlueDot, a social benefit company that predicts the spread of infectious diseases of global health significance. Dr. McGeer has received research grants to her institution from Pfizer, Sanofi Pasteur, Merck, and Seqirus; and has consulted for Sanofi Pasteur, Seqirus, GlaxoSmithKline, Merck, Pfizer, Cidara, and Medicago. Dr. Fröbert has been supported by Örebro University, Faculty of Health, Department of Cardiology; and has received unrestricted grant support for the IAMI study from Sanofi Pasteur. Dr. Loeb has consulted for Sanofi Pasteur, Seqirus, and Medicago; has received research funding from Seqirus; and has received influenza vaccine in-kind from Sanofi Pasteur. Dr. Vardeny has received grant support from the National Institutes of Health and AstraZeneca; and has provided consulting for Sanofi Pasteur, Novartis, and Amgen. Dr. Solomon has received research grants from Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, Bristol Myers Squibb, Celladon, Cytokinetics, Eidos, Gilead, GlaxoSmithKline, Ionis, Lone Star Heart, Mesoblast, MyoKardia, National Institutes of Health/National Heart, Lung, and Blood Institute, Novartis, Sanofi Pasteur, and Theracos; and has consulted for Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Bristol Myers Squibb, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi-Sankyo, Gilead, GlaxoSmithKline, Ironwood, Merck, Myokardia, Novartis, Roche, Sanofi Pasteur, Takeda, Theracos, Quantum Genetics, AoBiome, Janssen, Cardiac Dimensions, Tenaya, Dinaqor, and Tremeau. Dr. Udell has been supported by a Heart and Stroke Foundation of Canada National New Investigator-Ontario Clinician Scientist Award, an Ontario Ministry of Research, Innovation and Science Early Researcher Award, as well as by Women’s College Research Institute and the Department of Medicine, Women’s College Hospital; has received grant support to his institutions from AstraZeneca, Novartis, and Sanofi; has served as a consultant for Amgen, Boehringer Ingelheim, Janssen, Merck, Novartis, and Sanofi; and has received honoraria from Boehringer Ingelheim and Janssen. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received May 8, 2020.
- Revision received July 24, 2020.
- Accepted August 7, 2020.
- 2020 American College of Cardiology Foundation
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