Science Summary: Ischaemic heart disease, influenza and influenza vaccination: a prospective case control study
Competing interests Professor CR Macintyre has received grant funds and/or support for investigator-driven research from GSK, CSL, Sanofi Pasteur, Merck and Pfizer. Dr Anita Heywood has received grant funds for investigator-driven research from GSK and Sanofi Pasteur. Dr Holly Seale has received grant funds for investigator-driven research from GSK, CSL and Sanofi Pasteur. The other authors have no conflicts of interest to declare.
Abstract
Background Abundant, indirect epidemiological evidence indicates that influenza contributes to all-cause mortality and cardiovascular hospitalisations with studies showing increases in acute myocardial infarction (AMI) and death during the influenza season.
Objective To investigate whether influenza is a significant and unrecognised underlying precipitant of AMI.
Design Case-control study.
Setting Tertiary referral hospital in Sydney, Australia, during 2008 to 2010.
Patients Cases were inpatients with AMI and controls were outpatients without AMI at a hospital in Sydney, Australia.
Main outcome measures Primary outcome was laboratory evidence of influenza. Secondary outcome was baseline self-reported acute respiratory tract infection.
Results Of 559 participants, 34/275 (12.4%) cases and 19/284 (6.7%) controls had influenza (OR 1.97, 95% CI 1.09 to 3.54); half were vaccinated. None were recognised as having influenza during their clinical encounter. After adjustment, influenza infection was no longer a significant predictor of recent AMI. However, influenza vaccination was significantly protective (OR 0.55, 95% CI 0.35 to 0.85), with a vaccine effectiveness of 45% (95% CI 15% to 65%).
Conclusions Recent influenza infection was an unrecognised comorbidity in almost 10% of hospital patients. Influenza did not predict AMI, but vaccination was significantly protective but underused. The potential population health impact of influenza vaccination, particularly in the age group 50–64 years, who are at risk for AMI but not targeted for vaccination, should be further explored. Our data should inform vaccination policy and cardiologists should be aware of missed opportunities to vaccinate individuals with ischaemic heart disease against influenza.
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I'm not sure exactly where Charles Weber is going or where he's coming from, but I want to say that potassium's role in heart health and in healthy blood pressure maintenance has been recognized for years. We need about 4 grams a day of potassium and most get far less. An important point is that potassium should be ingested in food, not supplements. Potassium supplements are by prescription when a person is taking diuretics that cause potassium loss. Please note that even though potassium is important, if a large amount enters the bloodstream suddenly, it can cause a fatal arrhythmia. As I write this, I realize that it might be that there are low dose supplements that would approximate what one would get in a potassium rich meal. I don't know, but please be careful and know that there is such a thing as too much potassium at once.
Posted by: Linda | September 15, 2013 at 02:22 PM
Insufficient potassium and vitamin B-1 (thiamin) can not damage the heart significantly when both are deficient. This has important safety implications when supplementing each during heart disease, arrhythmias, rheumatoid arthritis, high blood pressure, gout, beri-beri, or diabetes caused or influenced by the deficiency of one of them. It is extremely important to know which kind of heart disease is involved. You may see this discussed in detail in http://charles_w.tripod.com/kandthiamin.html . This is probably the primary reason why the medical profession has not been able to prevent heart disease up to date and why potassium supplements cause neutral mortality statistics. Researchers almost across the board think that potassium has little impact on the body or/and is never deficient. This is a mistaken assumption. Most food processing procedures cause losses. Enormous attention is given to a single murder or handful of murders, while at the same time the food industry causing 500 thousand deaths from heart disease alone, gets almost no coverage. This is because a considerable fraction of their profits goes to promulgating these disasters by advertising and bribing politicians. Even the medical profession is responsible by procedures in hospital cafeterias.
Copper is crucial for strength of arteries because of its role as part of lysil oxidase, which cross links elastin tissue. A deficiency is probably the main cause of aneurisms and therefore many strokes, hemorrhoids, and many bleeding problems, as well as high blood cholesterol and is probably involved by a synergistic affect in the cause of diabetes by chili pepper (see http://charles_w.tripod.com/diabetes.html ). You may see how to increase copper from food in http://charles_w.tripod.com/copper3.html and a discussion of copper physiology in http://charles_w.tripod.com/copper.html . Finding ways to repair the heart is useful, but there is no good substitute for not damaging it in the first place.
You also may find a book about potassium nutrition as it relates to heart disease, gout, rheumatoid arthritis, high blood pressure, and diabetes, useful for your library. Its availability is through Paypal along with its introduction, table of contents and first two chapters may be accessed in http://charles_w.tripod.com/book.html .
Posted by: Charles Weber | September 15, 2013 at 11:27 AM
"Background Abundant, indirect epidemiological evidence indicates that influenza contributes to all-cause mortality and cardiovascular hospitalizations with studies showing increases in acute myocardial infarction (AMI) and death during the influenza season."
This cannot be taken as a serious medical study. They have made the first year medical student's mistake of confusing "ASSOCIATION with" with CAUSE in their very background information.
It has been well known for at least all my lifetime that TB is the "harvester of the infirm elderly". When your immune system goes you die. The TB does not kill you your immune system does.
The exact same thing can be said for the seasonal flu. The flu virus does not give you a serious case of the "flu" your immune system does. More to the point a lack of vitamin D which does not allow your immune system to function correctly and optimally gives you the flu.
http://healthyprotocols.com/2_flu_shot_intro.htm
When your immune system goes you die. "Vaccination" especially the hyper toxic "flu shot" which includes the H1N1 "vaccine" is helping to destroy our immune systems.
Posted by: Lou | August 24, 2013 at 11:25 AM
So my point with my previous post is, if the vaccine doesn't work in preventing the flu, why would it work in preventing heart attacks, since in order for it to prevent heart attacks it first has to prevent the flu.
Posted by: Victor Pavlovic | August 23, 2013 at 04:40 PM
The Cochrane collaboration doesn't seem to think the flu vaccine is effective, according to this article. "British Columbia (BC) launched a very aggressive anti-‘flu policy this fall, with healthcare workers being forced to get the ‘flu shot or wear a mask. The rationale is that anyone caring for patients shouldn’t also be passing on viruses to them and making them sick. Fair enough. But does the evidence support mandatory ‘flu shots for healthcare workers? Does the vaccine even work to prevent the spread of the virus?
BC Provincial Health Officer Dr. Perry Kendall thinks so and so do some of his colleagues, including Dr. Paul Van Buynder, Chief Medical Office of Fraser Health. A researcher friend of mine asked Dr. Van Buynder for the evidence used to support this new policy. He received a reference list that fits into the ‘shotgun’ category of literature reviews, containing dozens and dozens of references, some relevant studies as well as editorials, commentaries, eminent opinions, and other detritus. Hmmm. And this is somehow supposed to placate us as a reasonable ‘evidence base’?
When you use a shotgun, you’re likely to hit something – maybe. Included in the province’s ‘evidence’ to support the new policy was a whole range of studies and outcomes, including some deemed ‘biologically implausible’ - such as that vaccinating health workers reduces death by all causes, which is to say the ‘flu shot also prevents death by strangulation, gun shots, and zombies.
To counter this, I looked for the sniper rifle and spoke to Dr. Tom Jefferson, a Rome-based researcher who produces ‘flu vaccine reviews for The Cochrane Collaboration. He’s been doing systematic reviews of ‘flu vaccines and ‘flu drugs for over a decade, so he has more than a passing interest in the subject. Jefferson’s team examined four large cluster randomised trials and one cohort trial of nearly 20,000 healthcare workers. According to their findings, the ‘flu vaccine showed “no effect on specific outcomes: laboratory-proven influenza, pneumonia, or deaths from pneumonia”.
In other words, the ‘flu policy, while eminently agreeable, is unsupported by evidence that has been systematically collected, critically evaluated, and properly synthesised. BC is not the only jurisdiction to adopt a ‘trust us, we’re experts’ pose, but in my opinion, that response is only fit for underlings, not intelligent, responsible healthcare workers facing the pointy end of a syringe this season."
Posted by: Victor Pavlovic | August 23, 2013 at 04:37 PM
Hi Jen,
This is a new study so it could not have been reviewed by Cochrane who nevertheless have been generally sceptical about the scientific literature supporting flu vaccination.
John
Posted by: John Stone | August 23, 2013 at 12:16 PM
It could be true, those that go to the doctors for heart meds may well be more likely to get a flu shot. They're just happily dancing with the stupidity of this study and the people who buy into it. It does remind me of my dad, when he asked his vascular surgeon if he should get a flu shot, the doc said "NO" . clearly NO! No one with atherosclerosis should bring on inflammation on demand. Since we see that in the elderly the protective factor was something ridiculous , likely not even the 9% final figure, it can only cause harm. These studies are causing mortality, what happened to "first do no harm".
Posted by: barbara j | August 23, 2013 at 12:06 PM
Tobacco companies use to do this too.
Smoking is actually good for you - as the old farmers working in the tobacco fields would repeat what news they heard flash across the radio. They would just shakes their heads -- they did not believe it even though they had a lot riding on it.
The manufactures of margarine, soy bean oil and corn oil had their studies too as they talked the American people into changing over to their healthier product and shoveled coconut oil off the shelves. They used doctors too didn't they?
Then of course there is those new light bulbs with the mercury - energy savers, and they last five whole years - no more changing them-- that much!
On the other hand they can use reverse psychology, as in, there will no longer be 100 watt and 75 watt light bulbs; so you better hurry to get the last of them. Do store them for yourselves. Who got suckered into helping them clear out their supplies? I can raise my hand here on that one -- they got me. Who uses that much wattage?
Who has time to look deeper into every quick study that the news flashes onto the tube or writes in the newspaper, or is put on the radio?
News flash -Vitamins are bad for you and here are the studies proving it. I got that one shoved in front of my face by my parents. Frustrating that it was put out by the likes of Paul Offit.
And that is what this study is designed to do --get picked up by some news bozo and flashed over the tubes, wires, and paper.
And sell them there flu shots.
My Mother who reacted to a flu shot 30 years ago - has been offered it in every office visit - hospital visit, and watches a lot of TV - says: "They must not be doing too good about selling their product for they sure are having to work on it so hard."
Posted by: Benedetta | August 23, 2013 at 10:38 AM
What does Cochrane say about this study?
Posted by: jen | August 23, 2013 at 10:32 AM
Victor- thanks for commenting, we published the conflicts of interest to make our point.
Posted by: Managing Editor | August 23, 2013 at 10:01 AM
What's the point of putting this fake study on this site?
Posted by: Victor Pavlovic | August 23, 2013 at 08:40 AM
The study was funded by GSK. The control group consisted of outpatients at orthopaedic and opthalmic clinics who may have been persuaded to have the vaccine, and would likely have a different lifestyle profile from the cases.
This is an earlier study where they found a mild association between flu vaccine and heart disease but after they had added in confounders they ended up with a 19% benefit.
http://www.cmaj.ca/content/early/2010/09/20/cmaj.091891.short
Posted by: John Stone | August 23, 2013 at 06:33 AM