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Influenza Vaccination Is Associated With Reduced Cardiovascular Mortality in Adults With Diabetes: A Nationwide Cohort Study.
Diabetes Care. 2020 09; 43(9):2226-2233.DC

Abstract

OBJECTIVE

Recent influenza infection is associated with an increased risk of atherothrombotic events, including acute myocardial infarction (AMI) and stroke. Little is known about the association between influenza vaccination and cardiovascular outcomes in patients with diabetes.

RESEARCH DESIGN AND METHODS

We used nationwide register data to identify patients with diabetes in Denmark during nine consecutive influenza seasons in the period 2007-2016. Diabetes was defined as use of glucose-lowering medication. Patients who were not 18-100 years old or had ischemic heart disease, heart failure, chronic obstructive lung disease, cancer, or cerebrovascular disease were excluded. Patient exposure to influenza vaccination was assessed before each influenza season. We considered the outcomes of death from all causes, death from cardiovascular causes, and death from AMI or stroke. For each season, patients were monitored from December 1 until April 1 the next year.

RESULTS

A total of 241,551 patients were monitored for a median of four seasons (interquartile range two to eight seasons) for a total follow-up of 425,318 person-years. The vaccine coverage during study seasons ranged from 24% to 36%. During follow-up, 8,207 patients died of all causes (3.4%), 4,127 patients died of cardiovascular causes (1.7%), and 1,439 patients died of AMI/stroke (0.6%). After adjustment for confounders, vaccination was significantly associated with reduced risks of all-cause death (hazard ratio [HR] 0.83, P < 0.001), cardiovascular death (HR 0.84, P < 0.001), and death from AMI or stroke (HR 0.85, P = 0.028) and a reduced risk of being admitted to hospital with acute complications associated with diabetes (diabetic ketoacidosis, hypoglycemia, or coma) (HR 0.89, P = 0.006).

CONCLUSIONS

In patients with diabetes, influenza vaccination was associated with a reduced risk of all-cause death, cardiovascular death, and death from AMI or stroke. Influenza vaccination may improve outcome in patients with diabetes.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Modin D
Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark danielmodin.md@gmail.com.
Claggett B
Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Køber L
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Schou M
Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Jensen JUS
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Respiratory Medicine Section, Department of Internal Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Solomon SD
Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Vardeny O
Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, and University of Minnesota, Minneapolis, MN.
Knop FK
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Nielsen SD
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Fralick M
Sinai Health System and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Torp-Pedersen C
Department of Health Science and Technology, Aalborg University, and Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University, Aalborg, Denmark.
Gislason G
Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Biering-Sørensen T
Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark. Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

MeSH

AdolescentAdultAgedAged, 80 and overCause of DeathCohort StudiesDenmarkDiabetes MellitusDiabetic AngiopathiesFemaleHeart FailureHospitalizationHumansInfluenza VaccinesInfluenza, HumanMaleMiddle AgedMyocardial InfarctionMyocardial IschemiaRegistriesSeasonsStrokeVaccinationVaccination CoverageYoung Adult

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32647052

Citation

Modin, Daniel, et al. "Influenza Vaccination Is Associated With Reduced Cardiovascular Mortality in Adults With Diabetes: a Nationwide Cohort Study." Diabetes Care, vol. 43, no. 9, 2020, pp. 2226-2233.
Modin D, Claggett B, Køber L, et al. Influenza Vaccination Is Associated With Reduced Cardiovascular Mortality in Adults With Diabetes: A Nationwide Cohort Study. Diabetes Care. 2020;43(9):2226-2233.
Modin, D., Claggett, B., Køber, L., Schou, M., Jensen, J. U. S., Solomon, S. D., Vardeny, O., Knop, F. K., Nielsen, S. D., Fralick, M., Torp-Pedersen, C., Gislason, G., & Biering-Sørensen, T. (2020). Influenza Vaccination Is Associated With Reduced Cardiovascular Mortality in Adults With Diabetes: A Nationwide Cohort Study. Diabetes Care, 43(9), 2226-2233. https://doi.org/10.2337/dc20-0229
Modin D, et al. Influenza Vaccination Is Associated With Reduced Cardiovascular Mortality in Adults With Diabetes: a Nationwide Cohort Study. Diabetes Care. 2020;43(9):2226-2233. PubMed PMID: 32647052.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influenza Vaccination Is Associated With Reduced Cardiovascular Mortality in Adults With Diabetes: A Nationwide Cohort Study. AU - Modin,Daniel, AU - Claggett,Brian, AU - Køber,Lars, AU - Schou,Morten, AU - Jensen,Jens Ulrik Stæhr, AU - Solomon,Scott D, AU - Vardeny,Orly, AU - Knop,Filip Krag, AU - Nielsen,Susanne Dam, AU - Fralick,Michael, AU - Torp-Pedersen,Christian, AU - Gislason,Gunnar, AU - Biering-Sørensen,Tor, Y1 - 2020/07/09/ PY - 2020/02/04/received PY - 2020/05/28/accepted PY - 2020/7/11/pubmed PY - 2021/4/14/medline PY - 2020/7/11/entrez SP - 2226 EP - 2233 JF - Diabetes care JO - Diabetes Care VL - 43 IS - 9 N2 - OBJECTIVE: Recent influenza infection is associated with an increased risk of atherothrombotic events, including acute myocardial infarction (AMI) and stroke. Little is known about the association between influenza vaccination and cardiovascular outcomes in patients with diabetes. RESEARCH DESIGN AND METHODS: We used nationwide register data to identify patients with diabetes in Denmark during nine consecutive influenza seasons in the period 2007-2016. Diabetes was defined as use of glucose-lowering medication. Patients who were not 18-100 years old or had ischemic heart disease, heart failure, chronic obstructive lung disease, cancer, or cerebrovascular disease were excluded. Patient exposure to influenza vaccination was assessed before each influenza season. We considered the outcomes of death from all causes, death from cardiovascular causes, and death from AMI or stroke. For each season, patients were monitored from December 1 until April 1 the next year. RESULTS: A total of 241,551 patients were monitored for a median of four seasons (interquartile range two to eight seasons) for a total follow-up of 425,318 person-years. The vaccine coverage during study seasons ranged from 24% to 36%. During follow-up, 8,207 patients died of all causes (3.4%), 4,127 patients died of cardiovascular causes (1.7%), and 1,439 patients died of AMI/stroke (0.6%). After adjustment for confounders, vaccination was significantly associated with reduced risks of all-cause death (hazard ratio [HR] 0.83, P < 0.001), cardiovascular death (HR 0.84, P < 0.001), and death from AMI or stroke (HR 0.85, P = 0.028) and a reduced risk of being admitted to hospital with acute complications associated with diabetes (diabetic ketoacidosis, hypoglycemia, or coma) (HR 0.89, P = 0.006). CONCLUSIONS: In patients with diabetes, influenza vaccination was associated with a reduced risk of all-cause death, cardiovascular death, and death from AMI or stroke. Influenza vaccination may improve outcome in patients with diabetes. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/32647052/Influenza_Vaccination_Is_Associated_With_Reduced_Cardiovascular_Mortality_in_Adults_With_Diabetes:_A_Nationwide_Cohort_Study_ DB - PRIME DP - Unbound Medicine ER -