At the opening of the 48th National Congress of SEMERGEN in Santiago de Compostela, doctors highlighted a specific risk: flu can multiply the risk of a heart attack by ten in patients already vulnerable to cardiovascular disease. The risk of a cerebrovascular event can rise eightfold.
The threat goes beyond the infection itself. Respiratory infections can trigger systemic inflammation, destabilise atherosclerotic plaques and promote blood clotting. The resulting strain may cause myocardial infarction, stroke or decompensated heart failure.
For patients with established cardiovascular disease, an infection can become a vascular event. Chronic disease affecting the heart, lungs or kidneys raises the risk of severe respiratory infection. So do diabetes, immunodeficiency and cancer.
Vivencio Barrios, a cardiologist at Hospital Universitario Ramón y Cajal and a member of the SEMERGEN Cardiovascular Diseases Working Group, presented the figures. Pneumococcal pneumonia was linked to a 7% higher risk of a new heart attack and nearly a 6% increase in arrhythmias. Respiratory Syncytial Virus multiplied complications in patients with heart failure by eight.
Influenza vaccination has the strongest evidence for reducing cardiovascular events. Barrios pointed to the IAMI clinical trial, published in 2021, as a turning point in the field. In light of that evidence, the European Society of Cardiology began treating vaccination as the fourth pillar of cardiovascular prevention, alongside established drug-based approaches.
A meta-analysis of randomised studies involving 6,735 patients at high cardiovascular risk found cardiovascular events in 2.9% of vaccinated patients, compared with 4.7% in the control group, corresponding to a relative risk of 0.64. The association was strongest among patients who had recently experienced an acute coronary syndrome, with a relative risk of 0.45.
The evidence is less direct for vaccines against pneumococcal disease, COVID-19, Respiratory Syncytial Virus and Herpes Zóster. Still, these vaccines have a place in cardiovascular care: preventing infection can reduce decompensations and hospital admissions among older adults and people with chronic disease.
Researchers also stressed that larger multicentre studies are needed to establish effects on individual outcomes such as myocardial infarction and stroke. Cardiovascular mortality needs further study, too.
Under current US recommendations, adults aged 75 and older should receive a single dose of RSV vaccine. For adults aged 50 to 74, the decision depends on whether they face an increased risk of severe disease, including because of chronic cardiovascular conditions.
Esther Redondo, a specialist in Family and Community Medicine and member of the IMVAP Working Group at SEMERGEN, said vaccination for chronic patients should be part of their treatment, rather than an occasional, separate measure.
Redondo also rejected the idea that immunisation places an excessive burden on patients with heart failure. In her view, natural infection puts greater stress on the immune system.
The discussion turned to immunosenescence, the physiological ageing of the immune system. It affects how the body detects and presents antigens, along with the activation of T and B lymphocytes.
In people with cardiorespiratory disease, immunosenescence can compound existing chronic inflammation and weaken the response to conventional vaccines.
Newer products are being designed to produce immune responses that arrive sooner and last longer. María Fernández de Prada, a specialist in Preventive Medicine and Public Health at Hospital Álvarez Buylla de Mieres, said modern vaccinology is moving away from a one-size-fits-all approach.
Adjuvants can make the immune response faster and stronger, while extending its duration. They are not interchangeable.
Asturias was cited at the congress as a pioneer in financing the vaccine against Respiratory Syncytial Virus for everyone over 18 with advanced chronic conditions, including chronic heart disease. The policy targets clinical vulnerability, not age alone.
Primary Care will carry much of the practical responsibility. Family doctors can review vaccination records at regular follow-up visits, identify missed doses and use routine appointments to administer recommended vaccines. The experts also called for shared care pathways across Basic Care, Cardiology and Public Health.
Vaccination status must be reviewed, recommended and recorded. At the congress, coadministration was described as safe and effective, with costs also taken into account.
The 48th National Congress of SEMERGEN called for immunisation to join prescriptions and lifestyle advice in cardiovascular prevention. Vaccination should complement established measures, including control of blood pressure, lipids and diabetes, as well as smoking cessation.
