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Ischaemic heart disease, influenza and influenza vaccination: a prospective case control study
  1. C Raina MacIntyre1,2,
  2. Anita E Heywood1,
  3. Pramesh Kovoor3,
  4. Iman Ridda1,2,
  5. Holly Seale1,
  6. Timothy Tan3,4,
  7. Zhanhai Gao1,
  8. Anthea L Katelaris5,
  9. Ho Wai Derrick Siu5,
  10. Vincent Lo5,
  11. Richard Lindley3,
  12. Dominic E Dwyer3,6
  1. 1School of Public Health and Community Medicine, UNSW Medicine, the University of New South Wales, Sydney, New South Wales, Australia
  2. 2National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, New South Wales, Australia
  3. 3Westmead Hospital, Sydney Medical School, University of Sydney, Westmead, New South Wales, Australia
  4. 4Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  6. 6Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Microbiology (ICPMR), Westmead Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Dr Anita E Heywood, School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Level 2, Samuels Building, Sydney, NSW 2052, Australia; a.heywood{at}


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.

  • Coronary Artery Disease
  • Infection

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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