Patient Focus: CardioSmart Corner | Martha Gulati, MD, MS, CardioSmart Editor-in-Chief

CardioSource WorldNews | Cardiologists Should Stress the Importance of Vaccinations for Patients

Throughout the month of August, we recognize National Immunization Awareness Month, which was established to encourage people of all ages to make sure they are up to date on the vaccines recommended for them. Vaccines, like the flu and shingles vaccines, are even more important for people with cardiovascular disease as they are at a high risk for developing serious complications from flu infection or shingles.

People with heart disease may have a three times increased risk of flu-related hospitalization. Studies have shown that patients with heart disease who receive a flu vaccine had a decreased risk of acute coronary syndrome and heart disease-related deaths. The ACC, American Heart Association and the Centers for Disease Control and Prevention (CDC) recommend an annual influenza vaccine for secondary prevention of cardiac-related events in persons with coronary and other atherosclerotic vascular disease, including stroke. However, in recent years, less than half of people 18-64 years with heart disease were vaccinated during flu season.  It is important for cardiologists to recommend the yearly flu vaccine to their patients, or to even provide them in their practice.

Patients with heart disease may also need other vaccinations such as the pneumococcal polysaccharide vaccine and additional vaccines based on certain considerations, such as the patient’s age. The shingles vaccine is recommended for people aged 60 years or older, yet only 9% of eligible patients have received it. Anyone who has had chickenpox can get shingles, which increases the risk of stroke and heart attack. The shingles vaccine is a one-time, single-dose shot. Patients can visit for information to help them decide whether different vaccines are right for them.

“Silent” Heart Attacks Common in Middle-aged Adults

Nearly half of all heart attacks go unnoticed in middle-aged adults, according to the results of a large U.S. study published in Circulation.

The ARIC (Atherosclerosis Risk in Communities) study followed nearly 9,500 U.S. adults to investigate risk factors related to heart disease. Participants were 54 years old on average and free of heart disease at the start of the study. Across an average of 9 years, participants completed interviews and medical exams, including electrocardiograms, to assess their health and lifestyle.

During the follow-up period, 4% of participants had been diagnosed with heart attack. But upon further investigation, another 3% of participants had “silent” heart attacks based on ECG results. Overall, silent heart attacks accounted for 45% of all heart attacks in the study. Based on analysis, adults with evidence of silent heart attacks had 34% greater risk of death than adults with no history of heart attack. Researchers also noted that while silent heart attacks were more common in men than women, silent heart attacks were associated with greater risk of death in women.

According to researchers, the findings highlight the need for better detection of silent heart attacks. It’s important that patients know their cardiovascular risk to properly address any risk factors they may have. They add that future research to explore both sex and race differences related to silent heart attacks is needed. With additional research, experts hope to better understand silent heart attacks and improve outcomes for all heart attack patients.

Zhu-Ming Zhang, Pentti M. Rautaharju, etc. Circulation. 2016;doi: 10.1161/CIRCULATIONAHA.115.021177

Read the full August issue of CardioSource WorldNews at

Clinical Topics: Acute Coronary Syndromes, Prevention

Keywords: CardioSource WorldNews, Acute Coronary Syndrome, American Heart Association, Centers for Disease Control and Prevention (U.S.), Herpes Zoster, Herpes Zoster Vaccine, Immunization, Secondary Prevention, Stroke, Vaccination

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