Seasonal influenza vaccine development and mass production, as well as three international trials looking at influenza vaccine cardiovascular outcomes, could inform future efforts toward developing and evaluating vaccine strategies for COVID-19, according to a state-of-the-art review published Oct. 5 in the Journal of the American College of Cardiology.

Bahar Behrouzi, MSc, et al., reviewed the current state of influenza vaccine research in cardiovascular patients at high risk for cardiopulmonary morbidity and mortality, comparing influenza and current knowledge of COVID-19. The researchers also discussed the association between influenza and influenza-like illness and cardiovascular complications, potential cardioprotective effects of the standard seasonal influenza vaccine, and three ongoing trials that are testing influenza vaccines in high-risk cardiovascular patients. In addition, the authors evaluated whether existing influenza trial networks could offer primary and secondary prevention strategies for patients with cardiovascular disease at risk of complications from COVID-19.

There are currently three international cardiovascular outcomes trials examining the cardioprotective effects of different influenza vaccine formulations. The IVVE trial is a placebo-controlled, randomized clinical trial studying adverse cardiovascular events in NYHA Class II-IV heart failure in patients from Asia, the Middle East and Africa. The IAMI trial is also a placebo-controlled, randomized clinical trial testing patients ages 75 and older with STEMI, non-STEMI or stable coronary artery disease undergoing coronary angiography. The IAMI trial is collecting data from patients in several European countries, Australia and Bangladesh. Funded by the NIH and conducted in the U.S. and Canada, the INVESTED trial is comparing two types of influenza vaccines over several flu seasons in high-risk cardiovascular patients with a recent history of myocardial infarction or heart failure hospitalization.

If the trials show that "influenza vaccination is an effective, low-cost, widely available therapy that reduces cardiovascular risk, [it] may further help prevent fatal and nonfatal cardiovascular complications of COVID-19," the authors conclude.

"Three large ongoing influenza vaccine cardiovascular outcome trials have an opportunity to contribute further to our understanding of the underlying comorbidities in these patients that may be driving morbidity and mortality associated with COVID-19 infection," says Jacob A. Udell, MD, MPH, one of the authors. "These cohorts may also be an opportunity to explore novel infection prevention therapies beyond influenza vaccination in patients that have already volunteered to participate in a respiratory virus vaccine cardiovascular outcome study."

Clinical Topics: COVID-19 Hub, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Nuclear Imaging, Chronic Angina

Keywords: Influenza Vaccines, Influenza, Human, Coronary Artery Disease, Coronary Angiography, Cardiovascular Diseases, Secondary Prevention, COVID-19, ST Elevation Myocardial Infarction, Risk Factors, severe acute respiratory syndrome coronavirus 2, Myocardial Infarction

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