By Michael Merschel, American Heart Association News
In some ways, the link between viruses, vaccines and heart health is simple.
Now that the updated COVID-19 vaccine is available—and can be given at the same time as the flu shot—here are more straightforward answers from the experts on what people with cardiovascular issues should know about viruses and vaccines.
Viruses pose serious heart risks. Heart issues and infection are linked in many ways. One is inflammation, said Dr. Saate Shakil, an assistant professor of cardiology at the University of California, San Francisco.
Diseases caused by viruses, such as the coronavirus, influenza and respiratory syncytial virus, or RSV, can cause inflammation. So can bacterial illnesses such as pneumonia. If you have coronary heart disease, blood flow is restricted by plaque-filled arteries. In such cases, inflammation could lead to a plaque rupture, blood clot and blocked artery that causes a heart attack or stroke, said Shakil, who has studied links between COVID-19 and stroke.
A virus doesn’t have to attack the heart directly to endanger it, Shakil said. Someone with pneumonia might have trouble breathing, which strains the heart.
Meanwhile, Dr. Jorge Alvarez, an interventional cardiologist at Methodist Cardiology Clinic of San Antonio said, “a high fever caused by infection can sometimes lead to heart rhythm issues in certain people.”
Vaccines protect against those risks. Alvarez likens cardiovascular problems to a campfire. Cholesterol, which leads to arterial plaque, is like a growing pile of wood in his analogy. Inflammation is the lighter fluid. A viral or bacterial infection is the match that sets it all off. A vaccine, he said, is like a bucket of water for that match, stopping the whole process.
Research published in February 2023 (JACC) found that among more than 1.9 million people infected with the coronavirus, vaccination was associated with a lower risk of heart attacks, strokes, and other cardiovascular events. Flu vaccination, meanwhile, is associated with a lower risk of stroke.
The Centers for Disease Control and Prevention says that people who have heart disease or have had a stroke should talk to their health care team about vaccinations for COVID-19, flu and pneumococcal disease, which includes pneumonia and meningitis. They should also stay current on a Tdap vaccine, which protects against diphtheria, tetanus, and pertussis (also known as whooping cough).
The CDC also recommends that adults 60 and older ask about the new RSV vaccine.
A health care professional can offer advice on other vaccines, as well as whether to avoid certain formulations. For example, the CDC says people who are pregnant, have weakened immune systems or are 50 and older should not receive the nasal spray flu vaccine, which is a live virus-based vaccine. “It’s not that they can’t get vaccinated,” Shakil said. “It’s just that the type of vaccine has to be tailored for them.”
Vaccination risks are real – but far outweighed by the benefits. Vaccines can have side effects. The COVID-19 vaccine, for example, has been linked to rare cases of myocarditis and pericarditis, types of heart inflammation. However, the risks of the vaccine are very infrequent events. If you compare that against the large degree of benefit that you get by reducing the severity of COVID-19, reducing the odds of being hospitalized, or having a cardiovascular complication, the benefits are apparent.
When Dr. Alvarez’s patients express concerns about vaccine risks, he points out that their risk of getting in a major car accident on the way to his office—a risk they all were comfortable with—is higher than the risk of a serious reaction to the vaccine.
“Vaccines are safe and effective, and they help save lives,” he said.
Shakil said her patients often have asked about vaccine safety, so she examined the history of each patient for risks. “I see a lot of patients, and I don’t think there was a single patient where we went through their data and felt like it was risky for them to have the vaccination. If anything, it would have been more of a risk for them to have gotten COVID and not have been immunized.”
Vaccines aren’t perfect. Despite their overall benefits, COVID-19 and flu vaccines don’t stop every infection. That does not mean they didn’t work. A vaccine will help your immune system ‘study for a test’—it might not score 100%, but it’s going to do a lot better than someone who didn’t study at all.
You don’t have to sort this out alone. Worried or confused about which vaccines you need? It’s OK to grill your cardiologist or primary care physician, Dr. Alvarez said.
Ask them to explain their reasoning, then be open-minded about what they say. “There should be some thought and some discussion behind some of these things,” he said.
There are no silly questions, Shakil said. “The worst thing that could happen is that you walk away with more information than you came in with.”
To find locations that provide COVID-19 and flu vaccines, visit the federal website vaccines.gov or call 800-232-0233.
Adapted from an American Heart Association article https://www.heart.org/en/ news/2023/10/06/what-people-with-heart-disease-should-know-about-vaccines-today
