Can COVID-19 vaccines improve cardiovascular outcomes?

Thus far, the investigations on the efficacy of the COVID-19 vaccines in randomized trials [8,9] have been centered around reducing the risk of severe infection and mortality. We opine investigations on the efficacy of the COVID-19 vaccines to reduce the risk of cardiovascular outcomes should be performed to understand if COVID-19 vaccination has cardiovascular benefits. Such investigations could also develop more confidence toward the acceptance of COVID-19 vaccines by the public, especially when some of the COVID-19 vaccines (particularly the mRNA vaccines such as BNT162b2 and mRNA-1273 vaccines) have been associated with the rare occurrence of cardiovascular complications, including myocarditis and pericarditis [10,11]. While the infrequency and the mild nature of the myocarditis and pericarditis cases after vaccination greatly exceed the small increased risk, specious reports on social media are still fueling the COVID-19 vaccine hesitancy. Therefore, we urge the performance of prospective investigations to establish the relationship between COVID-19 vaccines and cardiovascular outcomes.

We congratulate Diaz-Arocutipa et al. [1] for their insightful systematic review and meta-analysis of randomized controlled trials which evaluated the efficacy of the influenza vaccine on cardiovascular outcomes in patients with coronary artery disease. As mentioned by the authors, influenza infection is associated with a myriad of cardiovascular manifestations, including thrombotic events, myocarditis, pericarditis, acute decompensated heart failure, arrhythmias, and sudden cardiac death. Indeed, since influenza infection is a predisposing factor for atherosclerosis, it can also trigger the occurrence of acute coronary syndromes. Therefore, the systematic review and meta-analysis by Diaz-Arocutipa et al. [1], which reported that influenza vaccination significantly reduced the risk of major adverse cardiovascular events (pooled relative risk = 0.63; 95% confidence interval 0.51 to 0.77) and cardiovascular mortality (relative risk = 0.53; 95% confidence interval 0.38 to 0.74), can serve as a reminder for the clinicians about the importance of influenza vaccination as secondary prevention for acute cardiovascular events.

The findings of the systematic review and meta-analysis by Diaz-Arocutipa et al. [1] have made us wonder if similar investigations can be replicated to shed some light on the efficacy of the COVID-19 vaccines to reduce the risk of cardiovascular outcomes, considering that coronavirus disease 2019 (COVID-19) cases still soaring around the globe. As with influenza infection, patients with acute COVID-19 may present with a broad spectrum of clinical cardiac presentations. For instance, as detected by troponin elevation, myocardial injury is commonly identified in patients hospitalized with COVID-19 [2]. In addition, patients with COVID-19 also have a heightened risk of developing myocarditis [3] and Takotsubo cardiomyopathy [4]. Moreover, studies [5,6] have also suggested that acquisition of COVID-19 increases the risk of developing acute coronary syndromes. For example, in one study [5], there was an increased risk of acute myocardial infarction in patients with COVID-19 compared to non-infected controls (adjusted odds ratio = 1.22; 95% confidence interval 1.08 to 1.38). Indeed, the increased risk of cardiovascular diseases extends beyond the acute phase of COVID-19, in which at one-year after COVID-19, patients still manifested an increased risk of developing major adverse cardiovascular events [7].

Funding

No external funding was used in the preparation of this manuscript.

Declaration of competing interest

All authors declare that they have no potential conflicts of interest that might be relevant to the contents of this article.