Совместная вакцинация от COVID-19 и гриппа снижает риск сердечно-сосудистых осложнений у пожилых

Coadministration of COVID-19, influenza vaccines may lower MACE risk in older adults Key takeaways: - Coadministration of COVID-19 and influenza vaccines may reduce MACE and mortality risk vs. influenza vaccination alone. - Risk reduction was strongest among older adults with comorbidities. The 2024-2025 COVID-19 vaccine was associated with reduced risk for COVID-19-related major adverse cardiovascular events among older adults, especially those with comorbidities, researchers reported. Coadministration of the COVID-19 vaccine alongside the annual influenza vaccine may reduce COVID-19-related and all-cause mortality among older, higher-risk individuals, according to a study published in JAMA Internal Medicine. “The 2024-2025 COVID-19 vaccine was associated with a lower risk of COVID-19-associated MACE; absolute risk reductions were generally modest, but more pronounced in older adults and individuals with comorbidities,” Miao Cai, PhD, biostatistician at the VA St. Louis Health Care System Clinical Epidemiology Center, and colleagues wrote. “Effectiveness extends to broader outcomes (all-cause MACE, hospitalization, and death), likely reflecting the hidden burden of undetected SARS-CoV-2 and associated complications that are reduced by COVID-19 vaccination. These findings provide timely evidence to help inform clinical and public health discussions about the role of updated COVID-19 vaccines in the current epidemiologic context.” The researchers conducted a target trial emulation using electronic health record data more than 1 million veterans (mean age, 70 years; 92% men) who received same-day coadministration of COVID-19 and influenza vaccines and compared outcomes with individuals who received the influenza vaccine alone over a median follow-up of 8 months. The main outcome of interest was a composite endpoint of COVID-19-associated MACE, including COVID-19-associated CV death, MI, stroke or heart failure hospitalization. The 2024-2025 COVID-19 vaccines included those manufactured by Moderna, Novavax and Pfizer-BioNTech and the 2024-2025 seasonal influenza vaccines included those manufactured by AstraZeneca, GlaxoSmithKline, Sanofi and Seqirus, according to the study. The researchers reported COVID-19 vaccination was associated with lower risk for COVID-19-associated MACE vs. no COVID-19 vaccination (risk difference, 2 per 10,000 population; 95% CI, 0.9-3.7), but was only statistically significant among people aged 75 years or older, a group that also experienced the largest absolute risk reduction (risk difference, 5.5 per 10,000 population). Among the individual components of the main composite endpoint, COVID-19 vaccination was associated with lower risk for COVID-19-associated CV death (risk difference, 1 per 10,000 population; 95% CI, 0.3-2.1), MI (risk difference, 0.8 per 10,000 population; 95% CI, 0.1-1.9), and HF hospitalization (risk difference, 0.8 per 10,000 population; 95% CI, 0.1-2.1) but not COVID-19-associated stroke (risk difference, 0.4 per 10,000 population; 95% CI, 0.2 to 1.2), according to the study. The researchers reported COVID-19-associated MACE risk reductions were consistent across subgroups; however, people with comorbidities appeared to derive more benefit from COVID-19 vaccination. In a secondary analysis designed to evaluate the association between 2024-2025 COVID-19 vaccination and non-COVID-19-specific outcomes, researchers observed reduced risk for all-cause MACE (risk difference, 23.7 per 10,000 population; 95% CI, 14.1-34.7), all-cause hospitalization (risk difference, 29.9 per 10,000 population; 95% CI, 19.7-41.8) and all-cause death (risk difference, 15.8 per 10,000 population; 95% CI, 8.6-24.1). “The epidemiologic landscape of COVID-19 has shifted considerably since vaccines were first introduced, impelled by SARS-CoV-2 variant evolution and widespread hybrid immunity from vaccination and infection,” the researchers wrote. “While this has led to an overall reduction in COVID-19 morbidity and mortality, our study findings show that vaccination continues to provide protection against associated cardiovascular outcomes. The magnitude of this vaccine effectiveness, however, is lower than estimates from the early phase of the vaccine rollout. The reduced effectiveness (compared to earlier studies) is likely driven by various factors including changes in SARS-CoV-2, residual immunity from prior infections and immunizations, and decline in testing practices that limit detection of SARS-CoV-2–associated events, allowing underestimation of vaccine effectiveness.”