{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T12:44:54Z","timestamp":1776689094943,"version":"3.51.2"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2020,4,7]],"date-time":"2020-04-07T00:00:00Z","timestamp":1586217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>There are several guidelines that recommend pneumococcal vaccination (PPSV23 and\/or PCV13) in adults with a history of cardiovascular disease (established heart failure, coronary disease, and cerebrovascular disease) or at a very high risk of cardiovascular disease. However, there is no randomized controlled trial (RCT) systematic review that evaluates the impact of vaccination on all-cause mortality compared to no vaccination in this particular population. Our objective is to conduct a systematic review and meta-analysis of the impact of pneumococcal vaccination in the referred population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>We searched CENTRAL and MEDLINE for relevant RCTs and observational studies. Data were screened, extracted, and appraised by two independent reviewers. We pooled results using a random effects model, and used hazard ratios (HRs) with 95% confidence intervals (CIs) to assess measure of effect. The primary outcome was all-cause mortality and we assessed the confidence in the evidence using the GRADE framework. No RCTs were found. Seven observational studies were included for analyses. Pooled results from five studies enrolling a total of 163\u00a0756 participants showed a significant decrease in all-cause mortality (HR 0.78, 95% CI 0.73\u20130.83, very low confidence), without statistically significant heterogeneity (\u03c72 test P\u2009=\u20090.21; I2 = 32%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Pneumococcal vaccination was associated with a 22% decrease of all-cause mortality in patients with cardiovascular disease or at a very high cardiovascular risk. However, limitations due to study design and the serious risk of bias in three of the included studies leads to a decreased level of result confidence.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcaa030","type":"journal-article","created":{"date-parts":[[2020,4,1]],"date-time":"2020-04-01T19:09:56Z","timestamp":1585768196000},"page":"97-106","source":"Crossref","is-referenced-by-count":40,"title":["Pneumococcal vaccination in adults at very high risk or with established cardiovascular disease: systematic review and meta-analysis"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0887-8219","authenticated-orcid":false,"given":"Miguel","family":"Marques Antunes","sequence":"first","affiliation":[{"name":"Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7802-1897","authenticated-orcid":false,"given":"Gon\u00e7alo S","family":"Duarte","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Farmacologia Cl\u00ednica e Terap\u00eautica, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal"},{"name":"Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal"}]},{"given":"Dulce","family":"Brito","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia, Hospital Universit\u00e1rio de Santa Maria (CHULN), CAML, Centro Cardiovascular da Universidade de Lisboa \u2014 CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8563-6846","authenticated-orcid":false,"given":"Margarida","family":"Borges","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Farmacologia Cl\u00ednica e Terap\u00eautica, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal"},{"name":"Centro de Estudos de Medicina Baseada na Evid\u00eancia, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5831-4921","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Costa","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Farmacologia Cl\u00ednica e Terap\u00eautica, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal"},{"name":"Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal"},{"name":"Centro de Estudos de Medicina Baseada na Evid\u00eancia, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal"}]},{"given":"Joaquim J","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Farmacologia Cl\u00ednica e Terap\u00eautica, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal"},{"name":"Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal"},{"name":"CNS\u2014Campus Neurol\u00f3gico S\u00e9nior, Bairro de Santo Ant\u00f3nio, N. 47 2560-280 Torres Vedras, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8034-4529","authenticated-orcid":false,"given":"Fausto J","family":"Pinto","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia, Hospital Universit\u00e1rio de Santa Maria (CHULN), CAML, Centro Cardiovascular da Universidade de Lisboa \u2014 CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2520-5673","authenticated-orcid":false,"given":"Daniel","family":"Caldeira","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Farmacologia Cl\u00ednica e Terap\u00eautica, Faculdade de Medicina, Universidade de Lisboa, Av. 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Prof. Egas Moniz, Lisboa 1649-028, Portugal"}]}],"member":"286","published-online":{"date-parts":[[2020,4,7]]},"reference":[{"key":"2021012519101922700_qcaa030-B1"},{"key":"2021012519101922700_qcaa030-B2","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1056\/NEJM200003233421202","article-title":"C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women","volume":"342","author":"Ridker","year":"2000","journal-title":"N Engl J Med"},{"key":"2021012519101922700_qcaa030-B3","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1056\/NEJM199704033361401","article-title":"Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men","volume":"336","author":"Ridker","year":"1997","journal-title":"N Engl J Med"},{"key":"2021012519101922700_qcaa030-B4","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1111\/imj.13377","article-title":"Triggering of acute myocardial infarction by respiratory infection","volume":"47","author":"Ruane","year":"2017","journal-title":"Intern Med J"},{"key":"2021012519101922700_qcaa030-B5","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1080\/14760584.2019.1690459","article-title":"The association of Influenza infection and vaccine with myocardial infarction: systematic review and meta-analysis of self-controlled case series","volume":"18","author":"Caldeira","year":"2019","journal-title":"Expert Rev Vaccines"},{"key":"2021012519101922700_qcaa030-B6","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1086\/518849","article-title":"The association between pneumococcal pneumonia and acute cardiac events","volume":"45","author":"Musher","year":"2007","journal-title":"Clin Infect Dis"},{"key":"2021012519101922700_qcaa030-B7","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.ijcard.2016.06.228","article-title":"Emergency department triage of acute heart failure triggered by pneumonia; 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