{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:53:55Z","timestamp":1790618035845,"version":"4.1.0"},"reference-count":37,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/00ca2c886","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"FEDER","doi-asserted-by":"publisher","award":["JR21\/00041"],"award-info":[{"award-number":["JR21\/00041"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"FEDER","doi-asserted-by":"publisher","award":["PI23\/01468"],"award-info":[{"award-number":["PI23\/01468"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"FEDER","doi-asserted-by":"publisher","award":["CB16\/11\/00486"],"award-info":[{"award-number":["CB16\/11\/00486"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Seasonal influenza is not only a respiratory infection but also a clinically relevant trigger of acute cardiovascular events. In adults with established cardiovascular disease, particularly older adults and patients with recent acute coronary syndrome or heart failure, influenza vaccination should be considered a low-risk, evidence-supported component of cardiovascular prevention rather than solely protection against respiratory disease. The evidence addresses three related but distinct questions: influenza infection as a cardiovascular trigger; influenza vaccination versus placebo or no vaccination; and enhanced or high-dose vaccination versus standard-dose vaccination. Randomized trials and meta-analyses support reductions in major adverse cardiovascular events, cardiovascular mortality, and all-cause mortality in higher-risk secondary-prevention populations, with particularly persuasive evidence after myocardial infarction. Recent pragmatic active-comparator trials of high-dose inactivated influenza vaccine, including DANFLU-2 and GALFLU, and the individual-level pooled FLUNITY-HD analysis provide incremental evidence in adults aged 65 years or older, strongest for hospitalization for influenza or pneumonia, cardiorespiratory hospitalization, and heart failure hospitalization. The current priority is implementation: screening, offering, documenting, and communicating vaccination across hospitalization, outpatient cardiology, cardiac rehabilitation, heart failure pathways, primary care, pharmacies, and long-term care. Influenza vaccination should complement, not replace, established guideline-directed cardiovascular therapies.<\/jats:p>","DOI":"10.3390\/jcm15145343","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T17:27:31Z","timestamp":1783531651000},"page":"5343","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Influenza Vaccination as Cardiovascular Prevention in Adults with Heart Disease"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8665-7107","authenticated-orcid":false,"given":"Clara","family":"Bonanad","sequence":"first","affiliation":[{"name":"Servicio de Cardiolog\u00eda, Hospital Cl\u00ednico Universitario de Valencia, 46010 Valencia, Spain"},{"name":"Fundaci\u00f3n Para la Investigaci\u00f3n del Hospital Cl\u00ednico de la Comunidad Valenciana (INCLIVA), 46010 Valencia, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6135-7685","authenticated-orcid":false,"given":"Vivencio","family":"Barrios","sequence":"additional","affiliation":[{"name":"Servicio de Cardiolog\u00eda, Hospital Universitario Ram\u00f3n y Cajal, Universidad de Alcal\u00e1, 28034 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Barreres","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Para la Investigaci\u00f3n del Hospital Cl\u00ednico de la Comunidad Valenciana (INCLIVA), 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Maidana","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Para la Investigaci\u00f3n del Hospital Cl\u00ednico de la Comunidad Valenciana (INCLIVA), 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2791-979X","authenticated-orcid":false,"given":"Esther","family":"Redondo","sequence":"additional","affiliation":[{"name":"Unidad T\u00e9cnica de Vacunaci\u00f3n y Salud Internacional, Organismo Aut\u00f3nomo Madrid Salud, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3518","DOI":"10.1093\/eurheartj\/ehaf384","article-title":"Vaccination as a new form of cardiovascular prevention: A European Society of Cardiology clinical consensus statement","volume":"46","author":"Heidecker","year":"2025","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2085","DOI":"10.1016\/j.jacc.2025.07.003","article-title":"2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on Adult Immunizations as Part of Cardiovascular Care: A Report of the American College of Cardiology","volume":"86","author":"Heidenreich","year":"2025","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","unstructured":"World Health Organization (2022). Vaccines against influenza: WHO position paper\u2014May 2022. Wkly. Epidemiol. Rec., 97, 185\u2013208."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"A6","DOI":"10.1016\/j.vaccine.2020.09.048","article-title":"The disease burden of influenza beyond respiratory illness","volume":"39","author":"Macias","year":"2021","journal-title":"Vaccine"},{"key":"ref_5","unstructured":"Mor\u00e1n Bay\u00f3n, A., and Redondo Marg\u00fcello, E. (2024). Vacunaci\u00f3n en el Adulto. Actualizaci\u00f3n 2024, SEMERGEN. Recomendaciones SEMERGEN."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1056\/NEJMoa1702090","article-title":"Acute myocardial infarction after laboratory-confirmed influenza infection","volume":"378","author":"Kwong","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"605","DOI":"10.7326\/M20-1509","article-title":"Acute Cardiovascular Events Associated with Influenza in Hospitalized Adults: A Cross-sectional Study","volume":"173","author":"Woodruff","year":"2020","journal-title":"Ann. Intern. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1001\/jamacardio.2019.0549","article-title":"Association of Influenza-like Illness Activity with Hospitalizations for Heart Failure: The Atherosclerosis Risk in Communities Study","volume":"4","author":"Hegde","year":"2019","journal-title":"JAMA Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1701794","DOI":"10.1183\/13993003.01794-2017","article-title":"Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: A self-controlled case series analysis of national linked datasets from Scotland","volume":"51","author":"Blackburn","year":"2018","journal-title":"Eur. Respir. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S1473-3099(09)70331-7","article-title":"Role of acute infection in triggering acute coronary syndromes","volume":"10","author":"Madjid","year":"2010","journal-title":"Lancet Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1056\/NEJMra1808137","article-title":"Acute Infection and Myocardial Infarction","volume":"380","author":"Musher","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_12","first-page":"1330","article-title":"Systematic review and meta-analysis of respiratory viral triggers for acute myocardial infarction and stroke","volume":"121","author":"Nguyen","year":"2025","journal-title":"Cardiovasc. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1016\/j.vaccine.2024.01.040","article-title":"The association between influenza vaccination, cardiovascular mortality and hospitalization: A living systematic review and prospective meta-analysis","volume":"42","author":"Liu","year":"2024","journal-title":"Vaccine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1093\/eurheartj\/ehac737","article-title":"Primary prevention of acute cardiovascular events by influenza vaccination: An observational study","volume":"44","author":"Davidson","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e914","DOI":"10.1016\/S2468-2667(22)00222-5","article-title":"Association between influenza vaccination and risk of stroke in Alberta, Canada: A population-based study","volume":"7","author":"Holodinsky","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1001\/jama.2013.279206","article-title":"Association between influenza vaccination and cardiovascular outcomes in high-risk patients: A meta-analysis","volume":"310","author":"Udell","year":"2013","journal-title":"JAMA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e228873","DOI":"10.1001\/jamanetworkopen.2022.8873","article-title":"Association of influenza vaccination with cardiovascular outcomes in patients with and without cardiovascular disease: A systematic review and meta-analysis","volume":"5","author":"Behrouzi","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1093\/eurjpc\/zwac152","article-title":"Cardioprotective effects of influenza vaccination among patients with established cardiovascular disease or at high cardiovascular risk: A systematic review and meta-analysis","volume":"29","author":"Jaiswal","year":"2022","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_19","first-page":"835","article-title":"Influenza vaccination and prevention of cardiovascular disease: A systematic review and meta-analysis","volume":"18","author":"Caldeira","year":"2019","journal-title":"Expert. Rev. Vaccines"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1002\/ejhf.2945","article-title":"Influenza vaccination and cardiovascular events in patients with ischaemic heart disease and heart failure: A meta-analysis","volume":"25","author":"Modin","year":"2023","journal-title":"Eur. J. Heart Fail."},{"key":"ref_21","first-page":"102311","article-title":"Influenza vaccination and cardiovascular events: A systematic review and meta-analysis","volume":"46","author":"Hernandez","year":"2022","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e019636","DOI":"10.1161\/JAHA.120.019636","article-title":"Effects of influenza vaccination on cardiovascular outcomes in patients with cardiovascular disease: A systematic review and meta-analysis","volume":"10","author":"Yedlapati","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1161\/CIRCULATIONAHA.121.057042","article-title":"Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial","volume":"144","author":"Erlinge","year":"2021","journal-title":"Circulation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1730","DOI":"10.1093\/eurheartj\/ehr004","article-title":"Influenza vaccination reduces cardiovascular events in patients with acute coronary syndrome","volume":"32","author":"Phrommintikul","year":"2011","journal-title":"Eur. Heart J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/S1062-1458(02)00948-0","article-title":"Influenza vaccine pilot study in acute coronary syndromes and planned percutaneous coronary interventions: The FLU Vaccination Acute Coronary Syndromes (FLUVACS) Study","volume":"11","author":"Gurfinkel","year":"2002","journal-title":"ACC Curr. J. Rev."},{"key":"ref_26","first-page":"53","article-title":"The effect of influenza vaccination on mortality in patients with heart failure: A meta-analysis","volume":"23","author":"Fukuta","year":"2018","journal-title":"Heart Fail. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1016\/S0140-6736(25)01485-0","article-title":"Influenza vaccination before hospital discharge in patients with acute heart failure (PANDA II): A cluster-randomised trial","volume":"406","author":"Anderson","year":"2025","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ahj.2018.05.007","article-title":"High-dose influenza vaccine to reduce clinical outcomes in high-risk cardiovascular patients: Rationale and design of the INVESTED trial","volume":"202","author":"Vardeny","year":"2018","journal-title":"Am. Heart J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2291","DOI":"10.1056\/NEJMoa2509907","article-title":"High-Dose Influenza Vaccine Effectiveness Against Hospitalization in Older Adults","volume":"393","author":"Johansen","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1001\/jamacardio.2025.3460","article-title":"High-Dose vs. Standard-Dose Influenza Vaccine and Cardiovascular Outcomes in Older Adults: A Prespecified Secondary Analysis of the DANFLU-2 Randomized Clinical Trial","volume":"10","author":"Johansen","year":"2025","journal-title":"JAMA Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2303","DOI":"10.1056\/NEJMoa2509834","article-title":"High-Dose Influenza Vaccine to Reduce Hospitalizations","volume":"393","author":"Mallah","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.1016\/S0140-6736(25)01742-8","article-title":"Effectiveness of high-dose influenza vaccine against hospitalisations in older adults (FLUNITY-HD): An individual-level pooled analysis","volume":"406","author":"Johansen","year":"2025","journal-title":"Lancet"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1161\/CIRCULATIONAHA.125.077801","article-title":"High-Dose vs. Standard-Dose Influenza Vaccine and Cardiovascular Outcomes in Older Adults: The FLUNITY-HD Prespecified Pooled Analysis","volume":"153","author":"Johansen","year":"2026","journal-title":"Circulation"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2642467","DOI":"10.1080\/21645515.2026.2642467","article-title":"Longitudinal assessment of influenza vaccination coverage in Spain: The \u201cGrip\u00f3metro\u201d as a real-time monitoring tool","volume":"22","year":"2026","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1056\/NEJMoa1315727","article-title":"Efficacy of high-dose versus standard-dose influenza vaccine in older adults","volume":"371","author":"DiazGranados","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1056\/NEJMoa1608862","article-title":"Efficacy of recombinant influenza vaccine in adults 50 years of age or older","volume":"376","author":"Dunkle","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_37","unstructured":"(2026, May 08). Seqirus. A Clinical Study to Evaluate the Efficacy, Safety and Immunogenicity of an Adjuvanted Influenza Vaccine Compared to a Non-adjuvanted Influenza Vaccine in Adults \u226565 Years of Age. 2023 [Actualizado el 24 de Abril de 2026]. Identificador de ClinicalTrials.gov: NCT06087640, Available online: https:\/\/clinicaltrials.gov\/study\/NCT06087640."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5343\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:25:16Z","timestamp":1783657516000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5343"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":37,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145343"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145343","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]}}}