{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T09:20:26Z","timestamp":1774862426042,"version":"3.50.1"},"reference-count":80,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T00:00:00Z","timestamp":1774742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Universidad Cient\u00edfica del Sur\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t              https:\/\/ror.org\/04xr5we72"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background\/Objectives: Vaccination against respiratory viruses\u2014such as respiratory syncytial virus (RSV), pneumococcal disease, influenza, and COVID-19\u2014may reduce the risk of adverse outcomes in older adults with cardiovascular disease. This study conducted a scoping review of the effects of respiratory vaccines in older adults with cardiovascular disease. Methods: We included studies evaluating adults aged \u2265 60 years with cardiovascular disease who received different types of respiratory vaccines. Eligible designs comprised clinical trials, observational cohort studies, and other relevant studies. Editorials, commentaries, and non-original publications were excluded. A comprehensive and targeted literature search was conducted in PubMed, Scopus, EMBASE, and Web of Science from database inception through January 2026. Results: A total of 25 studies were included, encompassing 1,782,787 adults aged \u2265 60 years with cardiovascular disease who received various respiratory vaccines. RSV vaccines were associated with a lower incidence of cardiorespiratory hospitalization and stroke among vaccinated individuals. Pneumococcal vaccines showed that sequential dual vaccination strategies were associated with a lower risk of cardiovascular events. Influenza vaccination was associated with improved cardiovascular outcomes, lower mortality, and reduced adverse events. COVID-19 vaccines were associated with reductions in mortality and hospitalizations. These benefits are particularly relevant in an older population with a high burden of comorbidities; therefore, complete vaccination schedules, including booster doses, should be considered a central strategy for prevention and comprehensive management in this high-risk group. Conclusions: Vaccination against respiratory viruses in older adults with cardiovascular disease demonstrates an overall favorable\/acceptable profile of efficacy and safety, with reductions in mortality, hospitalizations, and cardiovascular events, without a significant increase in serious adverse events.<\/jats:p>","DOI":"10.3390\/vaccines14040308","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T08:22:36Z","timestamp":1774858956000},"page":"308","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Respiratory Vaccines in Older Adults with Cardiovascular Diseases: A Scoping Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4045-0260","authenticated-orcid":false,"given":"Fernando M.","family":"Runzer-Colmenares","sequence":"first","affiliation":[{"name":"CHANGE Research Working Group, Universidad Cient\u00edfica del Sur, Lima 15067, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1228-1941","authenticated-orcid":false,"given":"Nelson Luis","family":"Cahuapaza-Gutierrez","sequence":"additional","affiliation":[{"name":"CHANGE Research Working Group, Universidad Cient\u00edfica del Sur, Lima 15067, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cielo Cinthya","family":"Calderon-Hernandez","sequence":"additional","affiliation":[{"name":"CHANGE Research Working Group, Universidad Cient\u00edfica del Sur, Lima 15067, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5700-9052","authenticated-orcid":false,"given":"Mariam Miyanay","family":"Umeres-Bravo","sequence":"additional","affiliation":[{"name":"CHANGE Research Working Group, Universidad Cient\u00edfica del Sur, Lima 15067, Peru"},{"name":"Facultad de Ciencias de la Salud, Carrera de Medicina, Universidad de Aquino Bolivia, Cochabamba, Bolivia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Vervoort, D., Minthor, L., and Pezzella, A.T. (2022). Monitoring, evaluation, and disease surveillance for cardiovascular surgical disease. Global Cardiac Surgery Capacity Development in Low and Middle-Income Countries, Springer.","DOI":"10.1007\/978-3-030-83864-5_9"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Pedretti, R.F.E., Asteggiano, R., Gevaert, A.B., Bowen, T.S., Caselli, S., Cornelissen, V.A., Christodorescu, R., Derosa, G., Dievart, F., and Kurpas, D. (2025). Cardiovascular risk factors management in older adults: A clinical consensus statement from the European Association of Preventive Cardiology of the ESC and the ESC Council for Cardiology Practice. Eur. J. Prev. Cardiol.","DOI":"10.1093\/eurjpc\/zwaf175"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101422","DOI":"10.1016\/j.arr.2021.101422","article-title":"Immunosenescence and inflammaging in the aging process: Age-related diseases or longevity?","volume":"71","author":"Santoro","year":"2021","journal-title":"Ageing Res. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Moffa, L., and Tana, C. (2025). Healthcare-associated infections (HAIs) in the elderly: Molecular mechanisms of immunosenescence and clinical, nutritional and therapeutic implications. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26199649"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e396","DOI":"10.1093\/cid\/ciaf310","article-title":"Comprehensive analysis of cardiovascular events and risk factors in patients hospitalized with respiratory syncytial virus","volume":"82","author":"Sudnik","year":"2026","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","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_7","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1001\/jamainternmed.2024.0212","article-title":"Acute cardiac events in hospitalized older adults with respiratory syncytial virus infection","volume":"184","author":"Woodruff","year":"2024","journal-title":"JAMA Intern. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1093\/eurjpc\/zwae016","article-title":"Association of respiratory infections and the impact of vaccinations on cardiovascular diseases","volume":"31","author":"Rademacher","year":"2024","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1016\/j.jacc.2018.02.013","article-title":"Respiratory syncytial virus and associations with cardiovascular disease in adults","volume":"71","author":"Ivey","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1161\/CIRCRESAHA.122.321636","article-title":"Pneumonia-induced inflammation, resolution and cardiovascular disease: Causes, consequences and clinical opportunities","volume":"132","author":"Stotts","year":"2023","journal-title":"Circ. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1159\/000544919","article-title":"Vaccination strategies in respiratory diseases: Recommendation from AIPO-ITS\/ETS, SIMIT, SIP\/IRS, and SItI","volume":"104","author":"Micheletto","year":"2025","journal-title":"Respiration"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3419","DOI":"10.1007\/s11357-023-00807-4","article-title":"Impact of influenza, herpes zoster, and pneumococcal vaccinations on the incidence of cardiovascular events in subjects aged over 65 years: A systematic review","volume":"45","author":"Addario","year":"2023","journal-title":"Geroscience"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4944","DOI":"10.1016\/j.vaccine.2020.05.070","article-title":"Influenza vaccination as a novel means of preventing coronary heart disease: Effectiveness in older adults","volume":"38","author":"Aidoud","year":"2020","journal-title":"Vaccine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"20235","DOI":"10.1038\/s41598-023-47690-9","article-title":"Influenza vaccination and major cardiovascular risk: A systematic review and meta-analysis of clinical trials studies","volume":"13","author":"Omidi","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.vaccine.2017.11.078","article-title":"Cardioprotective effect of influenza and pneumococcal vaccination in patients with cardiovascular diseases","volume":"36","author":"Ciszewski","year":"2018","journal-title":"Vaccine"},{"key":"ref_16","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_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann. Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1001\/jama.2025.15405","article-title":"Bivalent RSV prefusion F protein-based vaccine for preventing cardiovascular hospitalizations in older adults: A prespecified analysis of the DAN-RSV trial","volume":"334","author":"Lassen","year":"2025","journal-title":"JAMA"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4291","DOI":"10.1093\/eurheartj\/ehaf679","article-title":"Effectiveness of bivalent respiratory syncytial virus prefusion F protein-based vaccine in individuals with or without atherosclerotic cardiovascular disease: The DAN-RSV trial","volume":"46","author":"Pareek","year":"2025","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"dyae005","DOI":"10.1093\/ije\/dyae005","article-title":"Effects of sequential vs. single pneumococcal vaccination on cardiovascular diseases among older adults: A population-based cohort study","volume":"53","author":"Tong","year":"2024","journal-title":"Int. J. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e2869","DOI":"10.1097\/MD.0000000000002869","article-title":"A matched influenza vaccine strain was effective in reducing the risk of acute myocardial infarction in elderly persons: A population-based study","volume":"95","author":"Hsu","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ahj.2017.07.020","article-title":"Association between influenza vaccination and reduced risks of major adverse cardiovascular events in elderly patients","volume":"193","author":"Chiang","year":"2017","journal-title":"Am. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.ijcard.2016.12.074","article-title":"Influenza vaccination reduces hemorrhagic stroke risk in patients with atrial fibrillation: A population-based cohort study","volume":"232","author":"Liu","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_25","first-page":"326","article-title":"Influenza vaccination and risk of hospitalization in patients with heart failure: A self-controlled case series study","volume":"38","author":"Mohseni","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1007\/s00134-019-05648-4","article-title":"Influenza vaccination and 1-year risk of myocardial infarction, stroke, heart failure, pneumonia, and mortality among intensive care unit survivors aged 65 years or older: A nationwide population-based cohort study","volume":"45","author":"Christiansen","year":"2019","journal-title":"Intensive Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.atherosclerosis.2019.01.008","article-title":"Protective effect of influenza vaccination on outcomes in geriatric stroke patients: A nationwide matched cohort study","volume":"282","author":"Lam","year":"2019","journal-title":"Atherosclerosis"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wu, H.H., Chang, Y.Y., Kuo, S.C., and Chen, Y.T. (2019). Influenza vaccination and secondary prevention of cardiovascular disease among Taiwanese elders\u2014A propensity score-matched follow-up study. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0219172"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.amjcard.2020.05.019","article-title":"Influenza vaccination and outcome in heart failure","volume":"128","author":"Gotsman","year":"2020","journal-title":"Am. J. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1093\/infdis\/jiaa493","article-title":"Influenza vaccination and hospitalization outcomes among older patients with cardiovascular or respiratory diseases","volume":"223","author":"Pang","year":"2021","journal-title":"J. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.ijid.2022.05.059","article-title":"Effectiveness of influenza vaccination on in-hospital death and recurrent hospitalization in older adults with cardiovascular diseases","volume":"122","author":"Pang","year":"2022","journal-title":"Int. J. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"6700","DOI":"10.1016\/j.vaccine.2022.09.085","article-title":"High-dose influenza vaccines for the prevention of hospitalization due to cardiovascular events in older adults in the nursing home: Post-hoc analysis of a cluster-randomized trial","volume":"40","author":"Saade","year":"2022","journal-title":"Vaccine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e011496","DOI":"10.1161\/CIRCOUTCOMES.124.011496","article-title":"Relative effectiveness of high-dose versus standard-dose quadrivalent influenza vaccine in older adults with cardiovascular disease: A prespecified analysis of the DANFLU-1 randomized clinical trial","volume":"18","author":"Christensen","year":"2025","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1002\/cpt.3080","article-title":"High-dose vs. standard-dose influenza vaccine and cardiopulmonary hospitalization or mortality: Emulating the INVESTED trial using insurance claims data","volume":"115","author":"NajafZadeh","year":"2024","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/j.cardfail.2022.12.017","article-title":"Effect of flu vaccination on severity and outcome of heart failure decompensations","volume":"29","author":"Ivars","year":"2023","journal-title":"J. Card. Fail."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"103449","DOI":"10.1016\/j.eclinm.2025.103449","article-title":"Estimating cardiovascular effects of influenza vaccination in older adults: A target trial emulation using proximal causal inference","volume":"87","author":"Guo","year":"2025","journal-title":"EClinicalMedicine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"133246","DOI":"10.1016\/j.ijcard.2025.133246","article-title":"Independent effect of influenza vaccination on all-cause mortality in critically ill patients with atrial fibrillation: A retrospective study from the MIMIC-IV database","volume":"433","author":"Lei","year":"2025","journal-title":"Int. J. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Yang, T., Yang, H., Zhou, T., Wu, X., and Ye, L. (2025). Influenza vaccination and ischemic stroke risk reduction in elderly stroke survivors: A retrospective cohort study with negative control validation. BMC Geriatr., 25.","DOI":"10.1186\/s12877-025-06695-x"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1002\/ejhf.3469","article-title":"Effect of seasonal influenza and COVID-19 vaccination on severity and long-term outcomes of patients with heart failure decompensations","volume":"27","author":"Ivars","year":"2025","journal-title":"Eur. J. Heart Fail."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e044546","DOI":"10.1161\/JAHA.125.044546","article-title":"COVID-19 vaccination and cardiovascular outcomes in older adults with coronary artery disease and heart failure: Insights from a large propensity-matched cohort study","volume":"14","author":"Akbar","year":"2025","journal-title":"J. Am. Heart Assoc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1016\/j.cardfail.2022.05.008","article-title":"Association of reduced hospitalizations and mortality rates among COVID-19-vaccinated patients with heart failure","volume":"28","author":"Johnson","year":"2022","journal-title":"J. Card. Fail."},{"key":"ref_42","first-page":"e010617","article-title":"Risk of worsening heart failure and all-cause mortality following COVID-19 vaccination in patients with heart failure: A nationwide real-world safety study","volume":"16","author":"Michalik","year":"2023","journal-title":"Circ. Heart Fail."},{"key":"ref_43","first-page":"100630","article-title":"Safety of BNT162b2 or CoronaVac COVID-19 vaccines in patients with heart failure: A self-controlled case series study","volume":"30","author":"Ye","year":"2023","journal-title":"Lancet Reg. Health West. Pac."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1093\/infdis\/jiy056","article-title":"Respiratory syncytial virus seasonality: A global overview","volume":"217","author":"Sly","year":"2018","journal-title":"J. Infect. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"S577","DOI":"10.1093\/infdis\/jiz059","article-title":"Global disease burden estimates of respiratory syncytial virus-associated acute respiratory infection in older adults in 2015: A systematic review and meta-analysis","volume":"222","author":"Shi","year":"2020","journal-title":"J. Infect. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/S2213-2600(24)00255-8","article-title":"Respiratory syncytial virus infections in adults: A narrative review","volume":"12","author":"Wildenbeest","year":"2024","journal-title":"Lancet Respir. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e13031","DOI":"10.1111\/irv.13031","article-title":"Respiratory syncytial virus disease burden in adults aged 60 years and older in high-income countries: A systematic literature review and meta-analysis","volume":"17","author":"Savic","year":"2023","journal-title":"Influenza Other Respir. Viruses"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1128\/CVI.00580-12","article-title":"Adults 65 years old and older have reduced numbers of functional memory T cells to respiratory syncytial virus fusion protein","volume":"20","author":"Cherukuri","year":"2013","journal-title":"Clin. Vaccine Immunol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1056\/NEJMoa2209604","article-title":"Respiratory syncytial virus prefusion F protein vaccine in older adults","volume":"388","author":"Papi","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1093\/cid\/ciae010","article-title":"Efficacy and safety of respiratory syncytial virus (RSV) prefusion F protein vaccine (RSVPreF3 OA) in older adults over 2 RSV seasons","volume":"78","author":"Ison","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/S2213-2600(25)00048-7","article-title":"Efficacy, safety, and immunogenicity of the AS01E-adjuvanted respiratory syncytial virus prefusion F protein vaccine (RSVPreF3 OA) in older adults over three respiratory syncytial virus seasons (AReSVi-006): A multicentre, randomised, observer-blinded, placebo-controlled, phase 3 trial","volume":"13","author":"Ison","year":"2025","journal-title":"Lancet Respir. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2579385","DOI":"10.1080\/21645515.2025.2579385","article-title":"Epidemiological and clinical impact of pneumococcal disease in Spain in 2023: A nationwide retrospective analysis","volume":"21","year":"2025","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Mrabt, F., and Guedes, S. (2025). Systematic review on serotypes distribution of pneumococcal pneumonia in adults and the elderly. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-22164-x"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e711","DOI":"10.1093\/cid\/ciaa1427","article-title":"Major adverse cardiovascular events during invasive pneumococcal disease are serotype dependent","volume":"72","author":"Africano","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"107185","DOI":"10.1016\/j.ijid.2024.107185","article-title":"Cardiovascular events after invasive pneumococcal disease: A retrospective cohort study","volume":"147","author":"Dulfer","year":"2024","journal-title":"Int. J. Infect. Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.1093\/cid\/ciad065","article-title":"Risk of acute myocardial infarction among patients with laboratory-confirmed invasive pneumococcal disease: A self-controlled case series study","volume":"76","author":"Wiese","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2561315","DOI":"10.1080\/21645515.2025.2561315","article-title":"Effectiveness of pneumococcal vaccination in reducing hospitalization and mortality among the elderly: A systematic review and meta-analysis","volume":"21","author":"Bulkhi","year":"2025","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_58","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 Solution Set Oversight Committee","volume":"86","author":"Heidenreich","year":"2025","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_59","first-page":"CD005050","article-title":"Influenza vaccines for preventing cardiovascular disease","volume":"2015","author":"Clar","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ijid.2020.07.038","article-title":"The protective effect of pneumococcal vaccination on cardiovascular disease in adults: A systematic review and meta-analysis","volume":"99","author":"Marra","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s40266-024-01169-y","article-title":"Influenza and aging: Clinical manifestations, complications, and treatment approaches in older adults","volume":"42","author":"Rosero","year":"2025","journal-title":"Drugs Aging"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1007\/s40265-024-02083-8","article-title":"Influenza vaccine effectiveness and progress towards a universal influenza vaccine","volume":"84","author":"Cowling","year":"2024","journal-title":"Drugs"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/S0140-6736(22)00982-5","article-title":"Influenza","volume":"400","author":"Uyeki","year":"2022","journal-title":"Lancet"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1016\/S1473-3099(24)00497-3","article-title":"Optimising vaccine immunogenicity in ageing populations: Key strategies","volume":"25","author":"Jiang","year":"2025","journal-title":"Lancet Infect. Dis."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1952","DOI":"10.1016\/j.jacc.2017.01.064","article-title":"The aging cardiovascular system: Understanding it at the cellular and clinical levels","volume":"69","author":"Paneni","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1016\/S0140-6736(17)33293-2","article-title":"Estimates of global seasonal influenza-associated respiratory mortality: A modelling study","volume":"391","author":"Iuliano","year":"2018","journal-title":"Lancet"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"3875","DOI":"10.1111\/jgs.19176","article-title":"Protection against influenza hospitalizations from enhanced influenza vaccines among older adults: A systematic review and network meta-analysis","volume":"72","author":"Ferdinands","year":"2024","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"100327","DOI":"10.1016\/j.jvacx.2023.100327","article-title":"High-dose influenza vaccine in older adults by age and seasonal characteristics: Systematic review and meta-analysis update","volume":"14","author":"Lee","year":"2023","journal-title":"Vaccine X"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1097\/CRD.0000000000000533","article-title":"Role of influenza vaccination in cardiovascular disease: Systematic review and meta-analysis","volume":"32","author":"Gupta","year":"2024","journal-title":"Cardiol. Rev."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.amjmed.2023.02.004","article-title":"Influenza vaccination as prevention therapy for stable coronary artery disease and acute coronary syndrome: A meta-analysis of randomized trials","volume":"136","author":"Barbetta","year":"2023","journal-title":"Am. J. Med."},{"key":"ref_71","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":"2025","journal-title":"Circulation"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1038\/s41579-025-01185-8","article-title":"SARS-CoV-2 spike protein: Structure, viral entry and variants","volume":"23","author":"Chen","year":"2025","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1093\/cvr\/cvaa106","article-title":"COVID-19 and the cardiovascular system: Implications for risk assessment, diagnosis, and treatment options","volume":"116","author":"Guzik","year":"2020","journal-title":"Cardiovasc. Res."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e1037","DOI":"10.1161\/CIR.0000000000001064","article-title":"SARS-CoV-2 infection and associated cardiovascular manifestations and complications in children and young adults: A scientific statement from the American Heart Association","volume":"145","author":"Jone","year":"2022","journal-title":"Circulation"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"2705","DOI":"10.1093\/cvr\/cvab298","article-title":"Cardiovascular disease and COVID-19: A consensus paper from the ESC working groups and ACVC in collaboration with EHRA","volume":"117","author":"Cenko","year":"2021","journal-title":"Cardiovasc. Res."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1016\/j.jacc.2020.08.059","article-title":"Coronavirus and cardiovascular disease, myocardial injury, and arrhythmia: JACC focus seminar","volume":"76","author":"Giustino","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.cger.2022.03.006","article-title":"COVID-19 vaccines in older adults: Challenges in vaccine development and policy making","volume":"38","author":"Liang","year":"2022","journal-title":"Clin. Geriatr. Med."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"la Cruz, R.A.R.D., Flores-C\u00f3rdova, J.M., Calderon-Hernandez, C.C., Cahuapaza-Gutierrez, N.L., Ccallalli-Ruiz, N.A., and Runzer-Colmenares, F.M. (2025). Humoral and cellular immune responses against SARS-CoV-2 following COVID-19 vaccination in older adults: A systematic review. Vaccines, 13.","DOI":"10.3390\/vaccines13080852"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Yang, X.H., Bao, W.J., Zhang, H., Fu, S.K., and Jin, H.M. (2023). The efficacy of SARS-CoV-2 vaccination in the elderly: A systematic review and meta-analysis. J. Gen. Intern. Med.","DOI":"10.1007\/s11606-023-08254-9"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"6085","DOI":"10.1038\/s41467-024-49634-x","article-title":"Cohort study of cardiovascular safety of different COVID-19 vaccination doses among 46 million adults in England","volume":"15","author":"Ip","year":"2024","journal-title":"Nat. Commun."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/4\/308\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T08:38:04Z","timestamp":1774859884000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/4\/308"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,29]]},"references-count":80,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["vaccines14040308"],"URL":"https:\/\/doi.org\/10.3390\/vaccines14040308","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,29]]}}}