Link Between Heart Failure Risk and Lack of Pneumococcal Vaccination in the Octogenarian Community

Lack of pneumococcal vaccination can be linked to an elevated risk of incident heart failure (HF) and cardiovascular mortality among community-dwelling octogenarians, according to research published in ESC Heart Failure.¹

Ali Ahmed, MD, MPH, Associate Chief of Staff for Health and Aging at the Washington, DC Veterans Affairs (VA) Medical Center, and colleagues set out to determine the potential correlation between lack of pneumococcal vaccination in octogenarians and elevated risk of incident heart failure (HF).

Data from the Cardiovascular Health Study (CHS) were used to create a cohort of 5290 community-dwelling adults aged 65 or older. All participants were free of baseline HF and had data on their pneumococcal vaccination status. Primary outcomes were incident HF and all-cause mortality during the 13-year follow-up period. Secondary outcomes were cardiovascular mortality, non-cardiovascular mortality, all-cause hospitalization, and hospitalization due to pneumonia.

Mean age of the 851 octogenarians was 83±3 years; 52% were female and 17% were African American. The researchers found that a greater proportion of octogenarians who received the pneumococcal vaccination also received an influenza vaccination and had a higher prevalence of chronic obstructive pulmonary disease (COPD) and pneumonia.

During the follow-up period, non-receipt of the pneumococcal vaccination was associated with a significantly higher risk of incident HF (adjusted hazard ratio [aHR]: 1.37; 95% CI, 1.01-1.85). In the younger patient group (age 65-79 years, n=4439), non-receipt of the vaccination was not associated with incident HF (aHR: 0.88; 95% CI, 0.74-1.04). Additionally, non-receipt octogenarians were found to have a significantly higher risk of all-cause mortality (aHR: 1.23; 95% CI, 1.02-1.49) and cardiovascular mortality (aHR: 1.45; 95% CI, 1.06-1.98), but not of non-cardiovascular mortality (aHR: 1.10; 95% CI, 0.87-1.40). Dr Ahmed and colleagues identified a trend toward a higher hospitalization risk due to pneumonia (aHR: 1.35; 95% CI, 1-1.82) but no association with all-cause hospitalization (aHR: 1.04; 95% CI, 0.84-1.40). No link was found between vaccination and either mortality or hospitalization in the younger group.

Dr Ahmed and colleagues noted that the study findings indicate that pneumococcal infections may be considered a “non-traditional” risk factor for incident HF within an octogenarian cohort. “The association…is unlikely to be confounded by other major HF risk factors, as they were similarly distributed at baseline” between vaccination and non-vaccination groups, the researchers noted.

“If these hypothesis-generating findings can be replicated in other octogenarian populations, it may provide a tool to lower the risk of HF among octogenarians, the fastest growing segment of the population in developing nations, who also has the highest risk of HF,” the researchers concluded.

Limitations

• The potential for bias exists due to unmeasured confounders.
• The researchers did not have data on the time of pneumococcal vaccine administration.
• It is possible that octogenarians within the unvaccinated group may have been vaccinated during follow-up, or that recollection of vaccine was inaccurate.

Disclosures: The authors declare no conflicts of interest. Dr Ahmed was supported in part by the National Institutes of Health through grants (R01-HL085561, R01-HL085561-S, and R01-HL097047) from the National Heart, Lung, and Blood Institute.

Reference

1. Ahmed MB, Patel K, Fonarow GC, et al. Higher risk for incident heart failure and cardiovascular mortality among community-dwelling octogenarians without pneumococcal vaccination. ESC Heart Fail. 2016;3:11-17. doi: 10.1002/ehf2.12056