Heart Disease? Don’t Skip These Vaccines

If you have heart disease, getting vaccinated for common respiratory infections could do more than protect your lungs – it could help protect your heart. People with heart disease have a higher risk of severe complications from respiratory infections, including heart attacks and worsening heart failure.

New guidelines from the American College of Cardiology recommend that all adults with heart disease get vaccinated against flu, COVID-19, pneumonia and RSV (respiratory syncytial virus). The guidelines also include shingles. While not a respiratory illness, shingles is linked to a higher risk of heart attack and stroke, making prevention even more important for those with heart disease.

Amy Edwards, MD, a pediatric infectious disease specialist at University Hospitals Rainbow Babies & Children’s Hospital, says the guidance should extend to adults with multiple risk factors for heart disease, even if they haven’t been diagnosed. These risk factors include high blood pressure, high cholesterol, diabetes, obesity, smoking, family history and older age.

“It’s better to err on the side of caution and say everyone who has multiple risk factors for heart disease should get vaccinated, too, because you may not know you have developed cardiovascular disease,” Dr. Edwards says. “It’s often very silent at the beginning. You could be in the early stages.”

The Latest Vaccine Guidelines

Here’s who should get vaccinated, according to the College of Cardiology:

• Flu: All adults, regardless of heart disease.
• COVID 19: All adults with heart disease.
• Pneumonia: Adults 19 and older with heart disease.
• RSV: Adults 50 and older with heart disease.
• Shingles: Adults 50 and older.

“Shingles can cause heart disease, so if you have multiple risk factors and you’re age 50 or older, it’s best to be vaccinated,” Dr. Edwards says “You don’t want shingles to be what triggers significant cardiovascular disease.”

Respiratory Illnesses in Heart Patients

Respiratory infections put extra stress on heart and vascular system and the lungs. Some patients already have reduced respiratory function because of their heart condition, Dr. Edwards says.

“For someone with cardiovascular disease, particularly if they have severe disease, their lung capacity can be affected and they can develop respiratory failure more easily,” she says.

Inflammation from a fever can also take a toll on patients already dealing with inflammatory diseases like atherosclerosis and coronary artery disease, which is the build-up of plaque in the arteries. Inflammation from fever can make those plaques more vulnerable to rupture, causing a heart attack or stroke.

“When you introduce acute inflammation on top of chronic inflammation in the arteries, that’s a problem,” Dr. Edwards says. Dehydration that often accompanies illness also tends to be harder to manage for people with heart disease.

COVID Vaccine Barriers

Evidence-based vaccine recommendations from the College of Cardiology and other medical groups differ in some ways from new guidance from the U.S. Centers for Disease Control and Prevention. The CDC advocates more limited access to COVID-19 vaccines in particular.

New federal guidelines call for COVID-19 vaccination for adults 65 and older, and for younger individuals who are at high risk after consultation with a healthcare professional. Previously, the vaccine had been recommended for anyone 6 months and older regardless of health status. The guidance, which the CDC calls “shared decision-making,” makes it harder for people to access the shots, Dr. Edwards says.

The recommendation is particularly onerous for heart patients with few resources or who have serious illness. “You’re putting an unnecessary barrier there,” Dr. Edwards says. “A lot of pharmacies are now asking patients if they have a medical condition that would justify vaccination and if they have talked to their doctor about it. That’s an unfortunate barrier that doesn’t need to be there, particularly for high-risk individuals.”

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