As an internist and lipidologist, I’ve spent many years parsing information on statins, ezetimibe, PCSK9 inhibitors, and the infinite parade of “LDL-lowering breakthroughs.” But essentially the most potent, and maybe essentially the most underappreciated, intervention to forestall coronary heart assaults every winter doesn’t come from a cardiology journal or a pharmaceutical rep. It comes out of your native pharmacy fridge. For years, I’ve advised my sufferers that getting a flu shot might forestall a coronary heart assault extra successfully than beginning a statin. That’s not hyperbole; it’s information.
A landmark self-controlled case sequence in The New England Journal of Medication discovered that the threat of myocardial infarction (MI) jumped sixfold within the seven days after lab-confirmed influenza an infection. Catching the flu, it seems, is like lighting a brief fuse on a ticking cardiovascular bomb. Then got here the IAMI trial, which randomized hospitalized post-MI sufferers to obtain a flu vaccine or placebo earlier than discharge. Outcomes that may make any heart specialist jealous:
All-cause mortality: 4.9 p.c -> 2.9 p.c (ARR 2.0 p.c, NNT ~50)
Cardiovascular dying: 4.5 p.c -> 2.7 p.c (ARR 1.8 p.c, NNT ~56)
Composite (dying + MI + stent thrombosis): 7.2 p.c -> 5.3 p.c (ARR 1.9 p.c, NNT ~53)
These absolute threat reductions rival, and in some subgroups exceed, what we anticipate from statins. And the safety started inside weeks (not years) and with out myalgias, liver panels, or prior authorizations.
Influenza an infection drives cytokine launch, endothelial dysfunction, platelet activation, and the pro-thrombotic surroundings that turns a secure plaque right into a ruptured one. Stopping the an infection prevents the spark. It’s not decreasing ldl cholesterol; it’s decreasing ignition potential. Perhaps as a result of there’s no patent, no rebate card, no shiny sales space at ACC. Perhaps as a result of “get your flu shot” sounds too easy for grand rounds. Perhaps as a result of prevention that lives within the public-health area by no means will get the advertising and marketing push of a molecule that lives in a pipeline. But when we choose by absolute threat discount, not model visibility, the $25 vaccine outperforms loads of branded medication that dominate our tips and formularies.
Right here’s what I inform my sufferers: “Your statin lowers long-term threat. Your flu shot lowers subsequent week’s threat.” That framing clicks. It turns prevention into one thing quick and concrete, particularly for sufferers who wrestle to see the payoff of summary lab numbers. A meta-analysis in JACC discovered influenza vaccination decreased main antagonistic cardiovascular occasions (MACE) by 36 p.c general and 55 p.c in sufferers with latest ACS. Few interventions in cardiology ship that sort of impact for that sort of price. If we ranked interventions by absolute threat discount relatively than model visibility, the standard flu shot could be on the prime of each cardiology guideline. Till then, I’ll preserve recommending it as what it’s: a free, evidence-based, anti-inflammatory, anti-thrombotic, short-term statin that lives in your native CVS.
Larry Kaskel is an internist and “lipidologist in restoration” who has been practising medication for greater than thirty-five years. He operates a concierge observe within the Chicago space and serves on the instructing school on the Northwestern College Feinberg Faculty of Medication. As well as, he’s affiliated with Northwestern Lake Forest Hospital.
Earlier than podcasts entered mainstream tradition, Dr. Kaskel hosted Lipid Luminations on ReachMD, the place he produced a library of greater than 4 hundred packages that includes main voices in cardiology, lipidology, and preventive medication.
He’s the creator of Dr. Kaskel’s Dwelling in Wellness, Quantity One: Let Meals Be Thy Medication, works that mix evidence-based medical observe with accessible methods for enhancing healthspan. His present initiatives deal with reevaluating the ldl cholesterol speculation and investigating the infectious origins of atherosclerosis. Extra data is accessible at larrykaskel.com.
