Table 7.

Summary of the effects of influenza, pneumococcal, and herpes zoster vaccinations on cardiovascular events in the literature

Influenza vaccine
	Protective effect		No evidence of protective effect
Outcome	Study	Magnitudes of facts % [CI 95%]	Study	Magnitudes of facts % [CI 95%]
CVD	Liu et al., 2012 (with IHD)	− 16% [− 24%; − 7%]	Chang et al., 2016 (b) (systemic lupus erythematosus)	− 24% [− 50%; + 13%]
	Song et al., 2018 (a) (exacerbation CVD)	− 51% [− 73%; − 9%]
	Wang et al., 2002 (hospitalization)	− 50% [− 73%; − 9%]
	Nichol et al., 2003 (hospitalization)	− 19% [− 23%; − 11%]
MACE	Chiang et al., 2017 (ILI)	− 20% [− 22%; − 18%]
	Phrommintikul et al., 2011 (with ACS)	− 31% [− 46%; − 10%]
MI	Abajo et al., 2021	− 16% [− 19%; − 12%]	Christiansen et al., 2019 (hospitalization)	− 7% [− 17%; + 19%]
	Chiang et al., 2017 (ILI)	− 20% [− 24%; − 16%]	Heffelfinger et al., 2006	− 3% [− 25%; + 27%]
	Hsu et al., 2016	− 32% [− 50%; − 9%] (men)	Hung et al., 2010 (TIV alone)	− 13% [− 41%; + 33%]
	Hung et al., 2010 (double vaccination)	− 48% [− 29%; − 62%]	Lavallée et al., 2014	− 50% [− 78%; + 22%]
	Siriwardena et al., 2010	− 21% [− 17%; − 25%]	Meyers et al., 2004	− 44% [− 75%; + 27%]
IHD	Huang et al., 2013 (with COPD)	− 26% [− 7%; − 41%] (71–80 years old)	Hung et al., 2010 (TIV alone)	− 13% [− 34%; + 13%]
	Hung et al., 2010 (double vaccination)	− 35% [− 22%; − 46%]
	Nichol, 2003	− 20% [− 9%; − 30%]
ACS	Ishigami et al., 2020 (reduced kidney function)	− 7% [− 3%; − 12%]
	Sung et al., 2014 (hospitalization)	− 52% [− 39%; − 63%] (65 − 74 years old); − 59% [− 43%; − 71%] (75 years and older)
AF	Chang et al., 2016 (a)	− 12% [− 8%; − 17%]
CHF	Chang et al., 2012 (TIV alone + double vaccination)	− 24% [− 1%; − 42%]/ − 29% [− 8%; − 46%]	Hung et al., 2010 (TIV alone)	− 8% [− 27%; + 16%]
	Chen et al., 2013 (COPD)	− 63% [− 48%; − 74%] (65 − 74 y); − 64% [− 48%; − 75%] (75 years and older)	Christiansen et al., 2019	− 2% [− 14%; + 12%]
	Fang et al., 2016 (CKD)	− 69% [− 61%; − 74%]
	Hung et al., 2010 (double vaccination)	− 19% [− 6%; − 30%]
	Ishigami et al., 2020 (reduced kidney function)	− 8%; [− 1%; − 14%]
	Nichol et al., 1994	37% [NA]
	Nichol et al., 2003 (Hospitalization)	− 19% [− 8%; − 30%]
	Seo et al., 2014 (AF + CHF)	− 56% [− 32%; − 71%]
	Wu et al., 2019 (CVD)	− 17% [− 8%; − 26%]
Stroke	Chen et al., 2022 (women COPD)	− 40% [− 33%; − 46%]	Hung et al., 2010 (TIV alone)	− 15% [− 39%; + 17%]
	Chiang et al	− 20% [− 18%; − 23%]	Lavallée et al., 2014	− 8% [− 38%; + 37]
	Christiansen et al., 2019 (hospitalization)	− 16% [− 8%; − 22%]	Piñol-Ripoll et al., 2008	+ 2% [− 23%; 36%]
	Grau et al. 2005	− 64% [− 37%; − 80%]
	Hung et al., 2010 (double vaccination)	− 33% [− 17%; − 46%]
	Kao et al., 2017 (AF)	− 52% [− 39%; − 61%] (65–74 y); − 55% [− 47%; − 60%](75 years and older)
	Lavallée et al., 2002	− 55% [− 16%; − 76%]
	Lin et al., 2014 (hospitalization)	− 20% [− 2%; − 36%]
	Liu et al., 2017 (hemorrhagic)	− 39% [− 1%; − 62%] (75 years and older)
	Nichol et al., 2003 (hospitalization)	− 16% [− 3%; − 28%]
	Siriwardena et al., 2014	− 26% [− 22%; − 30%]
Pneumococcal vaccines
	Protective effect		No evidence of protective effect
Outcome	Study	Magnitudes of facts % [CI 95%]	Study	Magnitudes of facts % [CI 95%]
Cardiovascular disease	Marra et al., 2020	− 6% [− 1%; − 11%]	Song et al., 2018 (a)	− 6% [− 98%; + 44%]
MI	Marra et al., 2020	− 7% [− 1%; − 12%]
IHD	Hung et al., 2010 (double vaccination)	− 35% [− 22%; − 46%]	Hung et al., 2010 (PPV alone)	− 8% [− 31%; + 22%]
CHF	Chang et al., 2012 (double vaccination)	− 29% [− 8%; − 46%]	Chang et al., 2012(PPV alone)	+ 7% [− 16%, + 37%]
			Hung et al., 2010 (PPV alone)	− 1% [− 22%; 27%]
			Hedlund et al. 2003 (double vaccination)	− 5% [− 13%; + 5%]
Stroke			Marra et al. 2020	− 8% [− 19%; + 4%]
Herpes zoster vaccine
	Protective effect		No evidence of protective effect
Outcome	Study	Magnitudes of facts	Study	Magnitudes of facts
Stroke	Klaric et al., 2019	− 49% [− 12%; − 79%]
	Yang et al., 2021	− 16% [− 17; − 15%]