title: Clinical effectiveness of pneumococcal vaccination against acute myocardial infarction and stroke in people over 60 years: the CAPAMIS study, one-year follow-up.
abstract: BACKGROUND
  Conflicting results have been recently reported evaluating the relationship between pneumococcal vaccination and the risk of thrombotic vascular events. This study assessed the clinical effectiveness of the 23-valent polysaccharide pneumococcal vaccine (PPV23) against acute myocardial infarction and ischaemic stroke in older adults.
  
  
  METHODS
  Population-based prospective cohort study conducted from December 1, 2008 until November 30, 2009, including all individuals ≥ 60 years-old assigned to nine Primary Care Centres in Tarragona, Spain (N = 27,204 individuals). Primary outcomes were hospitalisation for acute myocardial infarction and/or ischaemic stroke. All cases were validated by checking clinical records. The association between pneumococcal vaccination and the risk of each outcome was evaluated by Multivariable Cox proportional-hazard models (adjusted by age, sex, influenza vaccine status, presence of comorbidities and cardiovascular risk factors).
  
  
  RESULTS
  Cohort members were followed for a total of 26,444 person-years, of which 34% were for vaccinated subjects. Overall incidence rates (per 1000 person-years) were 4.9 for myocardial infarction and 4.6 for ischaemic stroke. In the multivariable analysis, vaccination was associated with a marginally significant 35% lower risk of stroke (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.42-0.99; p = 0.046). We found no evidence for an association between pneumococcal vaccination and reduced risk of myocardial infarction (HR: 0.83; 95% CI: 0.56-1.22; p = 0.347).
  
  
  CONCLUSIONS
  Our data supports a benefit of PPV23 against ischaemic stroke among the general population over 60 years, suggesting a possible protective role of pneumococcal vaccination against some acute thrombotic events.
authors.affiliation: Primary Care Service of Tarragona, EPIVAC Study Group, Institut Catalá de la Salut, Tarragona, Spain. avila.tarte.ics@gencat.cat
authors.forename: Angel
authors.initials: A
authors.lastname: Vila-Corcoles
authors.forename: Olga
authors.initials: O
authors.lastname: Ochoa-Gondar
authors.forename: Teresa
authors.initials: T
authors.lastname: Rodriguez-Blanco
authors.forename: Antonia
authors.initials: A
authors.lastname: Gutierrez-Perez
authors.forename: Angel
authors.initials: A
authors.lastname: Vila-Rovira
authors.forename: Frederic
authors.initials: F
authors.lastname: Gomez
authors.forename: Xavier
authors.initials: X
authors.lastname: Raga
authors.forename: Cinta
authors.initials: C
authors.lastname: de Diego
authors.forename: Eva
authors.initials: E
authors.lastname: Satue
authors.forename: Elisabet
authors.initials: E
authors.lastname: Salsench
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology / Q000517:prevention & control*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011014:Pneumonia / Q000453:epidemiology / Q000517:prevention & control*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000517:prevention & control*; D011159:Population Surveillance; D011446:Prospective Studies; D013030:Spain; D016896:Treatment Outcome; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines