Influenza, influenza-like symptoms and their association with cardiovascular risks: a systematic review and meta-analysis of observational studies.
OBJECTIVE
To synthesise the evidence relating influenza and influenza-like symptoms to the risks of myocardial infarction (MI), heart failure (HF) and stroke.


METHODS
We conducted a systematic review and meta-analysis of the evidence relating influenza and influenza-like symptoms to the risks of MI, HF and stroke. We systematically searched all MEDLINE and EMBASE entries up to August 2014 for studies of influenza vs. the cardiovascular outcomes above. We conducted random effects meta-analysis using inverse variance method for pooled odds ratios (OR) and evaluated statistical heterogeneity using the I(2) statistic.


RESULTS
We identified 12 studies with a total of 84,003 participants. The pooled OR for risk of MI vs. influenza (serologically confirmed) was 1.27 (95% CI, confidence interval 0.54-2.95), I(2)  = 47%, which was significant for the only study that adjusted for confounders (OR 5.50, 95% CI 1.31-23.13). The pooled OR for risk of MI vs. influenza-like symptoms was 2.17 (95% CI 1.68-2.80), I(2)  = 0%, which was significant for both unadjusted (OR 2.23, 95% CI 1.65-3.01, five studies) and adjusted studies (OR 2.01, 95% CI 1.24-3.27, two studies). We found one study that evaluated stroke risk, one study in patients with HF, and one that evaluated mortality from MI - all of these studies suggested increased risks of events with influenza-like symptoms.


CONCLUSIONS
There is an association between influenza-like illness and cardiovascular events, but the relationship is less clear with serologically diagnosed influenza. We recommend renewed efforts to apply current clinical guidelines and maximise the uptake of annual influenza immunisation among patients with cardiovascular diseases, to decrease their risks of MI and stroke.
Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.
C S
CS
Kwok
Central Manchester Foundation Trust, Manchester, UK.
S
S
Aslam
Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK.
E
E
Kontopantelis
Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
P K
PK
Myint
Department of Cardiology, James Paget University Hospital, Gorleston-on-Sea, UK.
M J S
MJ
Zaman
Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK.
I
I
Buchan
Norwich Medical School, University of East Anglia, Norwich, UK.
Y K
YK
Loke
Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.|Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK.
M A
MA
Mamas
D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D007251:Influenza, Human / Q000150:complications*; D009203:Myocardial Infarction / Q000209:etiology*; D064887:Observational Studies as Topic; D016017:Odds Ratio; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*