Vacunas en cardiología, una estrategia subutilizada para reducir el riesgo cardiovascular residual

Sebastián García-Zamora; Laura Pulido

doi:10.47487/apcyccv.v5i1.349

Autores/as

Sebastián García-Zamora Unidad Coronaria del Sanatorio Delta, Rosario, Argentina; Facultad de Medicina, Universidad Nacional de Rosario (UNR). https://orcid.org/0000-0001-6846-0247
Laura Pulido Servicio de Neumonología del Hospital Italiano de Rosario, Rosario, Argentina; Facultad de Medicina, Instituto Universitario Italiano de Rosario (IUNIR). https://orcid.org/0000-0002-8450-8711

DOI:

https://doi.org/10.47487/apcyccv.v5i1.349

Palabras clave:

Vacunas, Influenza, Neumonía Neumocócica, Herpes Zóster, COVID-19, Virus Sincitial Respiratorio Humano, Prevención

Resumen

Las enfermedades cardiovasculares representan la primera causa de muerte en adultos de todo el mundo. Desde hace décadas se ha documentado que las infecciones en general, y particularmente las que involucran el aparato respiratorio, incrementan el riesgo de eventos cardiovasculares, cerebrovasculares y la mortalidad por todas las causas. Los mecanismos por los que las infecciones incrementan los eventos cardiovasculares son complejos, e incluyen la activación del sistema inmune, la inflamación sistémica, estados de hipercoagulabilidad, activación del sistema simpático y el aumento de la demanda miocárdica de oxígeno. En las infecciones respiratorias se agrega la hipoxemia. Estos mecanismos se interrelacionan, generando disfunción endotelial y accidentes de placa, y/o depresión miocárdica e insuficiencia cardíaca. Estos mecanismos pueden producir eventos cardiovasculares de novo o descompensar patologías preexistentes. Existe evidencia contundente de que las vacunas contra influenza, neumococo, herpes-zoster, COVID-19 y virus sincicial respiratorio son seguras en personas con factores de riesgo cardiovascular o enfermedad cardiovascular establecida. Incluso, la vacuna contra influenza ha demostrado ser segura cuando se administra en el período agudo de un síndrome coronario agudo en individuos que reciben angioplastia. Además de esto, estas intervenciones reducen la incidencia de eventos cardiovasculares en personas con riesgo cardiovascular incrementado. Sin embargo, las tasas de vacunación son marcadamente subóptimas. En el presente manuscrito se revisa la evidencia de la relación entre infecciones y eventos cardiovasculares. Además, se examina el rol de las inmunizaciones como una herramienta para reducir estos eventos y disminuir el riesgo cardiovascular residual. Finalmente, se plantea la necesidad de optimizar las tasas de vacunación en personas con cardiopatías.

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