Vaccination as a Strategy for Cardiovascular Prevention: Closing a Gap in Clinical Practice.

Prevention of the consequences of atherosclerotic disease has traditionally focused on controlling individual risk factors such as dyslipidaemia, hypertension and diabetes. In recent years, the term residual risk has been used to describe the persistence of cardiovascular events despite the optimal management of these classical risk factors, with particular attention given to inflammation. Far less attention, however, has been paid to environmental risk factors, which affect entire populations and may account for a substantial proportion of temporal variations in event incidence, as well as the marked seasonal fluctuations in hospital admissions for cardiovascular disease that periodically place considerable pressure on healthcare systems. Temperature, air pollution and infectious diseases-particularly respiratory infections-may help explain why an individual with a given baseline risk experiences an event in one month rather than another. Some environmental factors may promote the development of classical risk factors, whereas others may contribute directly to atherosclerosis. All of them may act either as triggers for acute ischemic events or as destabilising factors in previously stable patients, for example those with heart failure. Infections, especially those of respiratory tract, play a key role in the natural history of cardiovascular disease. Growing evidence indicates that preventing infections through vaccination can reduce the risk of acute ischemic events, hospitalisation and death. Nevertheless, vaccination coverage for many infections, including influenza and Coronavirus disease 2019 (COVID-19), remains low. In addition, pseudo-scientific campaigns continue to spread misinformation about vaccines, thereby reducing patient adherence. Leading cardiology societies now recognise vaccination against certain infections as an evidence-based strategy for cardiovascular prevention. It is therefore essential that this information be widely disseminated among healthcare professionals, patients and the general public. Of all the available measures to control environmental risk factors, vaccination is the only intervention that clinicians can directly implement in routine clinical practice. Vaccination recommendations should therefore be regarded with the same importance as advice on diet, exercise and smoking cessation.