Why Vaccination Must Become A Pillar Of Cardiovascular Prevention — Dr Musa Mohd Nordin & Dr Zulkifli Ismail

Earlier this year, the European Society of Cardiology (ESC) issued a landmark Clinical Consensus Statement that should fundamentally change how we think about preventing heart attacks and strokes.

The conclusion is clear: vaccination is no longer just a tool for infection control, but a foundational pillar of cardiovascular prevention.

For decades, cardiologists have focused on cholesterol, blood pressure, smoking cessation, and antiplatelet therapy. But a growing body of evidence — now crystallised by the ESC — shows that common infections such as influenza, pneumonia, SARS-CoV-2, and respiratory syncytial virus (RSV) directly exacerbate heart failure and trigger major adverse cardiovascular events.

In Malaysia, this paradigm shift is not a distant medical theory, but an urgent national priority. According to the Department of Statistics (DOSM), ischaemic heart diseases have persistently reigned as the principal cause of medically certified deaths in our country, accounting for roughly 13 to 15 per cent of all certified fatalities annually.

Disturbingly, the National Heart Institute (IJN) and the National Heart Association of Malaysia have highlighted a unique regional crisis: our citizens are being diagnosed with cardiovascular disease (CVD) at a much younger age than their Western counterparts, frequently presenting with life-threatening acute coronary syndrome before the age of 50.

The mechanism linking infection to cardiac arrest is no longer mysterious. Infections provoke intense systemic inflammation, destabilise arterial plaques, and place immense stress on an already failing heart. The ESC statement details how this inflammatory cascade drastically increases morbidity and mortality in patients with existing CVD.

This intersection of infectious disease and cardiac strain is painfully visible in local data: DOSM figures routinely show that while ischaemic heart disease is the leading cause of death nationwide, pneumonia follows as a dangerously close second (accounting for over 11 per cent of certified deaths).

For older adults over 60, pneumonia actually overtakes heart disease as the leading cause of death. When a vulnerable Malaysian cardiac patient contracts a severe respiratory tract infection, their risk of a major cardiac event spikes exponentially.

Here is the game-changer: vaccines that prevent these infections also reduce cardiovascular complications. The ESC consensus, published in the European Heart Journal, concludes that routine vaccination against influenza, pneumococcus, RSV, and Covid-19 should be considered alongside statins and antihypertensives for at-risk patients.

Serious adverse reactions remain exceptionally rare, while the potential benefi — preventing a secondary heart attack or hospitalisation for heart failure — is substantial.

Furthermore, ignoring this preventative tool carries a staggering economic penalty. Treating CVD costs Malaysia an estimated RM3.9 billion annually, with an additional RM4 billion lost in productivity due to premature illness and death among our working-age population.

Implementing routine adult immunisations for cardiac patients is a highly cost-effective intervention that can directly ease the severe financial strain on the health care system.

Leading cardiologists, including ESC president Prof Thomas F. Lüscher, note that “the totality of evidence indicates that vaccinations should become a foundational pillar of preventive strategies.” This is not a minor addition. It is a paradigm shift.

Yet, local uptake remains dismally, dangerously low. While organisations like the Malaysian Society of Infectious Diseases and Chemotherapy (MSIDC) strongly recommend pneumococcal and influenza vaccines for adults with comorbid conditions, Malaysia lacks a national, fully funded adult immunisation programme.

Consequently, nationwide studies show that influenza vaccine coverage among high-risk groups, such as the elderly and patients with diabetes, hovers at a minuscule 5.5 to 6.4 per cent.

For pneumococcal vaccines, recent cross-sectional data in the Klang Valley indicates that only about 29 per cent of older adults have received a dose, with the vast majority only doing so strictly as a prerequisite prior to undertaking the Hajj or Umrah pilgrimages.

Many patients with chronic coronary syndromes or heart failure are simply never offered these vaccines in Malaysian cardiology clinics. Gaps in public awareness persist, heavily exacerbated by pandemic-related hesitancy and the widespread misconception that these shots are “only for the lungs.”

The path forward requires action on three fronts:

• Integrate tracking: Malaysian cardiologists, physicians, and primary care providers must integrate vaccination status as a standard, mandatory vital sign during every CVD patient visit.
• Expand access: As a start, private health systems must try ensure same-day, affordable vaccination availability right inside the cardiac clinic.
• Shift the narrative: Public health campaigns must explicitly communicate to the public that pneumococcal conjugate vaccines (PCV), RSV, influenza, and Covid-19 shots are actively heart-protective, not just lung-protective.

We cannot afford to ignore this evidence. Cardiovascular disease remains our nation’s most lethal threat, robbing families of loved ones far too early.

Adding vaccination to our preventive arsenal is a safe, cost-effective, and scientifically grounded strategy that will save thousands of Malaysian lives. It is time to put a shot in the arm of cardiovascular prevention, literally.

Dr Musa Mohd Nordin and Dr Zulkifli Ismail are paediatricians from Damansara Specialist Hospital (DSH).