{ "abstract": "Background/Objectives: Streptococcus pneumoniae is a major cause of community-acquired pneumonia and invasive pneumococcal disease, particularly in older adults and people with cardiovascular disease. Pneumococcal infection may precipitate heart failure, arrhythmias, myocardial infarction, stroke, functional decline, hospitalization, and death. This review examines pneumococcal disease as a cardiovascular stressor, the effectiveness of adult pneumococcal vaccination, and the comparative clinical relevance of higher-valency conjugate vaccines. Methods: We conducted a narrative review of randomized trials, phase 3 immunogenicity and safety studies, real-world effectiveness analyses, observational cardiovascular cohorts, meta-analyses, epidemiological surveillance reports, regulatory documents, and current European, U.S., and Spanish recommendations. Results: Clinical evidence supports protection against vaccine-type invasive pneumococcal disease and pneumococcal pneumonia. Associations between pneumococcal vaccination and lower myocardial infarction risk derive predominantly from observational studies and do not establish causality; a reduction in cardiovascular events remains unproven. The 23-valent polysaccharide vaccine is an older, unconjugated platform that induces a T-cell-independent response without the immunological memory produced by conjugate vaccines; therefore, a higher nominal valency does not necessarily imply greater or more durable clinical effectiveness. PCV20 and PCV21 are higher-valency conjugate vaccines with partially overlapping non-nested serotype compositions. Both have adult regulatory indications in Spain, but their evidence bases differ: PCV20 has phase 3 immunogenicity and safety evidence plus emerging real-world effectiveness data, whereas PCV21 currently has a broad phase 3 immunogenicity and safety program. No head-to-head clinical-outcome study has established superior effectiveness of either vaccine. Differences in estimated serotype coverage reflect epidemiological overlap and do not directly quantify clinical protection. Spanish serotype epidemiology is highly dynamic, with persistent adult disease caused by serotypes included in each formulation and recent increases in selected legacy serotypes retained in PCV20. A serotype-specific association between serotypes 3 and 9N and cardiovascular events has been reported in one invasive-disease cohort but was not reproduced in a larger pneumococcal pneumonia cohort. Conclusions: Pneumococcal vaccination should be integrated into cardiovascular care for eligible adults to prevent pneumococcal disease. Any additional benefit in preventing myocardial infarction or other cardiovascular events, including long-term complications, remains uncertain. Vaccine selection should follow official recommendations and consider age, previous vaccination, regional epidemiology, serotype-associated disease burden and severity, antimicrobial resistance, and availability rather than valency or immunogenicity alone.", "abstract_shown": true, "affiliations": [ "Department of Medicine, University of Valencia, 46010 Valencia, Spain", "Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA), 46010 Valencia, Spain", "Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain", "Department of Cardiology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain", "Department of Cardiovascular Surgery, Hospital Universitario Virgen Macarena, 41042 Sevilla, Spain", "Department of Cardiology, Hospital Clínico San Carlos, 28040 Madrid, Spain", "Department of Cardiology, Hospital Universitario Álvaro Cunqueiro, 38312 Vigo, Spain", "Department of Cardiology, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain", "Department of Cardiology, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain", "Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain", "Department of Medicine, University of Granada, 18071 Granada, Spain", "Department of Cardiology, Hospital Universitario de Navarra, 31008 Pamplona, Spain", "Health Sciences Department, Universidad Pública de Navarra (UPNA), 31006, Pamplona, Spain", "Technical Unit for Vaccination and International Health, Madrid Salud Autonomous Organization, 28007 Madrid, Spain", "Departamento de Cardiología, Hospital Universitario Príncipe de Asturias, 28805 Alcalá de Henares, Madrid, Spain", "Department of Cardiology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, 28034 Madrid, Spain" ], "article_type": null, "arxiv": null, "author_total": 13, "authors": [ { "affs": [ 0, 1, 2, 3 ], "name": "Clara Bonanad", "orcid": "0000-0001-8665-7107" }, { "affs": [ 1 ], "name": "Guillermo Barreres", "orcid": "0009-0009-2259-4376" }, { "affs": [ 1 ], "name": "Nora Garcia-Collado" }, { "affs": [ 4 ], "name": "Daniela Maidana", "orcid": "0000-0002-3496-791X" }, { "affs": [ 5 ], "name": "David Vivas" }, { "affs": [ 6 ], "name": "Sergio Raposeiras" }, { "affs": [ 7 ], "name": "Elena Fortuny" }, { "affs": [ 8, 9, 10 ], "name": "Diego Segura-Rodriguez" }, { "affs": [ 11, 12 ], "name": "Gonzalo Alonso-Salinas", "orcid": "0000-0001-5914-8526" }, { "affs": [ 13 ], "name": "Esther Redondo", "orcid": "0000-0003-2791-979X" }, { "affs": [ 14 ], "name": "Alberto Garcia-Lledó", "orcid": "0000-0002-8986-2584" }, { "affs": [ 1, 2, 3 ], "name": "Sergio García-Blas", "orcid": "0000-0002-1998-3735" }, { "affs": [ 15 ], "name": "Vivencio Barrios", "orcid": "0000-0001-6135-7685" } ], "bibtex": "https://research.draconitic.com/paper/3h5n346dj5rvs.bib", "cited_by": 0, "doi": "10.3390/jcm15218220", "fulltext_url": null, "id": "3h5n346dj5rvs", "issns": [ "2077-0383" ], "landing_url": "https://www.mdpi.com/2077-0383/15/21/8220", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2713|Pneumonia and Respiratory Infections" ] ], "openalex": "W7223386653", "pdf_url": null, "pmcid": null, "pmid": null, "published": "2026-10-22", "publisher": "MDPI AG", "ris": "https://research.draconitic.com/paper/3h5n346dj5rvs.ris", "sources": [ { "first_seen": "2026-10-30T12:20:01Z", "native_id": "10.3390/jcm15218220", "source": "crossref", "url": "https://www.mdpi.com/2077-0383/15/21/8220" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2713|Pneumonia and Respiratory Infections", "subfield": "epidemiology-public-health" } ], "title": "Pneumococcal Vaccination as Cardiovascular and Cardiorespiratory Prevention in Adults with Heart Disease", "title_text": "Pneumococcal Vaccination as Cardiovascular and Cardiorespiratory Prevention in Adults with Heart Disease", "type": "peer-reviewed", "updated_at": "2026-10-30T12:20:01Z", "url": "https://research.draconitic.com/paper/3h5n346dj5rvs", "venue": "Journal of Clinical Medicine", "versions": [] }