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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Pneumococcal Vaccination as Cardiovascular and Cardiorespiratory Prevention in Adults with Heart Disease

  • Clara Bonanad1,2,3,4
  • Guillermo Barreres2
  • Nora Garcia-Collado2
  • Daniela Maidana5
  • David Vivas6
  • Sergio Raposeiras7
  • Elena Fortuny8
  • Diego Segura-Rodriguez9,10,11
  • Gonzalo Alonso-Salinas12,13
  • Esther Redondo14
  • Alberto Garcia-Lledó15
  • Sergio García-Blas2,3,4
1 more authors
  • Vivencio Barrios16
16 affiliations
  1. 1Department of Medicine, University of Valencia, 46010 Valencia, Spain
  2. 2Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA), 46010 Valencia, Spain
  3. 3Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
  4. 4Department of Cardiology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
  5. 5Department of Cardiovascular Surgery, Hospital Universitario Virgen Macarena, 41042 Sevilla, Spain
  6. 6Department of Cardiology, Hospital Clínico San Carlos, 28040 Madrid, Spain
  7. 7Department of Cardiology, Hospital Universitario Álvaro Cunqueiro, 38312 Vigo, Spain
  8. 8Department of Cardiology, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
  9. 9Department of Cardiology, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain
  10. 10Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
  11. 11Department of Medicine, University of Granada, 18071 Granada, Spain
  12. 12Department of Cardiology, Hospital Universitario de Navarra, 31008 Pamplona, Spain
  13. 13Health Sciences Department, Universidad Pública de Navarra (UPNA), 31006, Pamplona, Spain
  14. 14Technical Unit for Vaccination and International Health, Madrid Salud Autonomous Organization, 28007 Madrid, Spain
  15. 15Departamento de Cardiología, Hospital Universitario Príncipe de Asturias, 28805 Alcalá de Henares, Madrid, Spain
  16. 16Department of Cardiology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, 28034 Madrid, Spain
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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.

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Cite

BibTeXRIS
BibTeX
@article{bonanad2026pneumococcal,
  title = {{Pneumococcal Vaccination as Cardiovascular and Cardiorespiratory Prevention in Adults with Heart Disease}},
  author = {Clara Bonanad and Guillermo Barreres and Nora Garcia-Collado and Daniela Maidana and David Vivas and Sergio Raposeiras and Elena Fortuny and Diego Segura-Rodriguez and Gonzalo Alonso-Salinas and Esther Redondo and Alberto Garcia-Lledó and Sergio García-Blas and Vivencio Barrios},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15218220},
  url = {https://www.mdpi.com/2077-0383/15/21/8220},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Pneumococcal Vaccination as Cardiovascular and Cardiorespiratory Prevention in Adults with Heart Disease
AU  - Clara Bonanad
AU  - Guillermo Barreres
AU  - Nora Garcia-Collado
AU  - Daniela Maidana
AU  - David Vivas
AU  - Sergio Raposeiras
AU  - Elena Fortuny
AU  - Diego Segura-Rodriguez
AU  - Gonzalo Alonso-Salinas
AU  - Esther Redondo
AU  - Alberto Garcia-Lledó
AU  - Sergio García-Blas
AU  - Vivencio Barrios
PY  - 2026
DA  - 2026/10/22
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218220
UR  - https://www.mdpi.com/2077-0383/15/21/8220
AB  - 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.
SN  - 2077-0383
ER  -