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People who get influenza could be six times more susceptible to having a heart attack in the days following a flu diagnosis, a new study from the Netherlands has found.
The studys conclusions were scheduled to be presented on April 18 at the European Congress of Clinical Microbiology & Infectious Diseases in Copenhagen, Denmark, as reported by Medscape.
The lead researcher, Dr. Annemarijn de Boer with the Julius Center for Life Sciences and Primary Care at the University Medical Center Utrecht, analyzed test results from 16 labs in the Netherlands, as well as medical and death records.
Of 26,221 cases of influenza between the years 2008 and 2019, 401 people experienced at least one heart attack within a year of the diagnosis, the report said.
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Additionally, people had a 6.16 times higher likelihood of having a heart attack in the week after getting the flu compared to the year before or after, the researchers found.
However, when excluding the deaths that occurred outside the hospital, the increased risk was 2.42 times instead of 6.16.
People who get influenza could be six times more susceptible to having a heart attack in the days following a flu diagnosis, a new study from the Netherlands has found. (iStock)
This is likely because most flu testing in the Netherlands is performed in the hospital, which means patients are more likely to have severe illness, according to de Boer.
Similar findings came from a 2018 Canadian study led by Dr. Jeffrey C. Kwong from the Dalla Lana School of Public Health in Toronto, Ontario.
Researchers found that participants were 6.05 times more likely to have a heart attack in the week after diagnosis.
Board-certified cardiologist Dr. Mary Greene with Manhattan Cardiology in New York City was not involved in the study, but reviewed the findings.
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"While the methodology of this particular Dutch study did not yield as much robust data, the study certainly echoes previous studies that have come to similar conclusions," Greene told Fox News Digital.
"Seemingly common colds can turn into serious medical issues."
"I do agree that a flu diagnosis can increase the odds of heart attack in a select group of patients, especially those with underlying heart disease," she added.
The increase in heart attacks among patients diagnosed with influenza, said Greene, largely stems from the inflammatory process and the environment that is created within the body when someone is fighting off the flu or other viral illnesses.
To help minimize the risk of heart attacks, all people should have a cardiovascular screening starting at age 40, or earlier if there is a history of early heart disease in the family, says one cardiologist. (iStock)
"Such inflammation in the body can make cholesterol plaques more vulnerable to rupture and blood more likely to clot, which is the underlying mechanism of both myocardial infarction (heart attack) and ischemic stroke," she said.
Dr. Craig Bober, a family medicine physician at Inspira Medical Group Primary Care Mantua in Sewell, New Jersey, who was also not involved in the Dutch research, noted a key limitation of the study.
"It is important to note that the study was not designed to reflect the generalized population, as it looked at only those tested in hospital settings these patients tend to be the sickest and usually elderly," he told Fox News Digital in an email.
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"However, the study certainly emphasizes the dangers of seemingly benign virus-mediated infections."
Fox News Digital reached out to the study author for comment.
To help minimize the risk of heart attacks, all people should have a cardiovascular screening starting at age 40, or earlier if there is a history of early heart disease in the family, said Greene of New York City.
The increase in heart attacks among patients diagnosed with influenza, said one cardiologist, stems from the inflammation that occurs when someone is fighting off the flu or other viral illnesses. (iStock)
"I also recommend that all patients with underlying coronary artery disease, history of stents, history of heart attack and history of heart failure have their annual flu shot," she said.
"Cardiovascular patients see a larger benefit from influenza vaccination in terms of protection against a heart attack should they become infected with the influenza virus."
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These findings should serve as a reminder that seemingly common colds can turn into serious medical issues, Bober of New Jersey said.
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"Anyone with concerning chest pain or shortness of breath especially those with high-risk medical conditions such as underlying heart disease, lung conditions, diabetes or kidney disease should seek medical attention sooner rather than later," he added.
Melissa Rudy is health editor and a member of the lifestyle team at Fox News Digital.
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Species of virus
Influenza B virus is the only species in the genus Betainfluenzavirus in the virus family Orthomyxoviridae.
Influenza B virus is known only to infect humans, pigs and seals.[4][5] This limited host range is apparently responsible for the lack of associated influenza pandemics in contrast with those caused by the morphologically similar influenza A virus as both mutate by both antigenic drift and reassortment.[6][7][8] There are two known circulating lineages of Influenza B virus based on the antigenic properties of the surface glycoprotein hemagglutinin. The lineages are termed B/Yamagata/16/88-like and B/Victoria/2/87-like viruses.[9] The quadrivalent influenza vaccine licensed by the CDC is currently designed to protect against both co-circulating lineages and has been shown to have greater effectiveness in prevention of influenza caused by Influenza B virus than the previous trivalent vaccine.[10]
Further diminishing the impact of this virus, "in humans, influenza B viruses evolve slower than A viruses and faster than C viruses".[11] Influenzavirus B mutates at a rate 2 to 3 times slower than type A.[12] Nevertheless, it is accepted that Influenza B virus could cause significant morbidity and mortality worldwide, and significantly impacts adolescents and schoolchildren.[13]
The B/Yamagata lineage might have become extinct in 2020/2021 due to COVID-19 pandemic measures.[14][15]
The Influenza B virus capsid is enveloped while its virion consists of an envelope, a matrix protein, a nucleoprotein complex, a nucleocapsid, and a polymerase complex. It is sometimes spherical and sometimes filamentous. Its 500 or so surface projections are made of hemagglutinin and neuraminidase.[16]
The Influenza B virus genome is 14,548 nucleotides long and consists of eight segments of linear negative-sense, single-stranded RNA. The multipartite genome is encapsidated, each segment in a separate nucleocapsid, and the nucleocapsids are surrounded by one envelope.[16]
The subtypes of influenza A virus are estimated to have diverged 2,000 years ago. Influenza viruses A and B are estimated to have diverged from a single ancestor around 4,000 years ago, while the ancestor of influenza viruses A and B and the ancestor of influenza virus C are estimated to have diverged from a common ancestor around 8,000 years ago.[17] Metatranscriptomics studies have also identified closely related "Influenza B-like" viruses such as the Wuhan spiny eel influenza virus[18] and also "Influenza-B like" viruses in a number of vertebrate species such as salamanders and fish.[19]
In 1936, Thomas Francis Jr. discovered the ferret influenza B virus. Also in 1936, Macfarlane Burnet made the discovery that influenza virus may be cultured in hen embryonated eggs.[20] This prompted research into the properties of the virus and the creation and application of inactivated vaccines in the late 1930s and early 1940s. Inactivated vaccines' usefulness as a preventative measure was proven in the 1950s. Later, 2003 saw the approval of the first live, attenuated influenza vaccine.[21] Looking into influenza B specifically, Thomas Francis Jr. isolated influenza B virus in 1936. However, it was not until 1940 when influenza B viruses were discovered.[22]
In 1942, a new bivalent vaccine was developed that protected against both the H1N1 strain of influenza A and the newly discovered influenza B virus.[23] In todays current world, even while some technology has advanced and flu vaccines now cover both strains of influenza A and B, the science is still based on findings from almost a century ago.[24] The viruses included in flu vaccines are changed each year to match the strains of flu that are most likely to make people sick that year since flu viruses can develop swiftly and new mutations have appeared each year, like H1N1.[25]
Even though there are two different lineages of influenza B viruses that circulate during most seasons, flu vaccinations were long meant to protect against three different flu viruses: the influenza A(H1N1), influenza A(H3N2), and one influenza B virus.[26] The second lineage of the B virus was since added to provide greater defense against circulating flu viruses.[27] Two influenza A viruses and two influenza B viruses are among the four flu viruses that a quadrivalent vaccine is intended to protect against. All flu vaccines in the United States today are quadrivalent.[28] The four main types of Type A and B influenza viruses that are most likely to spread and make people sick during the upcoming flu season are the targets of seasonal influenza (flu) vaccines.[29] All of the available flu vaccinations in the United States offer protection against the influenza A(H1), A(H3), B/Yamagata, and B/Victoria lineage viruses. Each of these four vaccine virus components is chosen based on the following criteria: which flu viruses are infecting people ahead of the upcoming flu season, how widely they are spreading, how well the vaccines from the previous flu season may protect against those flu viruses, and the vaccine viruses' capacity to offer cross-protection.[30]
For the 2022-2023 flu season, there are three flu vaccines that are preferentially recommended for people 65 years and older; various influenza (flu) vaccinations are authorized for use in people of various age groups.[31] On March 3, 2022, the FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) convened in Silver Spring, Maryland, to choose the influenza viruses that will make up the influenza vaccine for the 20222023 influenza season in the United States. The committee proposed using A(H1N1)pdm09, A(H3N2), and B/Austria/1359417/2021-like viruses for trivalent influenza vaccines to be utilized in the U.S. for the 20222023 influenza season.[32]
In 1940, an acute respiratory illness outbreak in Northern America led to the discovery of influenza B virus (IBV), which was later discovered to not have any antigenic cross-reactivity with influenza A virus (IAV). Based on calculations of the rate of amino acid substitutions in HA proteins, it was estimated that IBV and IAV diverged from one another around 4000 years ago.[33] However, the mechanisms of replication and transcription, as well as the functionality of the majority of viral proteins, appear to be largely conserved, with some unusual differences.[34] Although IBV has occasionally been found in seals and pigs, its primary host species is the human.[35] IBVs can also spread epidemics throughout the world, but they receive less attention than IAVs do due to their less prevalent nature, both in infecting hosts and in the symptoms that result from infection. IBVs used to be unclassified, but since the 1980s, they have been divided into the B/Yamagata and B/Victoria lineages.[36] IBVs have further divisions known as clades and sub-clades, just like IAVs do.[37]
Hemagglutinin (HA) and neuraminidase (NA) are two virus surface antigens that are constantly changing.[38] Antigenic drift or antigenic shift are two possible influenza viral changes. Small changes in the HA and NA of influenza viruses caused by antigenic drift result in the creation of novel strains that the immune system of humans might not be able to identify.[39] These emerging strains are the influenza virus's evolutionary responses to a potent immunological response across the population. The main cause of influenza recurrence is antigenic drift, which makes it essential to reevaluate and update the influenza vaccine's ingredient list every year.[40] Annual influenza outbreaks are caused by antigenic drift and declining immunity, when the residual defenses from prior exposures to related viruses are incomplete. Antigenic drift occurs in Influenza A, B, and C.[41]
Hemagglutination-inhibition experiments using ferret serum after infection allowed the identification of two very different antigenic influenza type B variants in the years 1988 1989. These viruses shared antigens with either B/Yamagata/16/88, a variation that was discovered in Japan in May 1988, or B/Victoria/2/87, the most recent reference strain.[42] The B/Victoria/2/87 virus shared antigens with all influenza B viruses discovered in the United States during an outbreak in the winter of 1988 1989.[42]
In Japan, influenza B virus reinfection was investigated virologically in 1985 1991 and epidemiologically in 1979 1991 in children.[43] Four influenza B virus outbreaks that each included antigenic drift occurred during the course of this study. Between the epidemics in 1987 1988 and 1989 1990, there was a significant genetic and antigenic change in the viruses.[43] Depending on the influenza seasons, the minimum rate of reinfection with influenza B virus for the entire period was between 2 and 25%.[43] Haemagglutination inhibition assays were used to examine the antigens of the influenza B virus primary and reinfection strains that were isolated from 18 children between the years of 1985 and 1990, which encompassed three epidemic periods. The findings revealed that reinfection occurred with the viruses recovered during the 1984 1985 and 1987 1988 influenza seasons, which belonged to the same lineage and were antigenically close.[43]
Today, reinfection continues as increased influenza activity was reported in the United States in November 2022 due to the winter weather. [44]
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