Вакцинация от пневмококковой инфекции как способ снижения частоты сердечно-сосудистых осложнений

Проваторов С.И. Вакцинация от пневмококковой инфекции как способ снижения частоты сердечно-сосудистых осложнений. Consilium Medicum. 2026;28(1):60–64. DOI: 10.26442/20751753.2026.1.203662

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Provatorov SI. Vaccination against pneumococcal infection as a method to reduce the incidence of cardiovascular complications: A review. Consilium Medicum. 2026;28(1):60–64. DOI: 10.26442/20751753.2026.1.203662

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Аннотация

Сердечно-сосудистые заболевания (ССЗ) – основная составляющая в структуре смертности в большинстве промышленно развитых стран мира. Внебольничные пневмонии существенно ухудшают течение ССЗ и повышают вероятность сердечно-сосудистой смерти. Streptococcus pneumoniae (пневмококк) относится к наиболее частым этиологическим возбудителям внебольничных бактериальных пневмоний. Он может как вызывать прямое повреждение миокарда, проникая в него в результате гематогенной диссеминации, так и оказывать опосредованное повреждающее действие на сердечно-сосудистую систему из-за индуцируемой воспалительной реакции, а также воздействия бактериальных токсинов, ключевой из которых – пневмолизин. Повреждение миокарда и сосудистой стенки, а также активация тромбоцитов могут существенно способствовать декомпенсации сердечной недостаточности, развитию инфарктов и инсультов, а также нарушений сердечного ритма у пациентов с пневмонией. Большинство осложнений со стороны сердечно-сосудистой системы развивается в раннем остром периоде пневмонии, но некоторые из них могут возникнуть и в отсроченном периоде, что создает предпосылки к длительному сохранению повышенного риска сердечно-сосудистой смерти через несколько лет после перенесенной инфекции. Вероятность сердечно-сосудистых осложнений (ССО) у пациентов, страдающих пневмонией, может быть снижена за счет применения ацетилсалициловой кислоты и статинов, а также вследствие эффективной антибиотикотерапии, однако такие лечебные мероприятия не позволяют полностью исключить риск ССО. Наиболее эффективный метод профилактики ССО, вызываемых S. pneumoniae, – вакцинация от пневмококковой инфекции. В настоящее время существует несколько разновидностей пневмококковых вакцин, наиболее современные из которых – конъюгированные, позволяющие обеспечить устойчивую иммунизацию к наиболее распространенным вариантам пневмококка при однократном введении. Вакцинация от S. pneumoniae рекомендована при широком спектре ССЗ, включая легочную гипертензию, хроническую сердечную недостаточность, миокардиты и дилатационную кардиомиопатию. Широкое использование вакцинации от пневмококка у пациентов высокого сердечно-сосудистого риска позволит существенно снизить как количество ССО, так и общую смертность в этой группе пациентов.

Ключевые слова: пневмококковая вакцина, внебольничная пневмония, Streptococcus pneumoniae, сердечно-сосудистые заболевания, коморбидность, смертность

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Cardiovascular diseases (CVD) represent a leading cause of mortality in most industrialized countries. Community-acquired pneumonia significantly worsens the clinical course of CVD and increases the risk of cardiovascular death. Streptococcus pneumoniae (pneumococcus) is one of the most common etiological pathogens of community-acquired bacterial pneumonia. It may cause direct myocardial injury through hematogenous dissemination, as well as exert indirect deleterious effects on the cardiovascular system via the induced inflammatory response and the action of bacterial toxins, the most important of which is pneumolysin. Myocardial and vascular wall injury, along with platelet activation, may substantially contribute to the decompensation of heart failure, as well as to the development of myocardial infarction, stroke, and cardiac arrhythmias in patients with pneumonia. Most cardiovascular complications (CVC) occur during the early acute phase of pneumonia; however, some may also develop in the delayed period, creating conditions for the long-term persistence of an increased risk of cardiovascular death for several years after the infection. The risk of CVC in patients with pneumonia may be reduced by the use of aspirin and statins, as well as effective antibiotic therapy; however, these approaches do not completely eliminate the risk. Vaccination against pneumococcal infection is the most effective method for the prevention of CVC associated with S. pneumoniae. Currently, several types of pneumococcal vaccines are available, with conjugate vaccines being the most advanced, providing sustained immunity against the most prevalent pneumococcal serotypes after a single administration. Vaccination against S. pneumoniae is recommended across a wide spectrum of CVD, including pulmonary hypertension, chronic heart failure, myocarditis, and dilated cardiomyopathy. Broad implementation of pneumococcal vaccination in patients at high cardiovascular risk may significantly reduce both the incidence of cardiovascular complications and overall mortality in this population.

Keywords: pneumococcal vaccine, community-acquired pneumonia, Streptococcus pneumoniae, cardiovascular diseases, comorbidity, mortality

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1. Federalnaia sluzhba gosudarstvennoi statistiki (Rosstat). Demografiia. Smertnost naseleniia. 2023. Available at: https://rosstat.gov.ru/folder/11110/document/13269. Accessed: 22.12.2025 (in Russian).
2. Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37-43. DOI:10.1016/S0140-6736(12)60240-2
3. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. DOI:10.1016/0021-9681(87)90171-8
4. Mieno MN, Tanaka N, Arai T, et al. Accuracy of Death Certificates and Assessment of Factors for Misclassification of Underlying Cause of Death. J Epidemiol. 2016;26(4):191-8. DOI:10.2188/jea.JE20150010
5. Shoar S, Musher DM. Etiology of community-acquired pneumonia in adults: a systematic review. Pneumonia (Nathan). 2020;12:11. DOI:10.1186/s41479-020-00074-3
6. Bogaert D, De Groot R, Hermans PW. Streptococcus pneumoniae colonisation: the key to pneumococcal disease. Lancet Infect Dis. 2004;4(3):144-54. DOI:10.1016/S1473-3099(04)00938-7
7. Andrew PW, Mitchell TJ, Morgan PJ. Relationship of structure to function in pneumolysin. Microb Drug Resist. 1997;3(1):11-7. DOI:10.1089/mdr.1997.3.11
8. Van der Poll T, Opal SM. Pathogenesis, treatment, and prevention of pneumococcal pneumonia. Lancet. 2009;374(9700):1543-56. DOI:10.1016/S0140-6736(09)61114-4
9. Kadioglu A, Weiser JN, Paton JC, Andrew PW. The role of Streptococcus pneumoniae virulence factors in host respiratory colonization and disease. Nat Rev Microbiol. 2008;6(4):288-301. DOI:10.1038/nrmicro1871
10. Musher DM, Rueda AM, Kaka AS, Mapara SM. The association between pneumococcal pneumonia and acute cardiac events. Clin Infect Dis. 2007;45(2):158-65. DOI:10.1086/518849
11. Corrales-Medina VF, Alvarez KN, Weissfeld LA, et al. Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA. 2015;313(3):264-74. DOI:10.1001/jama.2014.18229
12. Yende S, D'Angelo G, Kellum JA, et al. GenIMS Investigators. Inflammatory markers at hospital discharge predict subsequent mortality after pneumonia and sepsis. Am J Respir Crit Care Med. 2008;177(11):1242-7. DOI:10.1164/rccm.200712-1777OC
13. Cangemi R, Pignatelli P, Carnevale R, et al. SIXTUS Study Group. Low-grade endotoxemia, gut permeability and platelet activation in community-acquired pneumonia. J Infect. 2016;73(2):107-14. DOI:10.1016/j.jinf.2016.05.013
14. Brown AO, Mann B, Gao G, et al. Streptococcus pneumoniae translocates into the myocardium and forms unique microlesions that disrupt cardiac function. PLoS Pathog. 2014;10(9):e1004383. DOI:10.1371/journal.ppat.1004383
15. Kaplan V, Clermont G, Griffin MF, et al. Pneumonia: still the old man's friend? Arch Intern Med. 2003;163(3):317-23. DOI:10.1001/archinte.163.3.317
16. Bers DM. Calcium fluxes involved in control of cardiac myocyte contraction. Circ Res. 2000;87(4):275-81. DOI:10.1161/01.res.87.4.275
17. Alhamdi Y, Neill DR, Abrams ST, et al. Circulating Pneumolysin Is a Potent Inducer of Cardiac Injury during Pneumococcal Infection. PLoS Pathog. 2015;11(5):e1004836. DOI:10.1371/journal.ppat.1004836
18. Bermpohl D, Halle A, Freyer D, et al. Bacterial programmed cell death of cerebral endothelial cells involves dual death pathways. J Clin Invest. 2005;115(6):1607-15. DOI:10.1172/JCI23223
19. McNeela EA, Burke A, Neill DR, et al. Pneumolysin activates the NLRP3 inflammasome and promotes proinflammatory cytokines independently of TLR4. PLoS Pathog. 2010;6(11):e1001191. DOI:10.1371/journal.ppat.1001191
20. Keane C, Tilley D, Cunningham A, et al. Invasive Streptococcus pneumoniae trigger platelet activation via Toll-like receptor 2. J Thromb Haemost. 2010;8(12):2757-65. DOI:10.1111/j.1538-7836.2010.04093.x
21. Tunjungputri RN, Mobegi FM, Cremers AJ, et al. Phage-Derived Protein Induces Increased Platelet Activation and Is Associated with Mortality in Patients with Invasive Pneumococcal Disease. mBio. 2017;8(1):e01984-16. DOI:10.1128/mBio.01984-16
22. Luquero-Bueno S, Galván-Román JM, Curbelo J, et al. Platelet count as an evolution marker of late mortality and cardiovascular events after an episode of community-acquired pneumonia. Eur Respir J. 2019;54:PA4532. DOI:10.1183/13993003.congress-2019.PA4532
23. Cangemi R, Casciaro M, Rossi E, et al. Platelet activation is associated with myocardial infarction in patients with pneumonia. J Am Coll Cardiol. 2014;64(18):1917-25. DOI:10.1016/j.jacc.2014.07.985
24. Ramirez J, Aliberti S, Mirsaeidi M, et al. Acute myocardial infarction in hospitalized patients with community-acquired pneumonia. Clin Infect Dis. 2008;47(2):182-7. DOI:10.1086/589246
25. Corrales-Medina VF, Serpa J, Rueda AM, et al. Acute bacterial pneumonia is associated with the occurrence of acute coronary syndromes. Medicine (Baltimore). 2009;88(3):154-9. DOI:10.1097/MD.0b013e3181a692f0
26. Aliberti S, Ramirez J, Cosentini R, et al. Acute myocardial infarction versus other cardiovascular events in community-acquired pneumonia. ERJ Open Res. 2015;1(1):00020-2015. DOI:10.1183/23120541.00020-2015
27. Lamontagne F, Garant MP, Carvalho JC, et al. Pneumococcal vaccination and risk of myocardial infarction. CMAJ. 2008;179(8):773-7. DOI:10.1503/cmaj.070221
28. Dulfer EA, Serbée MJV, Dirkx KKT, et al. Cardiovascular events after invasive pneumococcal disease: a retrospective cohort study. Int J Infect Dis. 2024;147:107185. DOI:10.1016/j.ijid.2024.107185
29. Carneiro J, Leite A, Lahuerta M, et al. Risk of stroke or myocardial infarction hospitalisation following hospitalisation for community-acquired pneumonia in Portugal: a self-controlled case series study. BMJ Open. 2025;15(11):e101068. DOI:10.1136/bmjopen-2025-101068
30. Mandal P, Chalmers JD, Choudhury G, et al. Vascular complications are associated with poor outcome in community-acquired pneumonia. QJM. 2011;104(6):489-95. DOI:10.1093/qjmed/hcq247
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Авторы

С.И. Проваторов*

ФГБУ «Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова» Минздрава России, Москва, Российская Федерация
*semaver@yandex.ru

________________________________________________

Sergei I. Provatorov*

Chazov National Medical Research Center of Cardiology, Moscow, Russian Federation
*semaver@yandex.ru

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