PMCC cardiologist wins national award

Dr. Jacob Udell, cardiologist at the Peter Munk Cardiac Centre and Women's College Hospital, won the Rising Star Award in May 2014 from the Canadian Institutes in Health Research (CIHR). The organization recognized three physicians from across Canada for innovative research. Dr. Udell examined the benefits of flu vaccines for cardiac patients.​

PMCC: When you got the call about this award, what was your reaction?

Dr. Udell:I was a little bit shocked and surprised. I've never won anything before like this so it was a very nice honour. You always watch those Academy Award nominations and everyone says it was just an honour to be nominated and everyone rolls their eyes…but it really was!

I think it's an affirmation that we're doing something good with the work we're doing at Peter Mu

k.

PMCC: Your research focused on the association between the flu vaccine and cardiovascular outcomes in high-risk patients…what does that mean?

Dr. Udell:When you get the flu, it's usually not a good thing. People don't usually come and get hospitalized because of overwhelming influenza, but usually because of a complication of the flu, which primarily can be a cardiovascular complication – so heart attack, stroke, heart failure, or even succumbing and dying from heart disease.

There was some emerging data that maybe then, a flu vaccine protecting you from flu, would also be protective from those cardiac complications.

We determined that the flu vaccine does have about a 50 per cent benefit of reducing the potential cardiovascular complications from the flu, particularly for those who have had a recent heart attack.

One shot, once a year, of flu vaccine with very low downside in terms of side effects could have a tremendous benefit in terms of reducing cardiac events beyond what we currently have available to us.

PMCC: What percentage of the population is classified as high-risk?

Dr. Udell:Overall, probably about 10 to 20 per cent of the general population, so about one in five people is considered high-risk. When we look at those who are seniors, so over 65, that population could be up to a third.

Certainly anyone who's had a documented cardiac event is considered high risk. We would be aiming to focus on that population (for clinical trials).

PMCC: What was involved in examining the data?

​Dr. Udell: It was a year-long process. We do what's called a systematic review – we sit down with a health librarian and we come up with the right question. We go systematically through the research literature to find all the clinical trials that would apply to this question. And there were several thousand studies, as you might imagine.

We then had to tease through that and look for those which had recorded, both at baseline and then at follow-up, who had heart disease.

PMCC: What surprised you about the data?

Dr. Udell:What surprised us, although we went looking for this question, was the degree to which the benefit from the flu vaccine was more amplified or moderated in those who had had a recent heart attack.

So it seems if this is something that's about protecting you either from the flu, or the inflammation associated with the flu, those with an acute heart attack usually have more circulating levels of higher inflammation and so this may actually have that extra benefit in those patients.

PMCC: What comes next?

​Dr. Udell:We're organizing a large, multi-centre, clinical trial in North America with our colleagues at Brigham and Women's Hospital and at Madison, Wisconsin and ourselves.

We're going to examine the health benefits of getting a flu vaccine versus a different strategy of flu protection for patients who've had recent cardiac events.

PMCC: What is your ultimate goal with this research?

Dr. Udell:That it would a standard of care in the future, if we can show that it's really that beneficial, that everyone should be getting a flu shot before they get discharged from hospital after a heart attack or a heart failure hospitalization during the flu season. We're also going to look at benefits outside the flu season.

PMCC: Your medical journey has included U of T, UBC, Harvard Medical School. Why did you decide to return to Toronto and the Peter Munk Cardiac Centre?

​Dr. Udell:Peter Munk Cardiac Centre being a world leader in cardiovascular care was a natural fit, to come to a place that supports the kind of research that I'm working with my colleagues here to perform.

   
Dr. Jacob Udell's award-winning research, As​sociation Between Influenza Vaccination and Cardiovascular Outcomes in High-Risk Patients, was published in 'The Journal of American Medical Association' (JAMA) in October 2013. It can be found here.​