A French population-based study provides further evidence that the BNT162b2 Pfizer-BioNTech mRNA COVID-19 vaccine does not increase the short-term risk for serious cardiovascular adverse events in older people.

The study showed no increased risk of myocardial infarction (MI), stroke, or pulmonary embolism (PE) following vaccination in adults aged 75 years or older in the 14 days following vaccination.

“These findings regarding the BNT162b2 vaccine’s short-term cardiovascular safety profile in older people are reassuring. They should be taken into account by doctors when considering implementing a third dose of the vaccine in older people,” Marie Joelle Jabagi, PharmD, PhD, with the French National Agency for Medicines and Health Products Safety, Saint-Denis, France, told.

The study was published as a research letter online November 22 in JAMA.

The Pfizer-BioNTech mRNA vaccine was the first SARS-CoV-2 vaccine authorized in France and has been widely used in older people. The phase 3 trials of the vaccine showed no increase in cardiovascular events, but older people were underrepresented in the trials.

As of April 30, 2021, nearly 3.9 million French adults aged 75 or older had received at least one dose of the Pfizer COVID-19 vaccine and 3.2 million had received two doses.

Using the French National Health Data System linked to the national COVID-19 vaccination database, Jabagi and her colleagues identified all unvaccinated or vaccinated adults aged 75 and older who were hospitalized between December 15, 2020, and April 30, 2021, for acute MI, hemorrhagic or ischemic stroke, or PE.

During the 4.5-month study period, 11,113 elderly were hospitalized for acute MI, 17,014 for ischemic stroke, 4804 for hemorrhagic stroke, and 7221 for PE. Of these, 58.6%, 54.0%, 42.7%, and 55.3%, respectively, had received at least one dose of vaccine.

In the 14 days following receipt of either dose, no significant increased risk was found for any outcome, the investigators report.

The relative incidence (RI) for MI after the first and second dose was 0.97 (95% CI, 0.88 – 1.06) and 1.04 (95% CI, 0.93 – 1.16), respectively.

For ischemic stroke, the RI was 0.90 after the first dose (95% CI, 0.84 – 0.98) and 0.92 (95% CI, 0.84 – 1.02) after the second; for hemorrhagic stroke, the RI was 0.90 (95% CI, 0.78 – 1.04) and 0.97 (95% CI, 0.81 – 1.15), respectively.

For PE, the RI was 0.85 (95% CI, 0.75 – 0.96) after the first dose and 1.10 (95% CI, 0.95 – 1.26) after the second dose.

There was also no significant increase for any of the cardiovascular events when the exposure risk window was subdivided into 1 to 7 days and 8 to 14 days.

“Evaluating the short-term risk of hospitalization for severe cardiovascular events after the BNT162b2 mRNA vaccine in older people was a priority, especially after signals for hypertension and cardiovascular, thromboembolic, and hemorrhagic events have been issued from spontaneous notification data,” Jabagi told.

“The results of this nationwide study provide further solid evidence regarding the lack of increase of serious cardiovascular adverse events in older people in the 14 days following both doses of the vaccine,” Jabagi said.

The French study supports a recent US study of more than 6 million people demonstrating that serious health risks were no more common in the first 3 weeks after Pfizer/BioNTech or Moderna COVID-19 vaccination compared with 22 to 42 days later.