Flu Prevent

Prevent The Flu, Protect Your Heart

Prevent The Flu, Protect Your Heart

Did you know you could end up with a heart attack or stroke when you get the flu?

Most of us associate influenza, also known as the flu, with respiratory complications such as pneumonia.

Recent studies have cautioned that influenza increases the risk of heart attack by more than 10 times in the first 7 days after contracting the flu. 1

This is especially so if you are 65 and over, regardless of whether you have a history of heart disease or are living with chronic illnesses such as heart disease, diabetes, lung disease and kidney disease. 2

As cautioned by Professor Datuk Dr Zulkifli Ismail, Technical Committee Chairman of the Immunise4Life Programme, it’s time to rethink the flu.

He added, “It is not just a fever, runny nose, cough and body aches, it could seriously harm your heart.”

In industrialised countries, most deaths associated with flu occur among older persons aged 65 years and above. 3

It is important to highlight that influenza can present as a relatively mild respiratory illness or even atypically without a fever and with a cough, fatigue and confusion in older persons only to set off a sequence of catastrophic events. 4

The best way to protect against flu and its potentially serious complications is by getting the annual flu vaccine. 5



An infection springs our immune system into action.

While our immune system protects us from infectious diseases such as the flu, the inflammation that occurs as part of the immune response can also damage our own tissues and organs when a strong response is stimulated.6

One example is the effect of COVID-19 that triggers the hyperactivation of the immune system and the uncontrolled release of cytokines which are small molecules that aid cell-to-cell communication in immune responses and stimulate the movement of cells towards sites of infection.

The uncontrolled release of cytokines termed “cytokine storm” is used to describe a variety of events that may ultimately result in multi-organ failure and death.7

Studies suggest that the same inflammatory response to infection can trigger a cardiovascular event when you get influenza infection.8

How exactly does this happen?

As explained by the President of the National Heart Association Malaysia (NHAM) and consultant cardiologist Dr Alan Fong, it is believed that your body’s immune response coupled with the direct effects of flu on the inner lining of blood vessels or atherosclerotic plaques during an influenza virus infection could lead to plaque rupture, occlusion of arteries and subsequently causing a heart attack or stroke.

He added, “Furthermore, there are other factors that play a role such as physiological stress, increased heart rate or changes in metabolic factors such as the utilisation of glucose, fatty acid and protein in response to infection.”



A pre-pandemic study found that influenza virus infection more likely triggers a heart attack compared to other respiratory infections.9

Another study found that flu increases the risk of heart attack and stroke in adults aged 40 years and above even though they had no prior history of these diseases.10

In older persons, there are changes that occur in the immune system that leads to a decline in the ability of the body to fight off infections such as the flu; this is known as immunosenescence. This was explained by Professor Dr Tan Maw Pin who chairs the Flu & Older Persons Sub-Committee of the Malaysian Influenza Working Group (MIWG).

She added, “In addition to this, aging contributes to chronic, non-infectious, low-grade inflammation, known as inflammaging which plays a key role in the cause and progression of chronic conditions such as cardiovascular diseases.”

“Aging also promotes the development and progression of atherosclerosis which is the most common cause of acute coronary syndrome, a term used for situations where the blood supplied to the heart is suddenly blocked.”

She concluded, “Hence, when an older person gets the flu, all these factors put them at higher risk of developing a heart attack and stroke.”



Here in Malaysia, we are a rapidly aging nation and although people are living longer, they are not necessarily living healthier lives.11

According to the National Health & Morbidity Survey 2018 findings for older persons aged 60 years and above, 5 in 10 self-reported hypertension, 28% for diabetes mellitus and 42% for hypercholesterolemia.12

Hypertension, high cholesterol levels, diabetes and obesity are risk factors for cardiovascular disease.13

According to consultant endocrinologist Dr Azraai Nasruddin, a representative from the Malaysian Endocrine & Metabolic Society (MEMS), diabetics are at a higher risk of developing prolonged illness, hospitalisation and even death caused by flu even though their diabetes is well-managed.

He added, “Since there is an increased susceptibility to both infections such as the flu and cardiovascular diseases in diabetics, they are at greater risk of suffering acute cardiovascular events caused by flu.”



Serious viral illness such as the flu can exacerbate underlying cardiovascular diseases such as coronary artery disease and heart failure.

This exacerbation contributes to a heart attack through the increased metabolic demand brought upon by fever, increased heart rate, and low oxygen levels in your blood.



Aside from the recommendation from the World Health Organisation (WHO), the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices have recommended influenza vaccination for everyone 6 months and older, including those with high-risk conditions, such as heart disease, for decades.15

The Inter-American Society of Cardiology and the World Heart Federation have also pointed out the strong correlation between influenza and cardiovascular events and believe that flu vaccination is a safe and proven strategy to reduce cardiovascular events.16

Studies have found that the flu vaccination was associated with a 34% lower risk of major adverse cardiovascular events, and patients with recent acute coronary syndrome had a 45% lower risk.17

There was also an 18% reduced risk of death reported in patients with heart failure.18

In type 2 diabetics, studies have shown that the flu vaccination reduces the risk of heart failure by 22%, stroke by 30%, heart attack by 19% and pneumonia by 15%.19

Flu vaccination does not require behaviour change or a daily intervention, yet it prevents cardiovascular events as well as as other evidence-based approaches such as statin therapy, antihypertensive therapy, and smoking cessation.20



As a population ages rapidly, new challenges arise for both individuals and the societies.

We see an increasing prevalence of multimorbidity, disability and frailty which reemphasises the need for healthy aging so that people can live longer and better lives.

Healthy aging is a concept that is promoted by the World Health Organisation (WHO).

The goal of healthy aging is to maintain and improve physical and mental health, independence, and quality of life throughout the life course of an individual.

The concept of healthy aging however does not mean aging without disease. One can have an underlying chronic disease but if it is well controlled, will have little impact on the quality of life.21

Alongside proper nutrition and exercise, immunisation is one of the pillars to promote and maintain healthy aging.22

The recent pandemic has highlighted the need for infection prevention for vaccine preventable diseases such as influenza especially in older persons with multiple chronic conditions and disabilities.

The best way to protect yourself from severe flu infection is by getting the annual flu shot.5

While some people who get a flu vaccine may still get sick with influenza, flu vaccination has been shown in several studies to reduce severity of illness.5

Besides vaccination, the spread of flu can be reduced by practicing COVID-19 SOPs such as wearing a mask, proper handwashing, avoiding contact with people who are sick, covering your coughs and sneezes and disinfecting contaminated surfaces.23

In Malaysia, flu can occur year-round.24

It is advisable to make flu vaccination an annual priority in older persons especially those with underlying chronic diseases.

The flu vaccination is available at most private clinics in Malaysia. Click here to find a clinic near you.



1 Risk of heart attack with flu https://world-heart-federation.org/influenza/

2 High-risk groups People at Higher Risk of Flu Complications | CDC

3 Flu related deaths https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)

4 Atypical flu presentation in the elderly https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989115/

5 Flu prevention https://www.cdc.gov/flu/about/keyfacts.htm

6 Immune response to flu How The Body Reacts To Viruses – HMX | Harvard Medical School

7 Cytokine storm https://virologyj.biomedcentral.com/articles/10.1186/s12985-022-01814-1#:~:text=COVID%2D19%20can%20trigger%20a,failure%20and%20death%20%5B3%5D

8 Flu and heart attacks https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642610/

9 Flu more likely to cause heart attacks https://academic.oup.com/jid/article/206/11/1636/897609?login=false

10 Warren-Gash, Charlotte et al. “Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland.” The European respiratory journal vol. 51,3 1701794. 29 Mar. 2018, doi:10.1183/13993003.01794-2017 

11 Malaysia a rapidly aging nation https://www.nst.com.my/news/nation/2022/01/760251/malaysias-path-becoming-ageing-nation-fast-even-global-standards#:~:text=Malaysia%2C%20he%20said%2C%20will%20be,fast%2C%20even%20by%20global%20standards.

12 National health & morbidity survey 2018 findings for the elderly https://iku.gov.my/images/IKU/Document/REPORT/NHMS2018/NHMS2018ElderlyHealthVolume2.pdf   

13 Risk factors for CVD https://www.cdc.gov/heartdisease/risk_factors.htm

14 Elderly with established CVD https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057534

15 WHO, CDC, ACIP flu vaccination recommendation https://www.acc.org/latest-in-cardiology/articles/2020/11/02/14/42/influenza-vaccination-proven-and-effective-cvd-prevention

16 Link between flu and CVD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344961/

17 Flu vaccination benefits (MACE & ACS) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9055450/

18 Flu vaccination benefits (heart failure) https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.036788

19 Flu vaccination benefits in T2DM https://www.cmaj.ca/content/188/14/E342

20 Flu vaccination as coronary intervention https://www.acc.org/latest-in-cardiology/articles/2020/11/02/14/42/influenza-vaccination-proven-and-effective-cvd-prevention

21 Healthy aging https://www.who.int/philippines/news/q-a-detail/healthy-ageing-and-functional-ability#:~:text=WHO%20defines%20healthy%20ageing%20as,they%20have%20reason%20to%20value.

22 Fostering healthy aging Fostering healthy aging: The interdependency of infections, immunity and frailty – ScienceDirect

23 Flu prevention NPIs https://www.cdc.gov/flu/prevent/actions-prevent-flu.htm#:~:text=Flu%20viruses%20spread%20mainly%20by,an%20alcohol%2Dbased%20hand%20rub.

24 Flu in Malaysia https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06360-9


Did you that know flu can trigger the first heart attack and stroke?

Did you that know flu can trigger the first heart attack and stroke?

In adults ≥ 40 years with no prior history of heart attack or stroke, influenza infection within the first 3 days can:

• Increase the risk of heart attack up to 10 times
• Increase the risk  of stroke up to 8 times

Here’s how vaccinating against the flu can protect your heart:


A Blessed Umrah With Your Flu-Free Family

A Blessed Umrah With Your Flu-Free Family

Ensure you and your family are protected from influenza for a blessed and safe Umrah

The end of the year is a highly anticipated time for many Muslims in Malaysia who eagerly look forward to perform the Umrah. This is particularly exciting for those who will be doing it for the first time as they finally have the opportunity to step onto the soil of Makkah. Umrah is a minor pilgrimage similar to Hajj but can be performed at any time of the year1.

Around this time of year, pilgrims-to-be would usually prepare for their journey by equipping themselves with religious knowledge and also plan for family gatherings or kenduri. Some would even spend a considerable amount of time looking for travel tips online while also enquiring about past experiences from relatives and friends who successfully completed the Umrah. Unfortunately, among all of the advice and reminders which we receive, many seem to neglect an important aspect while preparing for Umrah – health.

While listening to various stories shared by those who performed the Umrah, you would certainly hear of pilgrims who fell sick while in Makkah or upon returning to Malaysia. Some even end up being hospitalised. This is because these pilgrims are at risk of influenza or flu infection2. Unfortunately, the flu is often mistaken as the common cold due to the similar symptoms even though it is far more dangerous3.

The Flu is Around You

Influenza virus can spread from the moment you and your family gather at the airport for departure4. There are usually large crowds of people from all around the world, including those who are departing and those who just arrived. This mixing of people in a particular place could lead to the spread of different types of influenza virus as carried by individuals from different countries5,6.

However, the spread of influenza is not confined to the airport. Did you know that you could also catch the flu while on the plane?4 Flu virus can survive on surfaces for up to 48 hours, so the tray you just touched, the video screen or your seat could be housing the influenza virus7. Now, picture yourself arriving safely at Jeddah Airport, Saudi Arabia. You may think you are safe and well, but you could still catch the flu away from the airport while in Makkah and Madinah.


The Flu Hinders Umrah

Makkah hosts millions of Muslim pilgrims from all around the world during Umrah season. You can ask anyone who performed the Umrah – it can’t be denied that is an arduous journey which requires strong mental and physical health. Fatigue, dehydration, hot weather and also crowding contribute to additional stress which could weaken your immune system8, making you more susceptible to influenza.

Now, imagine if you are infected with influenza. You have limited time to perform your ibadah, but the flu can cause symptoms such as fever, runny nose, and cough which can last for a week2. How could you possibly perform the ibadah comfortably when you are feeling weak and unwell?

Furthermore, influenza can cause serious complications such as pneumonia, ear infection, sinus infection, and bronchitis9. These complications could cause you to be hospitalised or it could even be fatal10. You certainly did not fly all the way to Makkah just to end up sick in your hotel, or worse, be hospitalised. Unfortunately, if you are stuck in hospital without being able to complete your tawaf, it means you couldn’t perform the compulsory rituals in Umrah. Thus, your Umrah would automatically be void11.


The Flu, Umrah and Your Family

It’s not just about your health. Your family members who joined you for Umrah are also at risk of influenza infection. The flu virus spreads within five to seven days after the symptoms appear, with most of the infection occurring within the first three days2. However, what’s more concerning is that you may infect your family members and other pilgrims without realising. This is because the virus could also spread a day or two before the symptoms even appear2.

This is why you should take extra care especially if you are planning to bring your children along. The flu could be more dangerous for young children, particularly those below five years as their immune system is not fully matured compared with adults12,13.

Besides children, you should also be careful if your aged parents or relatives are joining you for Umrah. Those above 65 years are at high risk of developing serious flu-related complications as ageing may weaken the immune system14.

Apart from that, many older persons also have inherent chronic diseases. A survey on Malaysian Umrah pilgrims found that as many as 17.3% have an underlying chronic disease while 21.5% suffer from more than one disease15. It is difficult for them to fight the flu. So, don’t let the flu worsen their pre-existing conditions such as heart disease, lung disease, or diabetes9.

To truly gain the blessing of Umrah, make sure your journey is safe and flu-free. The flu may be dangerous, but it is preventable.


Tips to Prevent The Flu for Pilgrims

How can you have a safe and blessed Umrah journey? Pray and hope that you do not fall sick? Tawakkal without putting in effort is insufficient. Islam teaches us that prevention is better than cure. So, we need to make an effort to find the best way to prevent a disease before leaving it to God.

Vaccination is the basic and yet best way to protect against influenza16. The Malaysian Society of Infectious Diseases and Chemotherapy (MSIDC) recommends influenza vaccination for pilgrims before departing to Makkah17. It is especially encouraged for pilgrims who are at higher risk of flu-related complications including older persons, young children, and those with chronic diseases16,17.

Vaccination has been shown to be 60% effective in providing protection against influenza2. A study among Malaysian pilgrims found that influenza vaccination is able to prevent 50-60% of hospital admission and pneumonia[8]. It also helps to reduce the risk of mortality by 80% for those above 60 years8.

So, if you are planning to take off to the Holy Land, you need to make sure that you and your family are protected against influenza at least two weeks before you depart18. This is because vaccines require that much time to help your body build the antibodies needed to fight the invading influenza virus18.

Aside from vaccination, pilgrims can also take several precautionary steps to curb the spread of influenza. This can be done by having good personal hygiene at all times16. It’s as simple as washing your hands regularly with soap and water or using a hand sanitiser, covering your mouth while coughing or sneezing, and avoiding pilgrims who are ill16. These steps may be simple, but it can help reduce the spread of influenza.


The Flu Is More Serious Than You Think

The Flu Is More Serious Than You Think

Before the COVID-19 pandemic, annual flu epidemics are estimated to result in about:

Catching the flu could also lead to life-threatening complications like:

While the flu is deadliest among children, older adults, pregnant women, and people with weakened immune systems, no one is protected from the virus without vaccination.

Learn more about flu vaccination in the slideshow below:


How bad can the flu get?

How bad can the flu get?

Catching the flu may also lead complications such as pneumonia, acute respiratory distress syndrome (ARDS), multi organ failure, and inflammation of the heart, brain, or muscle tissues.

If this sounds familiar to you it’s because it can happen in COVID-19 too.

So, if you would protect yourself against COVID-19, you might want to consider extending that protection by getting vaccinated against the flu as well!