Primary vs. Secondary Cardiovascular Prevention and Vaccination Uptake: A Nationwide Study of Statin Users in Lithuania

Background/Objective: Influenza vaccination is recommended for patients at increased cardiovascular risk. Yet, despite Lithuania’s high cardiovascular mortality, it remains unclear whether uptake is higher among patients at greater cardiovascular risk, particularly those receiving secondary prevention. Vaccination uptake and its associated factors were assessed among statin users, a population at increased cardiovascular risk. Methods: A nationwide registry-based cohort study of Lithuanian statin users was conducted using national e-health records covering the 2020/21 to 2025/26 influenza seasons (1 September to 31 May). Patients were classified into primary- and secondary-prevention groups based on prescription indications coded according to ICD-10-AM. Factors associated with vaccination uptake were examined via multivariable logistic regression. Results: The final cohort included 812,086 unique statin users (81.6% primary, 18.4% secondary prevention). Crude uptake was higher among secondary-prevention (~21%) than primary-prevention patients (~14%; OR 1.73, 95% CI 1.71–1.75); after adjustment for age, prior vaccination and other covariates, the association was small (aOR 1.07, 95% CI 1.06–1.08). A documented prior influenza vaccination was strongly associated with vaccination (aOR 22.18, 95% CI 21.95–22.41). Statin non-persistence (aOR 0.76) and non-initiation (aOR 0.61) were associated with lower odds of vaccination. Conclusions: Influenza vaccination uptake only slightly differed among prevention groups and remained below the WHO 75% coverage target, suggesting that cardiovascular risk status may add little to vaccination uptake beyond age and vaccination history. Prior vaccination and statin treatment persistence were strongly associated with vaccination. This may reflect a shared pattern of engagement with preventive care, but engagement was not measured, and this interpretation remains a hypothesis. Whether bundling vaccination promotion with medication reviews, or involving pharmacists, would raise uptake in higher-risk patients needs to be tested.