1. Sign our petition calling on Cochrane to withdraw their review of Exercise Therapy for CFS here.
    Dismiss Notice
  2. Guest, the 'News in Brief' for the week beginning 18th March 2024 is here.
    Dismiss Notice
  3. Welcome! To read the Core Purpose and Values of our forum, click here.
    Dismiss Notice

Apparent risks of postural orthostatic tachycardia syndrome diagnoses after COVID-19 vaccination and SARS-Cov-2 Infection, 2022, Kwan et al

Discussion in 'Long Covid research' started by SNT Gatchaman, Dec 12, 2022.

  1. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

    Messages:
    4,255
    Location:
    Aotearoa New Zealand
    Apparent risks of postural orthostatic tachycardia syndrome diagnoses after COVID-19 vaccination and SARS-Cov-2 Infection
    Kwan, Alan C.; Ebinger, Joseph E.; Wei, Janet; Le, Catherine N.; Oft, Jillian R.; Zabner, Rachel; Teodorescu, Debbie; Botting, Patrick G.; Navarrette, Jesse; Ouyang, David; Driver, Matthew; Claggett, Brian; Weber, Brittany N.; Chen, Peng-Sheng; Cheng, Susan

    Postural orthostatic tachycardia syndrome (POTS) was previously described after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; however, limited data are available on the relation of POTS with Coronavirus Disease 2019 (COVID-19) vaccination.

    Here we show, in a cohort of 284,592 COVID-19-vaccinated individuals, using a sequence–symmetry analysis, that the odds of POTS are higher 90 days after vaccine exposure than 90 days before exposure; we also show that the odds for POTS are higher than referent conventional primary care diagnoses but lower than the odds of new POTS diagnosis after SARS-CoV-2 infection.

    Our results identify a possible association between COVID-19 vaccination and incidence of POTS. Notwithstanding the probable low incidence of POTS after COVID-19 vaccination, particularly when compared to SARS-Cov-2 post-infection odds, which were five times higher, our results suggest that further studies are needed to investigate the incidence and etiology of POTS occurring after COVID-19 vaccination.

    Link | PDF
     
    oldtimer, Mij, DokaGirl and 7 others like this.
  2. Hutan

    Hutan Moderator Staff Member

    Messages:
    26,520
    Location:
    Aotearoa New Zealand
    In Nature Cardiovascular Research, authors are associated with
    Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
    Department of Medicine, Division of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
    Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA.

    So, that's some pretty main-stream and influential entertainment of the idea of POTS occurring after an immunological challenge.

    The data suggests that having Covid-19 results in much worse odds than having the vaccine. I suspect the data gets pretty messy, with asymptomatic infections, and infections +vaccination, and the authors acknowledge that in a lengthy Limitations section. Note, that these odds are for out-patient data, so the before and after odds can be compared to each other but I don't think that they tell us about the absolute risk of developing POTS.

    I had more commentary, but I've run out of energy to properly read and understand the study, and can't hold thoughts, so I'll leave it there.
     
    ukxmrv, Milo, RedFox and 7 others like this.
  3. DokaGirl

    DokaGirl Senior Member (Voting Rights)

    Messages:
    3,664
    ETA: Speaking of energy to properly understand, I don't know how to quote just a small bit of a Member's comments. So, this my attempt to try to get that figured out. :facepalm:
     
    RedFox, alktipping and Hutan like this.
  4. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

    Messages:
    4,255
    Location:
    Aotearoa New Zealand
    News and Views commentary on this paper from Svetlana Blitshteyn and Artur Fedorowski

    The risks of POTS after COVID-19 vaccination and SARS-CoV-2 infection: it’s worth a shot (Nature Cardiovascular Research, Dec 2022)

     
    ukxmrv, DokaGirl, RedFox and 3 others like this.
  5. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

    Messages:
    4,255
    Location:
    Aotearoa New Zealand
    Note that an issue has been raised around the 5.3x odds ratio of POTS between infection-only and vaccine-only cohorts.

    https://twitter.com/user/status/1605677102635708416


    It's centred on the study design as summarised in their figure 3. This shows odds being calculated for the vaccination-only cohort, pre- and post- intervention: for both POTS diagnoses and Common Primary Care diagnoses. Then an odds ratio is calculated between these diagnoses, for the vaccination group.

    For the infection group, odds have not been expressed in this graphic, and what is labelled as "OR 5.35" would seem to be a post-intervention incidence ratio for POTS.

    Screenshot 2022-12-22 at 8.09.36 PM Medium.jpeg

    Obviously this is not a randomised trial - the two groups self-selected whether they would or would not have vaccination (with infection being under neither subject or investigator control). So their background rates might well be expected to be different. The findings that pre-intervention the POTS incidence was a little under 5x are now being highlighted as very close to the 5.3x, as summarised in the abstract.

    Perhaps people that chose no-vaccine had existing conditions or related reasons that associated with a higher rate of POTS development (pre- and post- infection). I note that the infection-only group had zero new EDS diagnoses, pre- or post- (vs 6.68 & 7.73 /100K for the vaccinated group). Does this mean that they already had EDS, so couldn't be newly diagnosed within the 90 days pre-intervention?
     
    Last edited: Dec 22, 2022
    Trish and RedFox like this.
  6. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

    Messages:
    13,268
    Location:
    London, UK
    Is it?
    I had never heard of Nature Cardiovascular Research and rather suspect it is yet another important-sounding clone journal designed specifically to sound good.
    I no longer have any faith that big USA university hospital names mean anything.
    I guess in a sense this is the mainstream now and yes it may be influential but that does not mean it isn't just empty cans jangling in the breeze.

    I have not gone through in detail but I am pretty sure nothing can be concluded from this sort of study in which ascertainment bias is likely to be huge.

    The Blitshteyn piece shows just how hyped things like this get.
     
    TrixieStix, FMMM1 and SNT Gatchaman like this.
  7. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

    Messages:
    4,255
    Location:
    Aotearoa New Zealand
    I've highlighted the EDS and mast cell disorder figures in the tables of the two groups. Zero for both is suspicious and I can imagine have either as a pre-existing diagnosis might affect the individual's decision to vaccinate.

    Screenshot 2022-12-22 at 9.09.30 PM Large.jpeg

    Screenshot 2022-12-22 at 9.10.12 PM Large.jpeg
     
    ukxmrv and RedFox like this.
  8. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

    Messages:
    13,268
    Location:
    London, UK
    Interesting. I am more and more confused by this. It seems that the people who were vaccinated had ten times as many diagnoses of everything? So not exactly matched.
     

Share This Page