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In a study that was published in Nature Cardiovascular Research yesterday, investigators pointed out the increased incidence rates in POTS for people who are vaccinated or who have had COVID-19.
“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,” the investigators wrote.
They also reported that people who had COVID-19 were reported to have POTS at a rate 5 times higher than the incidence rates of POTS after COVID-19 vaccination.
Postural orthostatic tachycardic syndrome is a health condition characterized by reduced blood flow when people stand-up. It occurs more frequently in women and typically happens between the teenage years into middle-age. There have been reports of POTS surfacing in people post-vaccination.
Investigators looked at two cohorts: a vaccinated group and those who had COVID-19.
Vaccine Group
In the post-vaccination analysis, the patients they looked at were 57% female; 63% White, 10% Asian, 8.9% African American and 12% Hispanic ethnicity. The age breakdown was 52 ± 20 years.
The vaccines included: 62% Pfizer-BioNTech; 31% Moderna (mRNA-1273); 6.9% Johnson & Johnson/Janssen (Ad26.COV2.S); and <0.1% other vaccines, including AstraZeneca (ChAdOx1-S), Novavax (NVX-CoV2373) and Sinovac (CoronaVac).
“The post-vaccination odds of new POTS-associated diagnoses (n = 4,526, odds = 1.33 (1.25–1.41), P < 0.001) was higher than for common primary care (CPC) diagnoses (n = 33,590, odds = 1.21 (1.18–1.23), P < 0.001) but lower than for myocarditis (n = 25, odds = 2.57 (1.02–6.77), P = 0.046).
Within this group, POTS had the third highest odds for reported conditions behind myocarditis and dysautonomia.
COVID-19 Infection Group
Investigators performed a separate analyses for new POTS diagnoses made after COVID-19 infection in 12,460 patients. The patient demographics included 50% female; 54% White, 6% Asian and 20% African American and 29% Hispanic ethnicity. The age breakdown was 47 ± 23 years.
“Overall, the post-infection odds of new POTS-associated diagnoses (n = 1,004, odds = 1.52 (1.33–1.72), P < 0.001) was numerically higher than that for CPC diagnoses (n = 3,325, odds = 1.4 (1.31–1.50), P < 0.001),” the investigators wrote.
For this group, “both the odds of new diagnoses and their rate of occurrence tended to be elevated particularly for conditions such as diabetes, POTS and hypertension,” they added.
Investigators said conditions were higher in the post-infection rates cohort than the post-vaccination rates.
Treatment
“Patients studied received clinical care that was reviewed to be consistent with guidelines recommendations, and referral to local experts in managing POTS was often pursued in cases that warranted consideration for more specialized evaluation and therapies,” investigators wrote.
For people with POTS, the recommended treatment can include proper hydration, taking salt pills, exercise programs, and compressive stockings.
For patients who have more serious issues with the condition, medication including beta blockers or ivabradine were prescribed. In patients with hyperadrenergic variants, clonidine was given or considered.
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