Study finds increased risk of POTS after SARS-CoV-2 infection or COVID vaccination

In a recent News & Views article published in the journal Nature Cardiovascular Research, researchers report the frequencies of novel postural orthostatic tachycardia syndrome (POTS)-related diagnoses including POTS, fatigue, dysautonomia, Ehlers–Danlos syndrome, and mast cell diseases, prior to and after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) vaccination.

Study: The risks of POTS after COVID-19 vaccination and SARS-CoV-2 infection: it’s worth a shot. Image Credit: Starocean / Shutterstock.com

Background

COVID-19 vaccinations have effectively mitigated the current pandemic throughout the world. However, several studies have reported adverse events following vaccination, including an increasing number of reports of several neurological and cardiovascular manifestations that are inclusive of POTS.

POTS is a common autonomic nervous system disorder that is characterized by tachycardia or an increase of 30 beats/minute or more during 10 minutes of being in the standing position and orthostatic intolerance symptoms. POTS symptomatology includes palpitations, pre-syncope, generalized weakness, light-headedness, nausea, and headache that lasts for more than three months.

Previous studies have documented bacterial or viral infections, surgical procedures, pregnancy, vaccinations, puberty, and concussions as POTS triggers, with an infection-to-vaccination ratio of 6.8. Novel POTS has reportedly developed following human papillomavirus (HPV) vaccination. However, data on the association between COVID-19 vaccination and POTS are limited and require further investigation.

In the present article, researchers summarize key findings of a recent study that showed POTS as post-acute sequelae of COVID-19 (PASC) and demonstrated that the rate of novel POTS diagnoses was marginally elevated following COVID-19 vaccination but is five-fold lower than that after SARS-CoV-2 infection.

About the study

Electronic health records (EHR) data from 284,592 COVID-19 vaccinees and 12,460 SARS-CoV-2-positive individuals were analyzed. The sample population of the study comprised 300,000 COVID-19 vaccinees from Los Angeles County in the United States of America.

The findings showed 0.3% novel POTS diagnoses post-COVID-19 vaccination in comparison to 0.2% novel POTS diagnoses in the period prior to COVID-19 vaccinations. This yielded an odds ratio (OR) value of 1.5 for post-COVID-19 vaccination novel POTS diagnoses.

The likelihood of new-onset POTS and POTS-related diagnoses was greater within three months after COVID-19 vaccination as compared to that within three months before vaccination, with a 33.0% increase in the relative risks. The odds of new-onset POTS-related diagnoses after SARS-CoV-2 infections were more than five-fold greater in comparison to the post-COVID-19 vaccination time period. The ratio of SARS-CoV-2 infection to COVID-19 vaccination was 5.4.

The assimilation of all new-onset POTS-related diagnoses together yielded marginally lower odds. Among SARS-CoV-2-positive individuals, the pre-COVID-19 incidence of new-onset POTS was 2% as compared to 3% post-COVID-19. Thus, the risk of developing POTS was greater among individuals with SARS-CoV-2 infections as compared to those after COVID-19 vaccination.

The risk of new-onset POTS diagnoses and POTS-related diagnoses was considerably more frequent as compared to myocarditis. The risk of developing myocarditis was greater following COVID-19 vaccination; however, myocarditis was a rarely observed post-vaccination complication.

Conclusions

Overall, the study findings showed that new-onset POTS diagnoses and POTS-related diagnoses occurred more frequently following COVID-19 vaccination as compared to the pre-vaccination period.  

Nevertheless, the rate of new POTS diagnoses was more than five-fold greater post-COVID-19 as compared to that following vaccinations. This finding underpins the importance of vaccinations and can be referenced by healthcare professionals to reduce COVID-19 vaccine reluctance among the public.

The study findings established dysautonomia and novel POTS as COVID-19 vaccination side effects that must be acknowledged and further investigated like other established post-vaccination conditions such as acute disseminated encephalomyelitis and Guillain-Barre syndrome. Furthermore, these results reaffirm new-onset POTS as a potentially significant PASC phenotype.

As global healthcare authorities and governments continue to develop and execute COVID-19 mitigation policies and strategies to prevent long-lasting adverse effects of this disease, the need for future studies and investments in research to improve the understanding of POTS diagnoses and treatment approaches has become more critical.  

Study limitations

The study findings had limited generalizability, as it was restricted to a particular population. Some of the POTS-affected individuals might have recovered after the 90-day-assessment period; therefore, new-onset POTS incidence and POTS-related diagnoses incidence may have been overestimated.