"CONCLUSIONS
We found a significant association between respiratory infections, especially influenza, and acute myocardial infarction.
RESULTS
We identified 364 hospitalizations for acute myocardial infarction that occurred within 1 year before and 1 year after a positive test result for influenza. Of these, 20 (20.0 admissions per week) occurred during the risk interval and 344 (3.3 admissions per week) occurred during the control interval. The incidence ratio of an admission for acute myocardial infarction during the risk interval as compared with the control interval was 6.05 (95% confidence interval [CI], 3.86 to 9.50). No increased incidence was observed after day 7. Incidence ratios for acute myocardial infarction within 7 days after detection of influenza B, influenza A, respiratory syncytial virus, and other viruses were 10.11 (95% CI, 4.37 to 23.38), 5.17 (95% CI, 3.02 to 8.84), 3.51 (95% CI, 1.11 to 11.12), and 2.77 (95% CI, 1.23 to 6.24), respectively."
Help me understand these 'incidence ratios'. Does this mean the chance of heart problems in the first week after influenza ranges from 3X to 10X the nominal rate for heart problems?
I can't get to the full article here, but naively, I'd expect "Illness increasing stress on the bodily systems increases likelihood of heart attack" to be the unsurprising result. Is there some other reason that we'd expect this not to be the case? Are there other infections as agressive that don't increase the risk in similar ways? Or did we just suspect this and haven't had the data to back it up before?
i.e. I'm not sure why this is interesting or revelatory? The free summary doesn't seem to answer this.
Influenza might act as an acute inflammatory and
procoagulant stimulus transiently altering endothelial
function. 58,59
Recent experimental studies in mice have
explored the links between influenza infection and
coronary artery remodelling. In one study, 60 inoculation
of influenza A virus into a mouse atherosclerosis model
of mice deficient in apolipoprotein E resulted in heavy
infiltration of atherosclerotic plaques by inflammatory
cells, as well as platelet aggregation and thrombosis—
only the plaques and not normal sections of coronary
arteries were disrupted. Evidence of influenza virus
RNA has been found in human atherosclerotic plaques,
although it is not known if this is clinically important.
61 Another study 62 revealed that infectious burden
(measured by the presence of antibodies to influenza,
hepatitis A virus, Chlamydophila pneumoniae
, Helicobacter pylori, and cytomegalovirus in serum) was independently associated with angiographically-proven atherosclerosis.
Yet another PAYWALL scheme, what is not revealed in the abstract is whether this data was plotted versus age, which would reveal what I suspect is a strong correlation between age and incidence of MI. Likely patients over 60 or 65 much more likely to exhibit. . .
I presume this was already suspected?
The last time i had a virus i was warned by a doctor not to use gym for a while as it could cause heart problems.
I once had the flu so bad that I could barely climb a couple of stairs without losing my breath. My heart was beating very hard afterwards.. I remember thinking to myself „Ok this is dangerous, I better lie down“, and I bet it was.
I always heard that connective tissue can be weakened by the virus and thus high level athletes are more susceptible to injuries like tendon rupture post-virus.
As with any infarctions. Take a clotting reducing agent. Non-aspirin anti-inflammatory should do the trick. (Prostaglandin system is fun.)
Aspirin is ok too if you can live with the tiny risk of Reye's syndrome.
Not sure if I understand you correctly, but what anti-inflammatory medications except for aspirin are you talking about? To my knowledge, NSAIDs such as ibuprofen or naproxen actually promote platelet aggregation and therefore increase the risk of cardiovascular events.
I'm not a medical professional, so I'm unsure about the details.
Aspirin is, to my knowledge, the only NSAID that works as an anticoagulant due to some mechanism other than affecting prostaglandins and is therefore recommended by doctors.
No, NSAIDs are actually supposed increase the risk of heart attacks. See the second source in my other post:
"It is generally accepted that oral non-steroidal anti-inflammatory drugs (NSAIDs) can increase the risk of acute myocardial infarction."
https://news.ycombinator.com/item?id=16239642
Because there was a huge study that indicated aspirin should be used as a minor blood thinner and reduced heart attacks, and because most/a lot of doctors recommend it for such.
You appeared confused as to why someone would say what they'd said. I pointed out one of the glaringly obvious reasons why someone could have done that. And there's also the fact that the study cited is fairly recent and news doesn't spread instantly...
Can you acknowledge that you realize the parent specifically said "non-aspirin", and everything you are talking about is regarding aspirin? It isn't clear to me that you realize this.
Also, the cardiovascular issues in question are not something recent. They were already widely reported in 2005 to the point the FDA commented:
I asked that question because the advice was so opposite the usual, and the tone so playful ("Prostaglandin system is fun"), that it almost seemed to be a troll who had gone too far.
1) I've read enough biomedical literature to know there is a source claiming just about anything you can think of. So regardless of what you mean, my answer is: "there is at least one such source".
2) Why is your question so loosely connected to the topic? Why say "things" instead of "non-aspirin NSAIDs", and "inhibit platelet aggregation" instead of "reduce risk of heart attack"?
3) If you are thinking of a particular paper, why not just say it?
But ok, I am probably being trolled at this point.
> I've read enough biomedical literature to know there is a source claiming just about anything you can think of
Then as I initially said, it really shouldn't be hard for you to imagine why someone would give the advice that the original person gave. This really isn't a difficult concept, yet you still act perplexed by it...
> Why is your question so loosely connected to the topic? Why say "things" instead of "non-aspirin NSAIDs", and "inhibit platelet aggregation" instead of "reduce risk of heart attack"?
Because I was hoping you were capable of following the thread. And because the specific things arn't all that important to whether or not one should be able to think of a reason why that piece of advice was given.
> If you are thinking of a particular paper, why not just say it?
Because if you're not just here to whine about being trolled, you can easily find it with Google.
Yes. Use of aspirin has been linked to Reyes in children and teenagers, but even that is rare. Before Tylenol and Advil people commonly gave their kids aspirin for fevers and in the vast majority of cases there were no problems.
> We identified 364 hospitalizations for acute myocardial infarction that occurred within 1 year before and 1 year after a positive test result for influenza.
Can somebody explain why they looked at hospitalizations for MI before having the flu as well as after? if the theory is that the flu causes heart issues why wouldn't they just look at MIs after hospitalizations?It seems to remove any explanatory ability.
Look at fig 1. They compared the number of people who had heart attacks from 1 -7 days after getting a positive lab test for influenza, and people who got heart attacks at any other time +/- 1 yr of the positive lab test.
They saw that out of these people who had both a positive flu test and heart attack, there were more heart attacks in the 7 days subsequent to the positive lab test than at 8+ days after or beforehand.
That abrupt cutoff at 7 days makes it sound like these people were being advised some kind of treatment that was increasing heart attack risk. This was in Ontario... they advise:
>"-stay home and get plenty of rest
-drink lots of fluids
-avoid caffeine
-speak to your doctor or nurse practitioner about over-the-counter medications that can help you feel better (basic pain or fever relievers), but do not give acetylsalicylic acid (ASA or Aspirin®) to children or teenagers under the age of 18
-treat muscle pain using a hot water bottle or heating pad — apply heat for short periods of time
-take a warm bath
-gargle with a glass of warm salt water or suck on hard candy or lozenges
More on the NSAID possibility (apparently it is not supposed to only be chronic use):
"Taking any dose of NSAIDs for one week, one month, or more than a month was associated with an increased risk of myocardial infarction."http://www.bmj.com/content/357/bmj.j1909
This may be a highly simplistic view but from your list the salt water gargle seemed like a simple explanation to me. ie. Excessive consumption/gargle of Salt Water leading to Elevated Blood Pressure leading to heart attack. could this be it ?
Interesting fact..if you put a pinch of salt under your tong you will see and almost immediate rise in BP. This tactic has been used for decades as a home remedy to quick revert the effects of spell of low blood pressure.
> Look at fig 1. They compared the number of people who had heart attacks from 1 -7 days after getting a positive lab test for influenza, and people who got heart attacks at any other time +/- 1 yr of the positive lab test.
That makes total sense. Was there a link to the actual paper? Its really hard to understand these abstracts or have any meaningful discussion without it, sadly.
> That abrupt cutoff at 7 days makes it sound like these people were being advised some kind of treatment that was increasing heart attack risk.
It would have been nice to a group that had the flu but didn't have any of the standard treatments to see how they compared to the flu group with treatments because their test group seems like more than just the flu. Could you have a group too that did the treatments without the flu? That would seem a little unethical though ("here do this - we have this theory that you'll have a heart attack")
All said, for those of you that have actually had influenza as an adult, a death actually sounds preferable.
The title link goes to the paper. It only shows the abstract by defualt though. You need to get access to it to read the rest. Perhaps someone else can help you there.
>"It would have been nice to a group that had the flu but didn't have any of the standard treatments to see how they compared to the flu group with treatments because their test group seems like more than just the flu."
It didn't look like they reported what treatments were involved, but I only glanced at the paper. It is possible they had this data and missed/ignored it though.
> "Could you have a group too that did the treatments without the flu?"
I'm sure there are many people on NSAIDs for headaches and such that could be included. The dosage regimen is probably important though. Eg, suddenly start taking them for a week then stop, etc.
> "All said, for those of you that have actually had influenza as an adult, a death actually sounds preferable."
This seems a little strong. I haven't heard before that people consider the flu to be worse than death...
36 comments
[ 0.23 ms ] story [ 92.1 ms ] threadRESULTS We identified 364 hospitalizations for acute myocardial infarction that occurred within 1 year before and 1 year after a positive test result for influenza. Of these, 20 (20.0 admissions per week) occurred during the risk interval and 344 (3.3 admissions per week) occurred during the control interval. The incidence ratio of an admission for acute myocardial infarction during the risk interval as compared with the control interval was 6.05 (95% confidence interval [CI], 3.86 to 9.50). No increased incidence was observed after day 7. Incidence ratios for acute myocardial infarction within 7 days after detection of influenza B, influenza A, respiratory syncytial virus, and other viruses were 10.11 (95% CI, 4.37 to 23.38), 5.17 (95% CI, 3.02 to 8.84), 3.51 (95% CI, 1.11 to 11.12), and 2.77 (95% CI, 1.23 to 6.24), respectively."
i.e. I'm not sure why this is interesting or revelatory? The free summary doesn't seem to answer this.
Here's an article from 2009 in the Lancet which performs a meta-analysis.
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.490...
In their discussion they say:
Influenza might act as an acute inflammatory and procoagulant stimulus transiently altering endothelial function. 58,59 Recent experimental studies in mice have explored the links between influenza infection and coronary artery remodelling. In one study, 60 inoculation of influenza A virus into a mouse atherosclerosis model of mice deficient in apolipoprotein E resulted in heavy infiltration of atherosclerotic plaques by inflammatory cells, as well as platelet aggregation and thrombosis— only the plaques and not normal sections of coronary arteries were disrupted. Evidence of influenza virus RNA has been found in human atherosclerotic plaques, although it is not known if this is clinically important. 61 Another study 62 revealed that infectious burden (measured by the presence of antibodies to influenza, hepatitis A virus, Chlamydophila pneumoniae , Helicobacter pylori, and cytomegalovirus in serum) was independently associated with angiographically-proven atherosclerosis.
Disclaimer: not an MD.
Aspirin is, to my knowledge, the only NSAID that works as an anticoagulant due to some mechanism other than affecting prostaglandins and is therefore recommended by doctors.
Other NSAIDs, however, consistently increase the risk of MI, for instance: http://www.bmj.com/content/357/bmj.j1909
"It is generally accepted that oral non-steroidal anti-inflammatory drugs (NSAIDs) can increase the risk of acute myocardial infarction." https://news.ycombinator.com/item?id=16239642
Why would you tell someone that?
Because there was a huge study that indicated aspirin should be used as a minor blood thinner and reduced heart attacks, and because most/a lot of doctors recommend it for such.
>"aspirin should be used as a minor blood thinner and reduced heart attacks"
>"Non-aspirin anti-inflammatory should do the trick"
You appeared confused as to why someone would say what they'd said. I pointed out one of the glaringly obvious reasons why someone could have done that. And there's also the fact that the study cited is fairly recent and news doesn't spread instantly...
Also, the cardiovascular issues in question are not something recent. They were already widely reported in 2005 to the point the FDA commented:
>"Back in 2005, the FDA warned that taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen increased the risk of having a heart attack or stroke." https://www.health.harvard.edu/blog/fda-strengthens-warning-...
I asked that question because the advice was so opposite the usual, and the tone so playful ("Prostaglandin system is fun"), that it almost seemed to be a troll who had gone too far.
2) Why is your question so loosely connected to the topic? Why say "things" instead of "non-aspirin NSAIDs", and "inhibit platelet aggregation" instead of "reduce risk of heart attack"?
3) If you are thinking of a particular paper, why not just say it?
But ok, I am probably being trolled at this point.
Then as I initially said, it really shouldn't be hard for you to imagine why someone would give the advice that the original person gave. This really isn't a difficult concept, yet you still act perplexed by it...
> Why is your question so loosely connected to the topic? Why say "things" instead of "non-aspirin NSAIDs", and "inhibit platelet aggregation" instead of "reduce risk of heart attack"?
Because I was hoping you were capable of following the thread. And because the specific things arn't all that important to whether or not one should be able to think of a reason why that piece of advice was given.
> If you are thinking of a particular paper, why not just say it?
Because if you're not just here to whine about being trolled, you can easily find it with Google.
Can somebody explain why they looked at hospitalizations for MI before having the flu as well as after? if the theory is that the flu causes heart issues why wouldn't they just look at MIs after hospitalizations?It seems to remove any explanatory ability.
They saw that out of these people who had both a positive flu test and heart attack, there were more heart attacks in the 7 days subsequent to the positive lab test than at 8+ days after or beforehand.
That abrupt cutoff at 7 days makes it sound like these people were being advised some kind of treatment that was increasing heart attack risk. This was in Ontario... they advise:
>"-stay home and get plenty of rest
-drink lots of fluids
-avoid caffeine
-speak to your doctor or nurse practitioner about over-the-counter medications that can help you feel better (basic pain or fever relievers), but do not give acetylsalicylic acid (ASA or Aspirin®) to children or teenagers under the age of 18
-treat muscle pain using a hot water bottle or heating pad — apply heat for short periods of time
-take a warm bath
-gargle with a glass of warm salt water or suck on hard candy or lozenges
-use spray or saline drops for a stuffy nose
-avoid alcohol and tobacco"
https://www.ontario.ca/page/flu-facts#section-4
My first guess would be ibuprofin: https://en.wikipedia.org/wiki/Ibuprofen#Cardiovascular_risk
EDIT:
More on the NSAID possibility (apparently it is not supposed to only be chronic use):
"Taking any dose of NSAIDs for one week, one month, or more than a month was associated with an increased risk of myocardial infarction." http://www.bmj.com/content/357/bmj.j1909
That makes total sense. Was there a link to the actual paper? Its really hard to understand these abstracts or have any meaningful discussion without it, sadly.
> That abrupt cutoff at 7 days makes it sound like these people were being advised some kind of treatment that was increasing heart attack risk.
It would have been nice to a group that had the flu but didn't have any of the standard treatments to see how they compared to the flu group with treatments because their test group seems like more than just the flu. Could you have a group too that did the treatments without the flu? That would seem a little unethical though ("here do this - we have this theory that you'll have a heart attack")
All said, for those of you that have actually had influenza as an adult, a death actually sounds preferable.
The title link goes to the paper. It only shows the abstract by defualt though. You need to get access to it to read the rest. Perhaps someone else can help you there.
>"It would have been nice to a group that had the flu but didn't have any of the standard treatments to see how they compared to the flu group with treatments because their test group seems like more than just the flu."
It didn't look like they reported what treatments were involved, but I only glanced at the paper. It is possible they had this data and missed/ignored it though.
> "Could you have a group too that did the treatments without the flu?"
I'm sure there are many people on NSAIDs for headaches and such that could be included. The dosage regimen is probably important though. Eg, suddenly start taking them for a week then stop, etc.
> "All said, for those of you that have actually had influenza as an adult, a death actually sounds preferable."
This seems a little strong. I haven't heard before that people consider the flu to be worse than death...
https://hn.algolia.com/?query=ibuprofen&sort=byPopularity&pr...
https://www.cdc.gov/flu/prevent/index.html