Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection
nejm.org
nejm.org
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.
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."
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...
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.