1 in 35 people bump their troponin after Moderna Covid vaccination

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Birdstrike

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European Journal of Heart Failure

Sex-specific differences in myocardial injury incidence after COVID-19 mRNA-1273 Booster Vaccination

Pedro Lopez-Ayala
Natacha Buergin, Julia R. Hirsiger, Philip Mueller, Daniela Median, Noemi Glarner, Klara Rumora, Timon Herrmann, Luca Koechlin, Philip Haaf, Katharina Rentsch, Manuel Battegay, Florian Banderet, Christoph T. Berger, Christian Mueller

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/ejhf.2978.

Abstract

Aims

To explore the incidence and potential mechanisms of oligosymptomatic myocardial injury following COVID-19 mRNA booster vaccination.

Methods and Results

Hospital employees scheduled to undergo mRNA-1273 booster vaccination were assessed for mRNA-1273 vaccination-associated myocardial injury, defined as acute dynamic increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration above the sex-specific upper-limit of normal on day 3 (48-96 h) after vaccination without evidence of an alternative cause. To explore possible mechanisms, antibodies against IL-1RA, the SARS-CoV2-Nucleoprotein(NP) and -Spike(S1) proteins and an array of 14 inflammatory cytokines were quantified. Among 777 participants, median age 37 years, 69.5% women, 40 participants (5.1% [95%CI, 3.7%–7.0%]) had elevated hs-cTnT concentration on day 3 and mRNA-1273 vaccine-associated myocardial injury was adjudicated in 22 participants (2.8% [95%CI, 1.7%–4.3%]). Twenty cases occurred in women (3.7% [95%CI, 2.3%–5.7%]), two in men (0.8% [95%CI, 0.1%–3.0%]). Hs-cTnT-elevations were mild and only temporary. No patient had ECG-changes, and none developed major adverse cardiac events within 30 days (0% [95%CI, 0%–0.4%]). In the overall booster cohort, hs-cTnT concentrations (day 3; median 5 [IQR, 4–6] ng/L) were significantly higher compared to matched controls (n = 777, median 3 [IQR, 3–5] ng/L, p < 0.001). Cases had comparable systemic reactogenicity, concentrations of anti-IL-1RA, anti-NP, anti-S1, and markers quantifying systemic inflammation, but lower concentrations of IFN-λ1(IL-29) and GM-CSF versus persons without vaccine-associated myocardial injury.

Conclusion

mRNA-1273 vaccine-associated myocardial injury was more common than previously thought, being mild and transient, and more frequent in women versus men. The possible protective role of IFN-λ1(IL-29) and GM-CSF warrant further studies.


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"No patient had ECG-changes, and none developed major adverse cardiac events within 30 days."


Maybe we should start getting troponin levels on babies too after they get their shots.
 
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I wonder how many bumped troponin with real COVID infection? Probably same if not more. Plus no measured adverse effects but this incidental finding.

Anecdotally about half of the 30-something cohort of medical professionals I work with who caught covid over the last few years had some lingering chest discomfort lasting for weeks and could have had a mild myopericarditis.
 
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I just deadlifted, bench pressed, squatted, and shoulder pressed. I'm sure my hsTnT is modestly up.
 
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"oligosymptomatic myocardial injury"

You gotta be kidding me with this nonsense
 
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I cut my finger on my mandoline yesterday and had vasovagal near-syncope , I’m sure my hs trop was bumped also. No more vegetables for me 🤣. /s
 
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I just deadlifted, bench pressed, squatted, and shoulder pressed. I'm sure my hsTnT is modestly up.
You obviously shouldn't exert yourself... a lab might become elevated. /s
 
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Hey, have you all heard about this Wakefield dude and how he's apparently associating MMR vaccines and autism?
 
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I just deadlifted, bench pressed, squatted, and shoulder pressed. I'm sure my hsTnT is modestly up.
I’ve seen studies showing extreme endurance events like marathons can elevate troponin, but I haven’t seen anything about brief weightlifting sessions. Does it do that?
 
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I cut my finger on my mandoline yesterday and had vasovagal near-syncope , I’m sure my hs trop was bumped also. No more vegetables for me 🤣. /s
I know you’re being funny, but show me where benign neurocardiogenic (“vasovagal”) syncope elevates troponin.
 
Hey, have you all heard about this Wakefield dude and how he's apparently associating MMR vaccines and autism?
This thread isn’t about autism, MMR vaccines and conspiracy theories. It’s about science 😉
 
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I wonder how many bumped troponin with real COVID infection?
Of course, COVID can elevate troponin. And when it does it’s associated with fatal outcomes.

Journal of Cardiac Failure - “Elevated troponin levels are frequent in patients with COVID-19 and significantly associated with fatal outcomes.”

 
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…no measured adverse effects but this incidental finding.
Correct, there was no finding of EKG changes or major adverse cardiac events.

Here are two problems I’m not totally reassured by that:

1-The study had 777 participants. It was powered enough to pick up a finding at a rate of 1 in 35, such as the elevated troponin. It did not have enough participants to pick up something happening at a rate of 1 in a 1,000 or 1 in 800. Severe adverse cardiac events in that number of people otherwise healthy people would be significant. There are hospitals that imply more than that, schools that have more students than that, etc.

2-The average age of the study participants was 37. Inducing so called “minor” cardiac damage in that population can’t be assume it would have a low rate of adverse cardiac events in other populations, such as elderly patients, those with pre-existing heart disease , or adolescent males (who we already know are at greater risk of myocarditis).
 
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There are lots of responses on this thread suggesting troponin is, 1) very non-specific and, 2) often associated with things that are very benign.

Below is a list of conditions commonly accepted to elevate troponin.

Acute Non-cardiac Critical Illness
Acute and Chronic Heart Failure
Acute Pulmonary Edema
Acute Inflammatory Myocarditis
Endocarditis/Pericarditis
Acute Pulmonary Embolism
Aortic Dissection
Cardiotoxic Drugs
Aortic Valve Disease
Stroke
Subarachnoid hemorrhage
Apical Ballooning Syndrome
Chronic Obstructive Pulmonary Disease Bradyarrhythmia
Heart Block
Chronic renal failure
Cardiac contusion from trauma
Extensive Burns
Cardiac surgery
Post-percutaneous Coronary Intervention, Endomyocardial biopsy
Infiltrative Disease (Amyloidosis) Cardioversion
Rhabdomyolysis with Myocyte Necrosis Direct Myocardial Trauma
Sepsis
Hypertrophic Cardiomyopathy
Severe Pulmonary Hypertension Tachycardia/Tachyarrhythmia
Bradyarrhythmia
Strenuous Exercise/Extreme Exertion

 
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There are lots of responses on this thread suggesting troponin is, 1) very non-specific and, 2) often associated with things that are very benign.

Below is a list of conditions commonly accepted to elevate troponin.

Acute Non-cardiac Critical Illness
Acute and Chronic Heart Failure
Acute Pulmonary Edema
Acute Inflammatory Myocarditis
Endocarditis/Pericarditis
Acute Pulmonary Embolism
Aortic Dissection
Cardiotoxic Drugs
Aortic Valve Disease
Stroke
Subarachnoid hemorrhage
Apical Ballooning Syndrome
Chronic Obstructive Pulmonary Disease Bradyarrhythmia
Heart Block
Chronic renal failure
Cardiac contusion from trauma
Extensive Burns
Cardiac surgery
Post-percutaneous Coronary Intervention, Endomyocardial biopsy
Infiltrative Disease (Amyloidosis) Cardioversion
Rhabdomyolysis with Myocyte Necrosis Direct Myocardial Trauma
Sepsis
Hypertrophic Cardiomyopathy
Severe Pulmonary Hypertension Tachycardia/Tachyarrhythmia
Bradyarrhythmia
Strenuous Exercise/Extreme Exertion


I think almost everyone is going to be concerned about the sensitivtity of hs-cTnT. I believe one of the ways the authors tried to address this was through their propensity-score matched cohort. This part of the study is what I was most interested in, as this part of the abstract is what drew my attention:

In the overall booster cohort, hs-cTnT concentrations (day 3; median 5 [IQR, 4–6] ng/L) were significantly higher compared to matched controls (n = 777, median 3 [IQR, 3–5] ng/L, p < 0.001).

The Methods section states the following regarding the matching (emphasis mine):

To assess cardiomyocyte injury also as a continuous variable, hs-cTnT concentrations on day 3 after vaccination were compared to age-, sex-, history of coronary artery disease/AMI-matched patients (controls) that had presented with acute chest discomfort to the emergency department in a multicenter study (NCT00470587) and were centrally adjudicated as having a non-cardiac cause. Seven hundred seventy-seven booster-vaccinated subjects and 3716 eligible controls (fulfilling inclusion criteria) were identified. Matching was conducted using a nearest neighborpropensity score matching method, without replacement of controls and with a case-to-control-ratio of 1:1.12 For details see Supplementary Methods.

Here is what the supplementary methods state regarding the adjudication of the matched cohort (emphasis mine):

Study design and population
Matched controls were selected from the Advantageous Predictors of Acute Coronary Syndromes Evaluation (APACE) study, a prospective, international, multicenter, diagnostic study (URL: https://clinicaltrials.gov; Unique identifier: NCT00470587) recruiting adult patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardial infarction (AMI). For this analysis, APACE patients were only eligible as controls if (1) their final adjudicated diagnosis was one of the following non-cardiac chest pain diagnoses: musculoskeletal, gastrointestinal, biliary, anxiety/psychological, asthmatic or >90% probability of extracardiac chest pain, (2) the patient was recruited before March 2019 (months before the first COVID-19 case was reported), (3) the patient had not had terminal kidney failure requiring dialysis, and (4) the patient had an available baseline troponin value.

Adjudication of the final diagnoses
Adjudication of the final diagnosis was performed centrally at the core laboratory of the University Hospital Basel according to the fourth universal definition of myocardial infarction (MI) (UDMI.1 All available medical records, including cardiac imaging and serial hs-cTn measurements, were reviewed by two independent cardiologists. Two sets of data were used: first, all clinical data derived from routine clinical investigations including all available medical records – patient history, physical examination, results of laboratory testing including serial local (h)s-cTn, radiologic testing, 12 lead electrocardiogram, echocardiography, cardiac exercise stress test, and lesion severity and morphology at coronary angiography – pertaining to the patient from the time of ED presentation to the 90-day follow-up. Second, study-specific assessments including detailed chest pain characteristics using 34 predefined criteria, serial hs-cTnT measurements obtained from study samples and clinical follow-up by telephone and mail. In situations of disagreement about the diagnosis, cases were reviewed and adjudicated in conjunction with a third cardiologist.

AMI was defined and (hs-)cTn interpreted as recommended in current guidelines.1-4 AMI was diagnosed when there was evidence of myocardial injury (at least one cTn value above the 99th percentile) together with a significant rise and/or fall of cTn values in association with a clinical setting consistent with myocardial ischemia. All other patients were classified in the categories of unstable angina, cardiac but non-coronary disease (e.g., heart failure, perimyocarditis), non-cardiac chest pain (e.g., musculoskeletal, gastrointestinal) and symptoms of unknown origin with normal hs-cTnT levels.

So the hs-cTnT of patients in this covid shot study was compared to that of patients from a population in which an elevated hs-cTnT had a high likelihood of getting them excluded? Am I interpreting this right?
 
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I run 3x wk, got the shot and for the next 6 months was SOB w running. Close but not back to normal now but I’m sure it had long lasting effects.

My uncle who never had any medical issues got the shot, over the next 3 months had endocarditis, bacterial meningitis, discitis, cholecystis.

Proof will eventually come out but from a personal standpoint side effects are real
 
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It was definitely safe AND effective! We will be litigating causality with these vaccines for the next 20 years. One would hope our public health agencies learned their lessons from the pandemic, but I wouldn't hold out hope.
 
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There are lots of responses on this thread suggesting troponin is, 1) very non-specific and, 2) often associated with things that are very benign.

Below is a list of conditions commonly accepted to elevate troponin.

Acute Non-cardiac Critical Illness
Acute and Chronic Heart Failure
Acute Pulmonary Edema
Acute Inflammatory Myocarditis
Endocarditis/Pericarditis
Acute Pulmonary Embolism
Aortic Dissection
Cardiotoxic Drugs
Aortic Valve Disease
Stroke
Subarachnoid hemorrhage
Apical Ballooning Syndrome
Chronic Obstructive Pulmonary Disease Bradyarrhythmia
Heart Block
Chronic renal failure
Cardiac contusion from trauma
Extensive Burns
Cardiac surgery
Post-percutaneous Coronary Intervention, Endomyocardial biopsy
Infiltrative Disease (Amyloidosis) Cardioversion
Rhabdomyolysis with Myocyte Necrosis Direct Myocardial Trauma
Sepsis
Hypertrophic Cardiomyopathy
Severe Pulmonary Hypertension Tachycardia/Tachyarrhythmia
Bradyarrhythmia
Strenuous Exercise/Extreme Exertion

Another common cause for an elevated troponin is being old.
 
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Since it's virtually certain that one will get covid (one or more times), what leads to less overall harm? Vaccination followed by infections or just infections? Also, anyone know rates of mild myocarditis and hs-troponin elevations after other common respiratory viruses?
 
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Another common cause for an elevated troponin is being old.
Does age alone, cause elevated troponin? Or can the elderly often have elevated troponins because they’re much more likely to have one of those serious conditions that actually does cause elevated troponin?

And if elevated troponin can be from “just being old,” yet perfectly healthy otherwise, is it benign to have healthy 37 year olds (like in that study) suddenly having lab findings mimicking those 40-50 years older?
 
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Since it's virtually certain that one will get covid (one or more times), what leads to less overall harm? Vaccination followed by infections or just infections? Also, anyone know rates of mild myocarditis and hs-troponin elevations after other common respiratory viruses?
It would be interesting to determine this. Unfortunately with the majority of the population being vaccinated, it would be difficult to establish whether it is the viral infection or the vaccination causing the myocarditis. An ideal study would look at incidence of myocarditis in unvaccinated population afte infection with various respiratory viruses, then compare with rates in vaccinated. I doubt this will happen as financial interests prevent serious intellectual curiosity around any potential vaccine injury.
 
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I’ve seen studies showing extreme endurance events like marathons can elevate troponin, but I haven’t seen anything about brief weightlifting sessions. Does it do that?

Nothing brief about my session, bro.
Nyuk-nyuk.

All gags aside; I don't know - but why not? hsTnT is freaking too sensitive as it is.
 
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I don't know - but why not? hsTnT is freaking too sensitive as it is.
I’m not saying weight lifting doesn’t elevate troponin. I’ve just never seen any study showing it does.
 
I know you’re being funny, but show me where benign neurocardiogenic (“vasovagal”) syncope elevates troponin.
Can’t show you a study, but it certainly can in patients with pre-existing CAD
 
Such a stupid study. They define “myocardial injury” as a rise in troponin above baseline and for which there is no alternate cause. F’ING terrible!! Is every chronic heart failure and fever-sepsis do they all have “ongoing myocardial injury?” This is just so much nonsense. Does anything that activates the immune system cause myocardial injury? Is it something about the COVID spike protein?

Why are they allowed to publish this crap?
 
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I just deadlifted, bench pressed, squatted, and shoulder pressed. I'm sure my hsTnT is modestly up.

I just took a shiiit and why did they whisk me to the cath lab? It was like immediate too. I didn’t even have a chance to flush the toilet.
 
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I run 3x wk, got the shot and for the next 6 months was SOB w running. Close but not back to normal now but I’m sure it had long lasting effects.

My uncle who never had any medical issues got the shot, over the next 3 months had endocarditis, bacterial meningitis, discitis, cholecystis.

Proof will eventually come out but from a personal standpoint side effects are real

Not related to the vaccine, c’mon now don’t stoop
 
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I am not saying that vaccinations was not good. I agreed with it, it saved more lives than it hurt, etc.

But to say it was completely safe is full of $hit.

I mean I have run 3+miles every other day for 25+ yrs without ever having sob even when I was sick. But a few days after vax, I was sob for 6 months to some extent. Sure it could have been a coincidence.l but I’m not believing it.
 
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Since anecdote rules the day here, I've had 5 shots and just earned 1st place in my age group in a 25k trail race around Mt. Hood. BUT, my achilles tendonitis has flared up again, so perhaps the shots aren't safe, after all???

I am 100% confident there is physiologic stress associated with vaccination, both mRNA and otherwise, and it is well-documented there are real, serious harms – we've had 3 or 4 deaths adjudicated to the COVID vaccine here in New Zealand, out of 11 million doses given. As one of the posters above noted, however, the comparison is not to an idealized standard of health in a world without COVID. Overall, there certainly no clear population-level harms associated with the mRNA COVID vaccine, as the number of age-adjusted excess deaths since 2020 is lower than historical standards in New Zealand – and obviously, we've fared far better than countries unable to vaccinate their populations before COVID arrived.

The "personal liberty" argument is entirely separate from just describing scientific findings; that's a good way to get this thread moved into the weeds where it belongs ...
 
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Since anecdote rules the day here, I've had 5 shots and just earned 1st place in my age group in a 25k trail race around Mt. Hood. BUT, my achilles tendonitis has flared up again, so perhaps the shots aren't safe, after all???

I am 100% confident there is physiologic stress associated with vaccination, both mRNA and otherwise, and it is well-documented there are real, serious harms – we've had 3 or 4 deaths adjudicated to the COVID vaccine here in New Zealand, out of 11 million doses given. As one of the posters above noted, however, the comparison is not to an idealized standard of health in a world without COVID. Overall, there certainly no clear population-level harms associated with the mRNA COVID vaccine, as the number of age-adjusted excess deaths since 2020 is lower than historical standards in New Zealand – and obviously, we've fared far better than countries unable to vaccinate their populations before COVID arrived.

The "personal liberty" argument is entirely separate from just describing scientific findings; that's a good way to get this thread moved into the weeds where it belongs ...
Were those deaths 2/2 mRNA vaccines or due to J&J (or some other vaccine)?

I think it's fair to say that any vaccine can harm, but I'm not convince that the mRNA covid vaccines had meaningful harm associated with them.
 
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This thread isn’t about autism, MMR vaccines and conspiracy theories. It’s about science 😉
Any clinical importance from what best could be described as a mild acute myocardial injury?

Any data on the amount of myocardial injury “natural immunity” take?
 
Such a stupid study. They define “myocardial injury” as a rise in troponin above baseline and for which there is no alternate cause. F’ING terrible!! Is every chronic heart failure and fever-sepsis do they all have “ongoing myocardial injury?” This is just so much nonsense. Does anything that activates the immune system cause myocardial injury? Is it something about the COVID spike protein?

Why are they allowed to publish this crap?
To be fair, that is the literal definition of an “acute myocardial injury”.

Most “type 2 MIs” aren’t actual MIs.

“Criteria for Myocardial Injury
Detection of an elevated cTn value above the 99th percentile URL is defined as myocardial injury. The injury is considered acute if there is a rise and/or fall of cTn values.”
 
I am not saying that vaccinations was not good. I agreed with it, it saved more lives than it hurt, etc.

But to say it was completely safe is full of $hit.

I mean I have run 3+miles every other day for 25+ yrs without ever having sob even when I was sick. But a few days after vax, I was sob for 6 months to some extent. Sure it could have been a coincidence.l but I’m not believing it.

Not your symptoms. Your friend who had serial infection everywhere in the body, brain, gallbladder, lung, and whatever else part of the body.
 
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itt: people who took the experimental medicine and want to feel better about their myocyte apoptosis
 
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itt: people who took the experimental medicine and want to feel better about their myocyte apoptosis
Strange. I had 2 years of seeing the ICU full of people aged 20 to 99 dying while obtaining natural immunity.


I have seen maybe 1 person that could be attributed to the vaccine… and that was a stretch.

How does the ratio compare in your practice?
 
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Strange. I had 2 years of seeing the ICU full of people aged 20 to 99 dying while obtaining natural immunity.


I have seen maybe 1 person that could be attributed to the vaccine… and that was a stretch.

How does the ratio compare in your practice?

Two different items, amigo.
 
Strange. I had 2 years of seeing the ICU full of people aged 20 to 99 dying while obtaining natural immunity.


I have seen maybe 1 person that could be attributed to the vaccine… and that was a stretch.

How does the ratio compare in your practice?

to be completely honest I never saw a young healthy person have a really bad time with covid, but I know there were a few that did. I believe I admitted one person in their 20s.

and even with your whataboutism, it's still bad to take a shot that has a known side effect of heart damage. would you take a statin if it had the side effect of an NSTEMI?

especially for people who gain nothing from it (NNT for young patients?) can you imagine taking a MRNA vaccine NOW? I haven't seen a case of ARDS from COVID in probably about 20 months. current COVID is now equivalent to rhinovirus.
 
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to be completely honest I never saw a young healthy person have a really bad time with covid, but I know there were a few that did. I believe I admitted one person in their 20s.

and even with your whataboutism, it's still bad to take a shot that has a known side effect of heart damage. would you take a statin if it had the side effect of an NSTEMI?

especially for people who gain nothing from it (NNT for young patients?) can you imagine taking a MRNA vaccine NOW? I haven't seen a case of ARDS from COVID in probably about 20 months. current COVID is now equivalent to rhinovirus.
Not even close
 
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to be completely honest I never saw a young healthy person have a really bad time with covid, but I know there were a few that did. I believe I admitted one person in their 20s.

and even with your whataboutism, it's still bad to take a shot that has a known side effect of heart damage. would you take a statin if it had the side effect of an NSTEMI?

especially for people who gain nothing from it (NNT for young patients?) can you imagine taking a MRNA vaccine NOW? I haven't seen a case of ARDS from COVID in probably about 20 months. current COVID is now equivalent to rhinovirus.
This is like the battle between CHADS-Vasc and HASBLED.

Are you suggesting that natural immunity is safer than the vaccine?

Because that’s the two options. There’s no third. It’s like a patient with a high CHADS-Vasc and HASBLED. The option isn’t “stroke or no stroke” it’s “hemorrhagic or ischemic”.


I’ve also seen completely debilitating rhabdo from statins and super acute liver failure from amiodarone.

No drug or vaccine is 100% safe, I agree with that.
However it’s almost always the case that they are safer than the alternative.


Also an elevated troponin isn’t a NSTEMI. I can link that cardiologists again if need be (4th Universal Definition of MI).
 
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There’s a 3rd option between natural immunity and vaccine?

Item 1.) Patient dies of COVID, or dies with COVID, or whatever it is.

Item 2.) Patient gets vaccine, and now is trying to explain why their other 5+ chronic diseases have progressed, concluding (using this paper as evidence) that "it musta been that there COVID shawwt and muh heart".

That's what he's going for.
 
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This is like the battle between CHADS-Vasc and HASBLED.

Are you suggesting that natural immunity is safer than the vaccine?

Because that’s the two options. There’s no third. It’s like a patient with a high CHADS-Vasc and HASBLED. The option isn’t “stroke or no stroke” it’s “hemorrhagic or ischemic”.


I’ve also seen completely debilitating rhabdo from statins and super acute liver failure from amiodarone.

No drug or vaccine is 100% safe, I agree with that.
However it’s almost always the case that they are safer than the alternative.


Also an elevated troponin isn’t a NSTEMI. I can link that cardiologists again if need be (4th Universal Definition of MI).

Please do link that. I'm generally in agreement with you, for the record. I'd like to read what the heartoids said.

Unless I'm misinterpreting emapp, he's trying to say "useless study is useless and will be misconstrued and weaponized". I think you're misinterpreting him.
 
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Please do link that. I'm generally in agreement with you, for the record. I'd like to read what the heartoids said.

Unless I'm misinterpreting emapp, he's trying to say "useless study is useless and will be misconstrued and weaponized". I think you're misinterpreting him.


Here ya go


TLDR: MIs require rise and fall + something else (chest pain/equivalent, EKG changes (ST changes, q waves), new wall motion abnormalities, new nuclear med changes, findings on autopsy, or findings on coronary cath (for type 1).

A rise and fall of troponins absent anything else is coined an "acute myocardial injury" and a chronically elevated troponin (like those ESRD, HF patients that always sit at 0.3) are "chronic myocardial injury."
 
Please do link that. I'm generally in agreement with you, for the record. I'd like to read what the heartoids said.

Unless I'm misinterpreting emapp, he's trying to say "useless study is useless and will be misconstrued and weaponized". I think you're misinterpreting him.
Ah, I think that we're in agreement there. Apologizes for being a bit argumentative.
 
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