Racionamiento, inflación e inequidad sanitaria en Venezuela: caso de las enfermedades cardiovasculares / Rationing, inflation and health inequity in Venezuela: case of cardiovascular diseases

los modelos público-sanitarios de caráctermonopólico como el venezolano, suelen asociarse a tendencias al racionamiento de los bienes y servicios que proveen a sus usuarios, así como a la merma de la calidad de estos. Por otro lado, la provisión de dichos bienes y servicios por la vía de mecanismos de mercado, tiene ante sí, el inconveniente que supone el ambiente inflacionario de su economía, cuyo impacto en los precios limita el acceso del paciente a su consumo. El caso de la enfermedad cardiovascular ofrece algunas claves para la comprensión de este fenómeno en el medio venezolano.

Public-health models of a monopolistic nature, suchas the Venezuelan, bring with them trends in the rationing ofthe goods and services they provide to their users, as well as inthe reduction of their quality. On the other hand, the provisionof these goods and services by means of market mechanisms hasbefore it, in our environment, the enormous impediment posedby the inflationary environment of its economy, whose impacton prices limits the patient's access to consumption. The case of cardiovascular disease offers some keys to understanding thisphenomenon in the Venezuelan environment.

Association between cardiometabolic diseases and quality of life and the mediation effect of perceived stress / 中华心血管病杂志

Objective: To explore the association between cardiometabolic diseases (CMD) and quality of life, the association between CMD and perceived stress, and the mediation effect of perceived stress on the association between CMD and quality of life, and to provide evidence for the prevention and treatment of CMD and the improvement of quality of life in these patients. Methods: This is a cross-sectional study. Data were collected by the employees' physical examination of a company in Xi'an in 2021. Multiple linear regression models were used to analyze the association between the status of CMD (divided into three categories: no CMD, presence of one kind of CMD, and with≥2 kinds of CMD (≥2 kinds of CMD were defined as cardiometabolic multimorbidity (CMM)), quality of life, and perceived stress. Mediation analysis with a multi-categorical independent variable was conducted to determine the mediation effect of perceived stress on the association between CMD and quality of life. Results: Among all 4 272 participants, 1 457 (34.1%) participants had one kind of CMD and 677 (15.8%) participants had CMM. The average scores for quality of life and perceived stress were (57.5±15.7) and (16.9±7.9), respectively. Compared with participants without CMD, after adjusting for demographic and lifestyle factors, no statistically significant associations were observed between one kind of CMD and perceived stress or quality of life (both P>0.05). Perceived stress did not mediate the association between one kind of CMD and quality of life. However, participants with CMM had lower quality of life and higher perceived stress than participants without CMD. The relative total effect coefficient c (95%CI) and the relative direct effect coefficient c' (95%CI) between CMM and quality of life were -3.71 (-5.04--2.37) and -2.52 (-3.81--1.24) (both P<0.05), respectively. The relative indirect effect coefficient a2b (95%CI) of perceived stress on the association between CMM and quality of life was -1.18 (-1.62--0.77) (P<0.05). The mediation effect size was 31.8%. Conclusions: CMM is negatively associated with quality of life and positively associated with perceived stress. Perceived stress partially mediates the association between CMM and quality of life. Our results suggest that, in addition to preventing and treating CMM actively, efforts should be taken to relieve the perceived stress of people with CMM to improve their quality of life.

Persistent organic pollutants distribution in plasma lipoprotein fractions / Distribuição persistente de poluentes orgânicos em frações de lipoproteínas plasmáticas

This study determines the associations among serum lipid profiles, risk of cardiovascular disease, and persistent organic pollutants. Using Gas chromatography technique, the intensity of toxic pollutant residues in serum samples of Hypertensive patients were measured. Based on statistical analysis, the effects of different covariates namely pesticides, age, systolic blood pressure, diastolic blood pressure, and lipid profile duration was checked using the logistic regression model. Statistical computation was performed on SPSS 22.0. The P-values of F-Statistic for each lipid profile class are greater than 0.01 (1%), therefore we cannot reject the null hypothesis for all cases. The estimated coefficients, their standard errors, Wald Statistic, and odds ratio of the binary logistic regression model for different lipid profile parameters indicate if pesticides increase then the logit value of different lipid profile parameters changes from -0.46 to -0.246 except LDL which increases by 0.135. The study reports a significantly increased threat of cardiovascular disease with increased concentrations of toxic pollutants.

Este estudo determina as associações entre o perfil lipídico sérico, o risco de doença cardiovascular e os poluentes orgânicos persistentes. Por meio da técnica de cromatografia gasosa, mediu-se a intensidade dos resíduos de poluentes tóxicos em amostras de soro de pacientes hipertensos. Com base na análise estatística, os efeitos de diferentes covariáveis – ou seja, pesticidas, idade, pressão arterial sistólica, pressão arterial diastólica e duração do perfil lipídico – foram verificados usando o modelo de regressão logística. O cálculo estatístico foi realizado no SPSS 22.0. Os valores P da estatística F para cada classe de perfil lipídico são maiores que 0,01 (1%), portanto não podemos rejeitar a hipótese nula para todos os casos. Os coeficientes estimados, seus erros padrão, estatística de Wald e odds ratio do modelo de regressão logística binária para diferentes parâmetros do perfil lipídico indicam se os pesticidas aumentam, então o valor logit de diferentes parâmetros do perfil lipídico muda de -0,46 para -0,246, exceto LDL, que aumenta em 0,135. O estudo relata um aumento significativo da ameaça de doença cardiovascular com aumento das concentrações de poluentes tóxicos.

Depression and Cardiovascular Disease in Women

Abstract The prevalence of depression varies from 1 to 17% in different geographic regions, and its incidence is 70% higher in women than men. Today, depression affects more than 300 million people worldwide, affecting twice as many women from adolescence to adulthood. In addition to this earlier onset, depression in women tends to be more severe. Cardiovascular disease and depression are chronic diseases that have a major impact on cardiovascular and all-cause morbidity and mortality, with evidence of a two-way relationship between them, in which depression is a predictor of cardiovascular disease and vice versa. In females, the degree of illness and prognosis are more severe when both diseases are present, than when diagnosed alone. In patients with acute or chronic cardiovascular disease, especially women, a systematic screening for depression should be considered as a preventive strategy of cardiovascular events, aiming to reduce the risk of future events. There are still no clinical studies designed to assess the impact of antidepressant treatment on cardiovascular outcomes in women.

Periodontitis and its associated factors in patients at the faculty of southern Brazil: a cross - sectional study

To verify the presence of periodontitis, its severity, and their association with associated factors based on medical records of patients who attended the Dental Clinic of the Faculty of Southern Brazil over 4 years. This is a cross-sectional study, which included 422 medical records of patients aged ≥ 18 years. The clinically analyzed data were: plaque index (PI),bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL). Sociodemographic data, dental hygiene, harmful habits and chronic systemic diseases were described. Statistical analysis of binary logistic regression was used to verify the relationship between the severity of periodontitis and the exposure variables. The older adults [odds ratio (OR) = 2.36; 95% confidence interval (CI): 1.23-4.54 ­41 to 55 years and OR = 3.0; 95% CI: 1.49-6.09 ­56 to 87 years], and men (OR = 1.9; 95% CI: 1.18-3.14) showed higher chances of periodontitis severity. Smokers (OR = 3.54; 95% CI: 2.05-6.12), those with hypertension (OR = 2.11; 95% CI: 1.23-3.63) and with diabetes (OR = 2.10; 95% CI: 1.08-4.12) showed higher chances of developing advanced periodontitis. Advanced or severe periodontitis occurred in one-third of the patients. The findings showed that men, older adults, with systemic arterial hypertension, diabetes mellitus, and smokers are more susceptible to severe periodontitis.

New mechanisms of chronic kidney disease-associated vascular calcification / 生理学报

Vascular calcification is the crucial factor of high cardiovascular disease morbidity and mortality in patients with chronic kidney disease (CKD), which causes a huge medical and economic burden. It is urgent to explore its pathogenesis and intervention methods. CKD-associated vascular calcification is an ectopic osteogenesis process actively regulated by multiple cells. Vascular smooth muscle cells (VSMCs) undergo osteogenic differentiation in a pro-calcification environment, and secrete matrix vesicles to form calcium and phosphorus crystal deposition sites, which are key events in the development of CKD-associated vascular calcification. This article reviews the new mechanism and technology of CKD-associated vascular calcification and discusses the role of the myokine Irisin in CKD-associated vascular calcification.

Caracterización del programa de salud cardiovascular GES DM2 e HTA bajo un modelo de intervenciones múltiples en una Unidad de Salud Familiar (UMF) de un centro médico privado / Characterization of a cardiovascular health program in Type 2 Diabetes Mellitus and Arterial Hypertension, under a model of multiple interventions in a Family Medicine Health Unit, of a private medical center

In the Family Medicine Unit (UMF) of the UC Health Network there is a program of multiple interventions based on a Chronic Control Model (CCM), led by a nurse who coordinates the activities and ensures compliance, aspiring to a change in its model of care and self-sustainability. It has been running for several years and its implementation and results have not been evaluated. Objective: This study aims to describe the situation of the Program, at its different levels: structure, processes and results. Material and method: Observational, descriptive longitudinal study of patients seen between July 2010 and June 2012, based on: methodology proposed by A. Donabedian; E. Wagner recommendations for the MTC; Monthly Statistical Registers and recommendations of the GES DM2 and HTA (MINSAL) Guides. Results: Hypertensive patients present a reduction of 11.2 mmHg in SBP and 7.8 mmHg in DBP (p 0.04). Diabetics present a reduction in HbA1c by 1.5 percentage points (p 0.04), and mixed patients present a SBP / DBP reduction of 10.3 and 6.8 mmHg respectively and an HbA1c reduction of 1.1 percentage points (p 0.092). Conclusions: After an average of 15 months, hypertensive patients significantly improve their mean SBP, DBP and compensation percentages; diabetics significantly improve their mean HbA1c and compensation percentages; mixed patients manage to improve their blood pressure and HbA1c levels, but this is not statistically significant.

Complicaciones cardiovasculares en pacientes con la COVID-19 / Cardiovascular complications in COVID-19 patients

Introducción: La COVID-19 se presenta como una infección del tracto respiratorio inferior. Entre sus diversas manifestaciones extrapulmonares se encuentra el daño cardiovascular, y estas son las que se asocian a la morbimortalidad. Se realizó una búsqueda de información científica utilizando recursos de las bases de datos PubMed, PubMed Central, SciELO, Ebsco, ClinicalKey y Scopus. Las estrategias de búsqueda formuladas fueron: SARS-CoV-2, COVID-19, complicaciones cardiovasculares; en inglés y español. Objetivo: Describir las complicaciones cardiovasculares en pacientes con la COVID-19. Desarrollo: Existe una amplia diversidad de criterios en la literatura científica acerca del daño cardiovascular en el contexto de la infección por la COVID-19. Las complicaciones cardiovasculares reportadas son: la lesión miocárdica aguda, miocarditis aguda, arritmias cardiacas, síndrome coronario agudo, insuficiencia cardiaca aguda, daño valvular cardiaco, enfermedad tromboembólica venosa y shock. Conclusiones: Se describen las complicaciones cardiovasculares en pacientes con la COVID-19. La infección por SARS-CoV-2 ocasiona daño directo o indirecto en el miocardio, las válvulas cardiacas y el resto del sistema cardiovascular(AU)

Introduction: The COVID-19 typically presents as a lower respiratory tract infection. Among its various extrapulmonary manifestations is cardiovascular damage, and these are the ones that are most associated with morbidity and mortality. A search for scientific information was carried; resources were obtained from databases PubMed, PubMed Central, SciELO, Ebsco, ClinicalKey, and Scopus. The search strategies formulated were: SARS-CoV-2, COVID-19, Cardiovascular complications; as well as its translations into the English language. Objective: To describe the cardiovascular complications in patients with the COVID-19. Development: There is a wide diversity of criteria in the scientific literature regarding cardiovascular damage in the context of COVID-19 infection. Frequently reported cardiovascular complications are acute myocardial injury, acute myocarditis, cardiac arrhythmias, acute coronary syndrome, acute heart failure, heart valve damage, venous thromboembolic disease, and shock. Conclusions: Cardiovascular complications in COVID-19 carriers were described. SARS-CoV-2 infection causes direct or indirect damage to the myocardium, heart valves and the rest of the cardiovascular system(AU)

Linear and Nonlinear Heart Rate Variability Analysis in Gonadal Dysgenesis (Swyer Syndrome): A Case Report

Abstract Swyer syndrome is one of the disorders of sexual differentiation. Previous studies have demonstrated increased sympathetic activity with heart rate variability (HRV) analysis with decreasing estradiol levels. One patient presented a pure 46, XY gonadal dysgenesis with female phenotype. Cardiac autonomic modulation was assessed through HRV analysis while at rest. This research analyzed linear and nonlinear indexes. HRV analysis showed reduced parasympathetic and global modulation with an apparent increase in sympathetic tone and a loss of HR fractal dynamics toward correlated behavior, characterized by low entropy and high determinism of time series.

Prevalencia de enfermedad arterial oclusiva crónica de extremidades inferiores en pacientes de alto riesgo cardiovascular pertenecientes a un centro de atención primaria mediante el uso del índice tobillo-brazo / Prevalence of peripheral arterial disease of lower extremities in high cardiovascular risk patients from primary care using the ankle-brachial index

Resumen Objetivo: La enfermedad arterial oclusiva crónica de extremidades inferiores (EAOC EEII) ha sido subestimada y subdiagnosticada especialmente a nivel de atención primaria. El objetivo de este estudio fue estimar la prevalencia de EAOC EEII en pacientes de alto riesgo cardiovascular pertenecientes a un centro de salud familiar. Materiales y Método: Estudio observacional de corte transversal. Se calculó un tamaño muestral de 246 pacientes, con una potencia estadística del 80% y un nivel de confianza del 95%, seleccionándolos aleatoriamente de 1.361 pacientes con riesgo cardiovascular alto del CESFAM Cordillera Andina, a quienes se les realizó la medición del índice tobillobrazo (ITB). Se estimaron IC 95% para cada media y porcentaje reportado, considerándose un valor de p significativo menor de 0,05 en las pruebas estadísticas utilizadas. Resultados: Se observó un ITB < 0,9 en el 43,2% (114), donde el 33,7% (89) refería síntomas de claudicación intermitente, mientras que un 9,5% (25) se encontraba asintomático. El mayor porcentaje de pacientes con EAOC EEII se observó en el grupo etario entre 60 y 80 años, que en conjunto alcanzaba el 85,1% de los pacientes con esta patología, siendo significativamente menor en pacientes menores de 60 y mayores de 80 años (p < 0,001). Conclusión: Encontramos una prevalencia de enfermedad arterial oclusiva crónica de extremidades inferiores de un 43,2% en pacientes de riesgo cardiovascular alto, quienes no presentaban este diagnóstico previamente. El índice tobillobrazo corresponde a un examen simple, rápido y con una gran utilidad diagnóstica por lo que debería considerarse su incorporación en las guías ministeriales para la evaluación de pacientes cardiovasculares en atención primaria.

Aim: The peripheral arterial disease (PAD) has been underestimated and underdiagnosed particularly at primary care setting. Our aim was to calculate the prevalence of PAD in high cardiovascular risk patients from a primary care center. Materials and Method: Is an observational, cross section study. We calculated a sample size of 246 patients, with a power of 80% and a significance level of 95%, who were selected randomly from 1.361 high cardiovascular risk patients according to the Framingham score, who attended at Cordillera Andina primary care center, measuring the anklebrachial index (ABI) in this group of patients. A 95% confidence interval was calculated for each mean and proportion and a p value less than 0.05 were considered as significant for all statistic tests. Results: We found an ABI < 0.9 in the 43.2% (114) of the sample, where 33.7% (89) presented symptoms of intermittent claudication, while 9.5% (25) did not have symptoms. The highest proportion of PAD was detected in patients between 60 and 80 years, who represented 85.1% of the patients with PAD, being significantly less its prevalence in people under 60 and over 80 years (p < 0.001). Conclusion: A prevalence of PAD of 43.2% in high cardiovascular risk patients who did not have this diagnosis before was found. The anklebrachial index is an easy, fast and very useful test to diagnose PAD in the majority of patients at primary care level, as consequent, its incorporation to clinical guidelines should be evaluated.

Manifestaciones cardiovasculares en pacientes con enfermedades reumáticas y COVID-19 / Cardiovascular manifestations in patients with rheumatic diseases and COVID-19

Introducción: La COVID-19 causa una variada gama de manifestaciones clínicas. En pacientes con enfermedades reumáticas destacan, además de las manifestaciones respiratorias, las manifestaciones articulares, dermatológicas, generales y cardiovasculares. Objetivo: Identificar las manifestaciones cardiovasculares que con mayor frecuencia se presentan en pacientes con enfermedades reumáticas afectados por la COVID-19. Métodos: Se realizó una investigación básica, no experimental, con alcance exploratorio, descriptivo y explicativo de un universo constituido por 37 pacientes con diagnóstico previo de enfermedad reumática y diagnóstico confirmado de COVID-19. Se empleó la observación dirigida y la revisión documental como técnicas de investigación para identificar la presencia de manifestaciones cardiovasculares en este tipo de pacientes. Resultados: Predominaron las pacientes femeninas (59,56 por ciento), con diagnóstico de osteoartritis (72,97 por ciento) y artritis reumatoide (72,97 por ciento) y con comorbilidades asociadas (83,78 por ciento). La hipertensión arterial (61,29 por ciento) y el hipotiroidismo (38,71 por ciento) fueron las comorbilidades más frecuentes. El 70,27 por ciento de los pacientes presentaron manifestaciones cardiovasculares: hipertensión arterial (65,38 por ciento), trastornos del ritmo cardiaco (57,69 por ciento) y el síndrome de Raynaud (53,85 por ciento). El 80,0 por ciento de los pacientes masculinos presentaron manifestaciones cardiovasculares, al igual que el 80,64 por ciento de los casos con enfermedad reumática, COVID-19 y comorbilidades asociadas. Conclusiones: Las manifestaciones cardiovasculares se presentaron con elevada frecuencia en los pacientes reumáticos con diagnóstico de COVID-19, sobre todo pacientes masculinos con comorbilidades asociadas. Las manifestaciones cardiovasculares más frecuentes fueron la hipertensión arterial, los trastornos del ritmo y el síndrome de Raynaud(AU)

Introduction: COVID-19 generates a wide range of clinical manifestations in general. In patients with rheumatic diseases, in addition to respiratory manifestations, joint, dermatological, general and cardiovascular manifestations, among others, stand out. Objective: To identify the cardiovascular manifestations that most frequently occur in patients with rheumatic diseases and COVID-19. Methods: A basic, non-experimental research was carried out, with an exploratory, descriptive and explanatory scope. Universe made up of 37 patients with a previous diagnosis of rheumatic disease and a confirmed diagnosis of COVID-19. Directed observation and documentary review were used as research techniques to identify the presence of cardiovascular manifestations in this type of patient. Results: Predominance of female patients (59.56 percent), diagnosed with osteoarthritis (72.97 percent) and rheumatoid arthritis (72.97 percent) and with associated comorbidities (83.78 percent). Hypertension (61.29 percent) and hypothyroidism (38.71 percent) were the most frequent comorbidities. 70.27 percent of the patients presented cardiovascular manifestations, predominantly arterial hypertension (65.38 percent), rhythm disorders (57.69 percent) and Raynaud´s syndrome (53.85 percent). 80.0 percent of the male patients presented cardiovascular manifestations, as did 80.64 percent of the cases with rheumatic disease, COVID-19 and associated comorbidities. Conclusions: Cardiovascular manifestations occurred with high frequency in rheumatic patients diagnosed with COVID-19; being more frequent in male patients and with associated comorbidities. High blood pressure, rhythm disorders and Raynaud's syndrome were the most frequent(AU)

Cardiovascular Risk Factors in Patients with Chronic Kidney Disease Under Conservative Treatment

Abstract Background Cardiovascular disease (CVD) is commonly associated with chronic kidney disease (CKD). These diseases have a significant impact on life expectancy. Individuals with CKD are more likely to die from CVD than to progress to end-stage kidney disease. Objective To assess cardiovascular risk factors of patients with CKD under conservative treatment. Methods This was an observational, cross-sectional study. Socioeconomic, anthropometric, biochemical, and physical inactivity data were assessed, and 10-year risk for CVD were estimated using the Framingham Score in patients with CKD under conservative treatment. For statistical analysis, the Student's t-test and Pearson's chi-square test were performed. Results A total of 172 individuals were evaluated, 57% of whom were male, with an average age of 68.85 ± 11.41 years. The prevalence of hypertension and diabetes were 87.2% and 53.5%, respectively; 62.2% were physically inactive; 9.9% of men were smokers and 12.8% consumed alcohol. According to BMI, 82.4% of adults <60 years old and 60.6% of those older than 60 years were overweight. High waist circumference and a high waist-hip ratio were highly prevalent in females (91.9% and 83.8%, respectively) and males (64.3% and 39.8%, respectively); 92.4% had a high body fat percentage and 73.3% high uric acid levels. According to the Framingham score, 57% have a medium or high risk of developing CVD in 10 years. Conclusion There was a high prevalence of cardiovascular risk factors in the population studied. The assessment of cardiovascular risk factors in patients with CKD makes it possible to guide the conduct of health professionals to prevent mortality from cardiovascular causes. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Correlação ecocardiográfica da função diastólica do ventrículo direito com idade e gênero em indivíduos com função sistólica preservada / Echocardiographic correlation between right ventricular diastolic function and age and gender in subjects with preserved systolic function

Introdução: As funções sistólica e diastólica do ventrículo direito influenciam no desfecho de doenças cardiovasculares. A avaliação sistemática das dimensões e da função das câmaras direitas, de acordo com sexo e idade, não é uniformemente realizada. Objetivo: Avaliar, ao ecocardiograma transtorácico, a correlação da função diastólica do ventrículo direito com idade e sexo, em uma população ambulatorial variada, com função sistólica dos ventrículos esquerdo e direito preservada. Métodos: Estudo observacional, transversal. Foram selecionados 97 pacientes, 61,5 ± 12,5 anos, sendo 56 mulheres. Foram avaliadas as seguintes medidas da função diastólica do ventrículo direito: velocidade de pico das ondas E e A, relação E/A, tempos de aceleração e desaceleração de onda E, integral velocidade-tempo da onda E, integral velocidade-tempo da onda A, além da pressão sistólica de artéria pulmonar, velocidade do refluxo tricúspide, diâmetro da veia cava inferior e volume do átrio direito. Resultados: Ocorreu redução da onda E com o aumento da idade (coeficiente de correlação de Pearson de -0,30; p=0,003) e da relação E/A (coeficiente de correlação de Pearson de -0,21; p=0,035). Houve associação positiva e significativa entre idade e os resultados das variáveis pressão sistólica de artéria pulmonar (coeficiente de correlação de Pearson de 0,40; p=0,004) e velocidade do refluxo tricúspide (coeficiente de correlação de Pearson de 0,36; p=0,008). Não houve diferença significativa na comparação entre os sexos em relação a variáveis ecocardiográficas. Conclusão: O presente estudo mostrou impacto da idade nos índices de função diastólica do ventrículo direito em indivíduos com função sistólica biventricular preservada, embora ainda com valores dentro da normalidade. O estudo não evidenciou diferença significativa entre os sexos em relação a função diastólica do ventrículo direito. (AU)

Introduction: Right ventricular (RV) systolic and diastolic functions influence the outcomes of cardiovascular diseases. However, right chamber size and function have not been uniformly assessed by age and sex. Objective: To evaluate RV diastolic function by age and sex in an outpatient population with preserved left ventricular (LV) and RV systolic function using transthoracic echocardiography. Method: This observational cross-sectional study included a total of 97 patients (56 women) aged 61.5 ± 12.5 years. The assessed parameters included RV E/A ratio; peak E-wave and A-wave velocity, E-wave acceleration and deceleration time, and integral E-wave and A-wave velocitytime; and pulmonary artery systolic pressure (PASP), tricuspid reflux velocity, inferior vena cava diameter, and right atrial volume. Results: A reduced E-wave was observed with increasing age (Pearson's correlation coefficient [PCC], -0.30; p = 0.003). The same was observed for the E/A ratio (PCC, -0.21; p = 0.035). There was a significant positive association between age and PASP results (PCC, 0.40; p = 0.004) and tricuspid reflux velocity (PCC, 0.36; p = 0.008). There was no significant intersex difference in echocardiography variables. Conclusion: The present study showed the impact of age on RV diastolic function indices, which remained within the normal range, in subjects with preserved LV and RV function. The study did not evidence a significant difference between genders in relation to the diastolic function of the right ventricle.(AU)

Association Analysis of Hyperlipidemia with the 28-Day All-Cause Mortality of COVID-19 in Hospitalized Patients / 中国医学科学杂志(英文版)

Objective This study aimed to determine the association of hyperlipidemia with clinical endpoints among hospitalized patients with COVID-19, especially those with pre-existing cardiovascular diseases (CVDs) and diabetes. Methods This multicenter retrospective cohort study included all patients who were hospitalized due to COVID-19 from 21 hospitals in Hubei province, China between December 31, 2019 and April 21, 2020. Patients who were aged < 18 or ≥ 85 years old, in pregnancy, with acute lethal organ injury (e.g., acute myocardial infarction, severe acute pancreatitis, acute stroke), hypothyroidism, malignant diseases, severe malnutrition, and those with normal lipid profile under lipid-lowering medicines (e.g., statin, niacin, fenofibrate, gemfibrozil, and ezetimibe) were excluded. Propensity score matching (PSM) analysis at 1:1 ratio was performed to minimize baseline differences between patient groups of hyperlipidemia and non-hyperlipidemia. PSM analyses with the same strategies were further conducted for the parameters of hyperlipidemia in patients with increased triglyceride (TG), increased low-density lipoprotein cholesterol (LDL-C), and decreased high-density lipoprotein cholesterol (HDL-C). Mixed-effect Cox model analysis was performed to investigate the associations of the 28-days all-cause deaths of COVID-19 patients with hyperlipidemia and the abnormalities of lipid parameters. The results were verified in male, female patients, and in patients with pre-existing CVDs and type 2 diabetes. Results Of 10 945 inpatients confirmed as COVID-19, there were 9822 inpatients included in the study, comprising 3513 (35.8%) cases without hyperlipidemia and 6309 (64.2%) cases with hyperlipidemia. Based on a mixed-effect Cox model after PSM at 1:1 ratio, hyperlipidemia was not associated with increased or decreased 28-day all-cause death [adjusted hazard ratio (

Relationship between corticotherapy and increased cardiac risk in patients with rheumatoid arthritis

Rheumatoid arthritis is an autoimmune inflammatory joint disease with global prevalence of 0.4% to 1.0%. Extra-articular manifestations increase its morbidity and severity, and cardiovascular diseases present the greatest risk. Therapeutic approaches have been used to treat rheumatoid arthritis, often involving the use of multiple classes of drugs with different mechanisms and forms of action. Corticosteroid therapy is widely used in this therapeutic combination; however, its use has been widely questioned because of its high toxicity and some negative effects, including the possibility of increased cardiovascular risk, depending on the dosage. Some studies have provided important insights into how glucocorticoids have an impact on cardiac complications in patients with rheumatoid arthritis. Most of these studies have concluded that exposure to these drugs at high or cumulative doses is associated with increased risk of death, as well as possibly being associated with the presence of a positive rheumatoid factor.