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2.
Cardiovasc Res ; 118(10): 2253-2266, 2022 Jul 27.
Article in English | MEDLINE | ID: covidwho-2032022

ABSTRACT

Cardiovascular (CV) disease (CVD) remains the leading cause of major morbidity and CVD- and all-cause mortality in most of the world. It is now clear that regular physical activity (PA) and exercise training (ET) induces a wide range of direct and indirect physiologic adaptations and pleiotropic benefits for human general and CV health. Generally, higher levels of PA, ET, and cardiorespiratory fitness (CRF) are correlated with reduced risk of CVD, including myocardial infarction, CVD-related death, and all-cause mortality. Although exact details regarding the ideal doses of ET, including resistance and, especially, aerobic ET, as well as the potential adverse effects of extreme levels of ET, continue to be investigated, there is no question that most of the world's population have insufficient levels of PA/ET, and many also have lower than ideal levels of CRF. Therefore, assessment and promotion of PA, ET, and efforts to improve levels of CRF should be integrated into all health professionals' practices worldwide. In this state-of-the-art review, we discuss the exercise effects on many areas related to CVD, from basic aspects to clinical practice.


Subject(s)
Cardiorespiratory Fitness , Cardiovascular Diseases , Cardiorespiratory Fitness/physiology , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/prevention & control , Exercise/physiology , Humans , Risk Factors
3.
Semin Thromb Hemost ; 2022 Sep 02.
Article in English | MEDLINE | ID: covidwho-2016946
6.
Am J Med ; 135(11): 1288-1295, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1982511

ABSTRACT

Tragically, the United States (US) surpassed one million documented deaths due to the coronavirus disease 2019 (COVID-19) pandemic. A convincing association between unhealthy lifestyle behaviors and poorer outcomes associated with COVID-19 infection has already been demonstrated and communicated by the Centers for Disease Control and Prevention in public health messaging. The US is experiencing not a pandemic, but a syndemic, specifically an unhealthy lifestyle behaviors-chronic diseases-COVID-19 syndemic. This syndemic has almost certainly significantly contributed to the more than one million deaths the United States has experienced during the pandemic. Decades of a high prevalence of unhealthy lifestyle behaviors laid the foundation for our current unfortunate situation by increasing vulnerability to a novel virus, especially among subgroups who have been historically marginalized. As such, a major pathway to defeating this syndemic is through the promotion of healthy living behaviors for all. Now is the time for action appropriate to meet the demands of a syndemic and a new path forward to a healthier and more equitable future.


Subject(s)
COVID-19 , United States/epidemiology , Humans , Syndemic , SARS-CoV-2 , Pandemics/prevention & control , Life Style
8.
Curr Opin Cardiol ; 37(5): 419-423, 2022 09 01.
Article in English | MEDLINE | ID: covidwho-1973297

ABSTRACT

PURPOSE OF REVIEW: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mostly uses the angiotensin-converting enzyme 2 (ACE-2) as cellular receptor for entering the host cells. Some, but not all, animal studies have shown that renin-angiotensin-aldosterone system (RAAS) inhibitors can increase ACE-2 expression. On that premise, it was hypothesized that these agents could make it more likely to develop coronavirus disease 2019 (COVID-19). On the other hand, there was also evidence that being on these agents could lessen the severity of the lung injury in patients with severe SARS-CoV-2 infection. Herein, we review the available evidence on the role of RAAS inhibitors on SARS-CoV-2 and COVID-19 development. RECENT FINDINGS: Recent randomized controlled trials demonstrate that RAAS blockade or withdrawal does not influence the severity of COVID-19 in patients who are already on these medications. Currently, there is no evidence to support stopping RAAS inhibitors in patients hospitalized for COVID-19. Several questions still need to be addressed. Ongoing studies are currently evaluating the de novo use of RAAS inhibitors in patients with COVID-19. Another area that needs to be investigated is whether or not using these medications increase the risk of infection. SUMMARY: The wealth of evidence indicates that ACE inhibitors and angiotensin-receptor blocker administration has no harmful effects on hospitalizations and severity of COVID-19 in patients already on these medications and might even reduce mortality among hypertensive patients diagnosed with COVID-19. More evidence and data need to be collected, and at this time, these agents should not be discontinued.


Subject(s)
COVID-19 , Hypertension , Angiotensin Receptor Antagonists/therapeutic use , Animals , COVID-19/drug therapy , Humans , Hypertension/drug therapy , Renin-Angiotensin System , SARS-CoV-2
9.
Can J Cardiol ; 38(9): 1342-1351, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1926297

ABSTRACT

Cardiovascular disease (CVD), a disease typically associated with aging and the definitive leading cause of death worldwide, now threatens young and middle-aged populations. Recreational abuse of alcohol, marijuana, cocaine, and amphetamine-type stimulants has been an escalating public health problem for decades, but now use of these substances has become a significant contributor to early-onset CVD. While this remains a global phenomenon, the epicentre of substance abuse is rooted in North America, where it has been exacerbated by the response to the COVID-19 pandemic. For the first time in history, the United States crossed 100,000 overdose-related deaths in a calendar year. Sadly, Canada's recreational drug abuse problem closely mirrors that of the US. This is indicative of the larger public health crisis, as we now know that these substances are cardiotoxic and are contributing to the rising levels of premature chronic CVD, including hypertension, arrhythmias, heart failure, stroke, myocardial infarction, arterial dissection, sudden cardiac death, and early mortality.


Subject(s)
COVID-19 , Cannabis , Cardiovascular Diseases , Cocaine , Amphetamines/adverse effects , Cannabis/adverse effects , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/epidemiology , Cocaine/adverse effects , Ethanol , Humans , Middle Aged , Pandemics , United States
10.
Ther Adv Cardiovasc Dis ; 16: 17539447221105013, 2022.
Article in English | MEDLINE | ID: covidwho-1910188

ABSTRACT

INTRODUCTION: Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection resulting in COVID-19 disease is associated with widespread inflammation and a prothrombotic state, resulting in frequent venous thromboembolic (VTE) events. It is currently unknown whether anticoagulation is protective for VTE events. Therefore, we conducted a systematic review to identify predictors of VTE in COVID-19. METHODS: We searched PubMed, EMBASE, Google Scholar, and Ovid databases for relevant observational studies of VTE in COVID-19 disease. The effect size for predictors of VTE was calculated using a random-effects model and presented as forest plots. Heterogeneity among studies was expressed as Q statistics and I2. Bias was assessed using the Newcastle Ottawa Scale for all identified observational studies. Publication bias was assessed with funnel plot analysis. RESULTS: We identified 28 studies involving 6053 patients with suspected or confirmed COVID-19. The overall pooled prevalence of VTE events was 20.7%. Male sex was associated with a higher risk of VTE events, whereas prior history of VTE, smoking, and cancer were not. VTE events were significantly higher in severely ill patients, mechanically ventilated patients, those requiring intensive care admission, and those with a low PaO2/FiO2 ratio (P/F ratio). Chronic comorbidities, including cardiovascular disease, heart failure, renal disease, and pulmonary disease, did not increase the risk of VTE events. Patients with VTE had higher leukocyte counts and higher levels of D-dimer, C-reactive protein, and procalcitonin. The occurrence of VTE was associated with increased length of stay but did not impact mortality. Therapeutic and prophylactic doses of anticoagulation were not protective against VTE. CONCLUSION: VTE in COVID-19 is associated with male gender and severe disease but not with traditional risk factors for VTE. The occurrence of VTE does not appear to be mitigated by either prophylactic or therapeutic anticoagulation. The occurrence of VTE in this population is associated with an increased length of stay but does not appear to impact mortality.


Subject(s)
COVID-19 , Venous Thromboembolism , Anticoagulants/therapeutic use , Blood Coagulation , COVID-19/complications , COVID-19/diagnosis , Humans , Male , SARS-CoV-2 , Venous Thromboembolism/diagnosis , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology
13.
Front Endocrinol (Lausanne) ; 13: 876028, 2022.
Article in English | MEDLINE | ID: covidwho-1855337

ABSTRACT

Background: An increasing level of evidence suggests that obesity not only is a major risk factor for cardiovascular diseases (CVDs) but also has adverse outcomes during COVID-19 infection. Methods: We used the German nationwide inpatient sample to analyze all hospitalized patients with confirmed COVID-19 diagnosis in Germany from January to December 2020 and stratified them for diagnosed obesity. Obesity was defined as body mass index ≥30 kg/m2 according to the WHO. The impact of obesity on in-hospital case fatality and adverse in-hospital events comprising major adverse cardiovascular and cerebrovascular events (MACCE), acute respiratory distress syndrome (ARDS), venous thromboembolism (VTE), and others was analyzed. Results: We analyzed data of 176,137 hospitalizations of patients with confirmed COVID-19 infection; among them, 9,383 (5.3%) had an additional obesity diagnosis. Although COVID-19 patients without obesity were older (72.0 [interquartile range (IQR) 56.0/82.0] vs. 66.0 [54.0/76.0] years, p < 0.001), the CVD profile was less favorable in obese COVID-19 patients (Charlson comorbidity index 4.44 ± 3.01 vs. 4.08 ± 2.92, p < 0.001). Obesity was independently associated with increased in-hospital case fatality (OR 1.203 [95% CI 1.131-1.279], p < 0.001) and MACCE (OR 1.168 [95% CI 1.101-1.239], p < 0.001), ARDS (OR 2.605 [95% CI 2.449-2.772], p < 0.001), and VTE (OR 1.780 [95% CI 1.605-1.973], p < 0.001) and also associated with increased necessity of treatment on intensive care unit (OR 2.201 [95% CI 2.097-2.310], p < 0.001), mechanical ventilation (OR 2.277 [95% CI 2.140-2.422], p < 0.001), and extracorporeal membrane oxygenation (OR 3.485 [95% CI 3.023-4.017], p < 0.001). Conclusions: Obesity independently affected case fatality, MACCE, ARDS development, VTE, and other adverse in-hospital events in patients with COVID-19 infection. Obesity should be taken into account regarding COVID-19 prevention strategies, risk stratification, and adequate healthcare planning. Maintaining a healthy weight is important not only to prevent cardiometabolic diseases but also for better individual outcomes during COVID-19 infection.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Venous Thromboembolism , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing , Hospitals , Humans , Obesity/complications , Obesity/epidemiology , Respiratory Distress Syndrome/epidemiology , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , SARS-CoV-2 , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology
14.
J Clin Med ; 11(9)2022 Apr 22.
Article in English | MEDLINE | ID: covidwho-1809959

ABSTRACT

COVID-19 restrictions are associated with poor physical-activity (PA). Less is known about the relationship between the combination of these restrictions with Ramadan intermittent fasting (RIF), PA, mental health, and sleep-quality. The present study aimed to evaluate whether COVID-19 restrictions and RIF during the fourth wave of the COVID-19 pandemic in Iran are associated with poor PA, anxiety, well-being, and sleep-quality outcomes. A total of 510 individuals participated in an online questionnaire that was disseminated to adults (≥18 years) residing in Iran from 13 May 2021 to 16 May 2021 (~3 days), just after the end of Ramadan 2021. PA behavior (Godin-Shephard Leisure-Time Exercise Questionnaire), anxiety (General Anxiety Disorder-7), well-being (Mental Health Continuum-Short Form), and sleep-quality (Pittsburgh Sleep Quality Index). Of 510 individuals included in the study (331 female (64.9%); mean ± SD, 31 ± 12 years), 172 (33.7%) reported less PA during the Ramadan 2021. PA was associated with better well-being and sleep-quality outcomes. Regardless of PA, participants who fasted for all of Ramadan had less anxiety and better well-being outcomes than those who fasted part of Ramadan or did not fast at all. However, the fasting part of Ramadan decreased the sleep-quality of active participants. The Ramadan 2021 was associated with poor PA, well-being, and sleep-quality of Iranians. However, PA was associated with better well-being and sleep-quality outcomes, and those who fasted all Ramadan had better anxiety and well-being outcomes. Therefore, PA during Ramadan might be an essential and scalable mental health resilience builder during COVID-19 restrictions which should be encouraged.

15.
Semin Thromb Hemost ; 2022 Apr 25.
Article in English | MEDLINE | ID: covidwho-1805732

ABSTRACT

A hypercoagulable state associated with coronavirus disease 2019 (COVID-19) has been well documented and is believed to be strongly supported by a proinflammatory state. The hypercoagulable state in turn results in increased incidence of arterial and venous thromboembolism (VTE) seen in hospitalized COVID-19 when compared with hospitalized non-COVID-19 patient cohorts. Moreover, patients with arterial or VTE and COVID-19 have higher mortality compared with COVID-19 patients without arterial or VTE. Prevention of arterial or VTE thus remains an essential question in the management of COVID-19 patients, especially because of high rates of reported microvascular and macrovascular thrombosis. This has prompted multiple randomized control trials (RCTs) evaluating different anticoagulation strategies in COVID-19 patients at various stages of the disease. Herein, we review findings from RCTs in the past 2 years of antithrombotic therapy in critically ill hospitalized patients, noncritically ill hospitalized patients, patients postdischarge from the hospital, and outpatients. RCTs in critically ill patients demonstrated therapeutic dose anticoagulation does not improve outcomes and has more bleeding than prophylaxis dose anticoagulant in these patients. Trials in noncritically ill hospitalized patients showed a therapeutic dose anticoagulation with a heparin formulation might improve clinical outcomes. Anticoagulation with a direct oral anticoagulant posthospital discharge may improve outcomes, although there is a large RCT in progress. Nonhospitalized COVID-19 patients have an insufficient burden of events to be candidates for antithrombotic therapy. Anticoagulation in pregnant and lactating patients with COVID-19, as well as antiplatelet therapy for COVID-19, is also reviewed.

18.
Ann Med ; 53(1): 151-159, 2021 12.
Article in English | MEDLINE | ID: covidwho-1574907

ABSTRACT

OBJECTIVE: To utilize publicly reported, state-level data to identify factors associated with the frequency of cases, tests, and mortality in the USA. MATERIALS AND METHODS: Retrospective study using publicly reported data collected included the number of COVID-19 cases, tests and mortality from March 14th through April 30th. Publicly available state-level data was collected which included: demographics comorbidities, state characteristics and environmental factors. Univariate and multivariate regression analyses were performed to identify the significantly associated factors with percent mortality, case and testing frequency. All analyses were state-level analyses and not patient-level analyses. RESULTS: A total of 1,090,500 COVID-19 cases were reported during the study period. The calculated case and testing frequency were 3332 and 19,193 per 1,000,000 patients. There were 63,642 deaths during this period which resulted in a mortality of 5.8%. Factors including to but not limited to population density (beta coefficient 7.5, p < .01), transportation volume (beta coefficient 0.1, p < .01), tourism index (beta coefficient -0.1, p = .02) and older age (beta coefficient 0.2, p = .01) are associated with case frequency and percent mortality. CONCLUSIONS: There were wide variations in testing and case frequencies of COVID-19 among different states in the US. States with higher population density had a higher case and testing rate. States with larger population of elderly and higher tourism had a higher mortality. Key messages There were wide variations in testing and case frequencies of COVID-19 among different states in the USA. States with higher population density had a higher case and testing rate. States with larger population of elderly and higher tourism had a higher mortality.


Subject(s)
Clinical Laboratory Techniques/statistics & numerical data , Coronavirus Infections/mortality , Pneumonia, Viral/mortality , COVID-19 , COVID-19 Testing , Comorbidity , Coronavirus Infections/diagnosis , Female , Healthcare Disparities , Humans , Male , Pandemics , Pneumonia, Viral/diagnosis , United States/epidemiology
20.
Am J Cardiovasc Drugs ; 22(1): 9-26, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1530485

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus causing coronavirus disease 2019 (COVID-19), has affected human lives across the globe. On 11 December 2020, the US FDA granted an emergency use authorization for the first COVID-19 vaccine, and vaccines are now widely available. Undoubtedly, the emergence of these vaccines has led to substantial relief, helping alleviate the fear and anxiety around the COVID-19 illness for both the general public and clinicians. However, recent cases of vaccine complications, including myopericarditis, have been reported after administration of COVID-19 vaccines. This article discusses the cases, possible pathogenesis of myopericarditis, and treatment of the condition. Most cases were mild and should not yet change vaccine policies, although prospective studies are needed to better assess the risk-benefit ratios in different groups.


Subject(s)
COVID-19 Vaccines , Myocarditis , COVID-19 Vaccines/adverse effects , Humans , Myocarditis/drug therapy , Myocarditis/etiology , Myocarditis/pathology , Vaccines, Synthetic/adverse effects , /adverse effects
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