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1.
Kardiologiia ; 62(3): 82-88, 2022 Mar 31.
Article in Russian | MEDLINE | ID: covidwho-1789753

ABSTRACT

This review focuses on the pathogenesis, most common clinical manifestations, and methods for diagnosis of damages to the cardiovascular system in coronavirus infection. The search for studies to be reviewed included publications of Elsevier, PubMed, and Web of Science resources by the key words "COVID-19", "myocarditis", "coronavirus", and "myocardial injury". The clinical presentation of coronavirus infection can include acute heart failure, myocardial injury, arrhythmias, pericarditis, venous thromboembolism, and microcirculatory dysfunction. Since symptoms of this pathology are non-specific, it is important to pay attention to monitoring of clinical laboratory and instrumental indexes for early differential diagnosis of cardiovascular disease. In all cases of parameter deviation from the normal range, cardiovascular complications of COVID-19 should be suspected. Measures should be taken for specifying the occurrence and severity of cardiac and/or vascular injury, and approaches should be developed for comprehensive treatment or prevention of these conditions.


Subject(s)
COVID-19 , Cardiovascular Diseases , Cardiovascular System , Myocarditis , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Humans , Microcirculation , Myocarditis/diagnosis , SARS-CoV-2
2.
Cardiol Rev ; 30(3): 123-128, 2022.
Article in English | MEDLINE | ID: covidwho-1778950

ABSTRACT

Cardiometabolic disease describes a combination of metabolic abnormalities that increases the risk of type 2 diabetes and cardiovascular diseases, including pathological changes such as insulin resistance, hyperglycemia, dyslipidemia, abdominal obesity, and hypertension, and environmental risk factors such as smoking, sedentary lifestyle, poor diet, and poverty. As the number of coronavirus disease 2019 (COVID-19) patients continues to rise, type 2 diabetes, cardiovascular disease, hypertension, and obesity, all components of, or sequelae of cardiometabolic disease, were identified among others as key risk factors associated with increased mortality in these patients. Numerous studies have been done to further elucidate this relationship between COVID-19 and cardiometabolic disease. Cardiometabolic disease is associated with both increased susceptibility to COVID-19 and worse outcomes of COVID-19, including intensive care, mechanical ventilation, and death. The proinflammatory state of cardiometabolic disease specifically obesity, has been associated with a worse prognosis in COVID-19 patients. There has been no evidence to suggest that antihypertensives and antidiabetic medications should be discontinued in COVID-19 patients but these patients should be closely monitored to ensure that their blood pressure and blood glucose levels are stable. Assessment of vaccination efficacy in cardiometabolic disease patients is also discussed.


Subject(s)
COVID-19 , Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Hypertension , COVID-19/complications , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Humans , Hypertension/complications , Hypertension/drug therapy , Hypertension/epidemiology , Obesity/complications , Obesity/epidemiology , Risk Factors
3.
Cardiol Rev ; 30(3): 145-157, 2022.
Article in English | MEDLINE | ID: covidwho-1778952

ABSTRACT

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 and was first reported in December 2019 in Wuhan, China. Since then, it caused a global pandemic with 212,324,054 confirmed cases and 4,440,840 deaths worldwide as of August 22, 2021. The disease spectrum of COVID-19 ranges from asymptomatic subclinical infection to clinical manifestations predominantly affecting the respiratory system. However, it is now evident that COVID-19 is a multiorgan disease with a broad spectrum of manifestations leading to multiple organ injuries including the cardiovascular system. We review studies that have shown that the relationship between cardiovascular diseases and COVID-19 is indeed bidirectional, implicating that preexisting cardiovascular comorbidities increase the morbidity and mortality of COVID-19, and newly emerging cardiac injuries occur in the settings of acute COVID-19 in patients with no preexisting cardiovascular disease. We present the most up-to-date literature summary to explore the incidence of new-onset cardiac complications of coronavirus and their role in predicting the severity of COVID-19. We review the association of elevated troponin with the severity of COVID-19 disease, which includes mild compared to severe disease, in nonintensive care unit compared to intensive care unit patients and in those discharged from the hospital compared to those who die. The role of serum troponin levels in predicting prognosis are compared in survivors and non-survivors. The association between COVID-19 disease and myocarditis, heart failure and coagulopathy are reviewed. Finally, an update on beneficial treatments is discussed.


Subject(s)
COVID-19 , Cardiovascular Diseases , Heart Diseases , Myocarditis , COVID-19/complications , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Heart Diseases/epidemiology , Humans , Pandemics , Troponin
4.
Front Public Health ; 9: 725009, 2021.
Article in English | MEDLINE | ID: covidwho-1775842

ABSTRACT

Background and Aims: Cardiovascular diseases (CVDs) are the leading cause of death globally and in Brazil. Evidence suggests that the risk of CVDs differs by race/ethnicity. Scarce information exists about the association between CVD risk, obesity indicators and sociodemographic characteristics in the Brazilian population. Objectives: We aimed to assess the CVD risk following the Framingham risk score in relation to the population's sociodemographic profile. Further, we examined the association between anthropometric markers and risk of CVDs. Methods: A total of 701 subjects aged ≥20 years from North-eastern Brazil were recruited randomly to participate in a population-based, cross-sectional survey. Age-adjusted data for CVD risk, sociodemographic characteristics, and anthropometric indices were assessed, and their relationships examined. Results: High CVD risk (Framingham risk score ≥10%) was observed in 18.9% of the population. Males (31.9 vs. 12.5%) and older subjects (age ≥45 years: 68.9% vs. age <45 years: 4.2%) had significantly higher risk of CVDs, whereas those employed in manual labor showed lower risk (7.6 vs. 21.7%). Central obesity measures like waist-to-hip ratio and waist-to-height ratio were more strongly associated with predicted CVD risk than body mass index. Conclusions: Our population had a high risk of CVDs using the Framingham risk score. Cost-effective strategies for screening, prevention and treatment of CVDs may likely reduce disease burden and health expenditure in Brazil. Central obesity measures were strongly associated with predicted CVD risk and might be useful in the clinical assessment of patients. Follow-up studies are warranted to validate our findings.


Subject(s)
Cardiovascular Diseases , Adult , Brazil/epidemiology , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cross-Sectional Studies , Heart Disease Risk Factors , Humans , Male , Middle Aged , Obesity/epidemiology , Risk Factors , Young Adult
5.
Bioessays ; 43(9): e2100046, 2021 09.
Article in English | MEDLINE | ID: covidwho-1756555

ABSTRACT

Air pollution is a major global challenge for a multitude of reasons. As a specific concern, there is now compelling evidence demonstrating a causal relationship between exposure to airborne pollutants and the onset of cardiovascular disease (CVD). As such, reducing air pollution as a means to decrease cardiovascular morbidity and mortality should be a global health priority. This review provides an overview of the cardiovascular effects of air pollution and uses two major events of 2020-the Australian bushfires and COVID-19 pandemic lockdown-to illustrate the relationship between air pollution and CVD. The bushfires highlight the substantial human and economic costs associated with elevations in air pollution. Conversely, the COVID-19-related lockdowns demonstrated that stringent measures are effective at reducing airborne pollutants, which in turn resulted in a potential reduction in cardiovascular events. Perhaps one positive to come out of 2020 will be the recognition that tough measures are effective at reducing air pollution and that these measures have the potential to stop thousands of deaths from CVD.


Subject(s)
Air Pollution , COVID-19 , Cardiovascular Diseases , Fires , Air Pollution/adverse effects , Australia/epidemiology , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Communicable Disease Control , Humans , Pandemics , Particulate Matter/analysis
6.
Mayo Clin Proc ; 97(3): 579-599, 2022 03.
Article in English | MEDLINE | ID: covidwho-1720595

ABSTRACT

Coronavirus disease 2019 (COVID-19) is the third deadly coronavirus infection of the 21st century that has proven to be significantly more lethal than its predecessors, with the number of infected patients and deaths still increasing daily. From December 2019 to July 2021, this virus has infected nearly 200 million people and led to more than 4 million deaths. Our understanding of COVID-19 is constantly progressing, giving better insight into the heterogeneous nature of its acute and long-term effects. Recent literature on the long-term health consequences of COVID-19 discusses the need for a comprehensive understanding of the multisystemic pathophysiology, clinical predictors, and epidemiology to develop and inform an evidence-based, multidisciplinary management approach. A PubMed search was completed using variations on the term post-acute COVID-19. Only peer-reviewed studies in English published by July 17, 2021 were considered for inclusion. All studies discussed in this text are from adult populations unless specified (as with multisystem inflammatory syndrome in children). The preliminary evidence on the pulmonary, cardiovascular, neurological, hematological, multisystem inflammatory, renal, endocrine, gastrointestinal, and integumentary sequelae show that COVID-19 continues after acute infection. Interdisciplinary monitoring with holistic management that considers nutrition, physical therapy, psychological management, meditation, and mindfulness in addition to medication will allow for the early detection of post-acute COVID-19 sequelae symptoms and prevent long-term systemic damage. This review serves as a guideline for effective management based on current evidence, but clinicians should modify recommendations to reflect each patient's unique needs and the most up-to-date evidence. The presence of long-term effects presents another reason for vaccination against COVID-19.


Subject(s)
COVID-19/complications , Cardiovascular Diseases/etiology , Humans , Lung Diseases/etiology , Nervous System Diseases/etiology
7.
Rev Endocr Metab Disord ; 23(2): 293-297, 2022 04.
Article in English | MEDLINE | ID: covidwho-1718863

ABSTRACT

Patients with pre-existing cardiovascular disease (CVD) are at high risk for adverse outcomes with coronavirus disease 2019 (COVID-19). Further, COVID-19 infection is associated with numerous cardiovascular (CV) complications including arrhythmia, myocardial injury, cardiomyopathy, and thrombotic events. Increased susceptibility to COVID-19 and CV complications related to COVID-19 may be in part related to immune dysregulation and inflammation associated with CV disease which is exacerbated with viral infection. Vitamin D plays a major role in immune function and exerts anti-inflammatory effects, which may prove important in the context of CVD and COVID-19. To date, studies have shown minimal benefit for vitamin D supplementation in patients with COVID-19, though there are no studies specific to patients with CVD and related complications. Further, given that vitamin D has important protective effects on the CV system, including augmentation of myocardial contractility and anti-thrombotic effects, it is unknown if supplementation with vitamin D can mitigate CVD complications associated with COVID-19.


Subject(s)
COVID-19 , Cardiovascular Diseases , Vitamin D Deficiency , COVID-19/complications , COVID-19/drug therapy , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Humans , Vitamin D/physiology , Vitamin D/therapeutic use , Vitamin D Deficiency/complications , Vitamin D Deficiency/drug therapy , Vitamins/therapeutic use
9.
Arch. latinoam. nutr ; 71(4): 281-289, dic. 2021. tab
Article in Spanish | WHO COVID, LILACS (Americas) | ID: covidwho-1668087

ABSTRACT

Conocer la asociación específica de las enfermedades metabólicas en la mortalidad por COVID-19, ocurrida en México durante el año crítico de la pandemia de marzo 2020 a marzo 2021. Método. Se utilizó la base nacional de COVID-19 de la Dirección General de Epidemiología. Se analizaron los casos positivos que presentaron las enfermedades metabólicas: cardiovasculares, hipertensión, diabetes y obesidad. Se realizó un análisis descriptivo para conocer la distribución de los casos fallecidos y no fallecidos. Se empleó la prueba de ji cuadrada para la diferencia de las proporciones. Se utilizaron análisis de regresión logística para conocer la asociación entre las enfermedades metabólicas y la mortalidad por COVID-19 en personas positivas al virus SARS-CoV-2. Los datos fueron ajustados por edad y sexo. Resultados. Se observó la asociación de las enfermedades metabólicas en la mortalidad. La diabetes tuvo mayor porcentaje de letalidad 18,4%. Cuando se conjuntaron las enfermedades cardiovasculares y diabetes el porcentaje de letalidad subió a 31,5%; la conjunción de las enfermedades cardiovasculares, con hipertensión y diabetes fue la de mayor porcentaje de letalidad 38,7%. La obesidad fue la que tuvo menor incidencia. Conclusiones. Las enfermedades metabólicas en México son un problema de salud pública que afectó la mortalidad por covid-19. Es prioritario atender con políticas públicas preventivas y efectivas en favor de un modelo de consumo alimentario sano, acorde con las necesidades nutrimentales de la población(AU)


To know the specific association of metabolic disease on COVID-19 mortality, occurred during the critical year of the pandemic, from march 2020 to march 2021. Method: The Covid-19 national base of the General Directorate of Epidemiology was used. Positive cases of metabolic diseases were analyzed: cardiovascular disease, hypertension, diabetes and obesity. A descriptive analysis was carried out to find out the distribution of deceased and non-deceased cases. The chi-square test was used for the difference in proportions. Logistic regression analysis was used to understand the association between metabolic diseases and COVID 19 mortality in people who tested positive for the SARS-CoV-2 virus. The data were adjusted for age and gender. Results: The association of metabolic diseases on mortality was observed. Diabetes had a higher percentage of lethality 18,4%. When cardiovascular disease and diabetes were combined, the fatality rate rose to 31,5%; the combination of cardiovascular diseases, with hypertension and diabetes was the highest percentage of lethality 38,7%. Obesity had the least incidence. Conclusions: Metabolic diseases in México are a public health problem that affected COVID-19 mortality. It is a priority to deal with preventive and effective public policies in favor of a healthy food consumption model, in line with the nutritional needs of the population(AU)


Subject(s)
Humans , Male , Female , Cardiovascular Diseases/etiology , Diabetes Mellitus , Eating , COVID-19/mortality , Metabolic Diseases/complications , Metabolic Diseases/mortality , Obesity/physiopathology , Dietary Fats, Unsaturated , Epidemiology , Industrialized Foods , Pandemics , Hypertension
10.
Int J Environ Res Public Health ; 19(3)2022 02 01.
Article in English | MEDLINE | ID: covidwho-1667167

ABSTRACT

Lockdown measures have obvious psychological impacts, which could, in turn, increase cardiovascular risk. We assessed the association between lockdown-related factors and the worsening of cardiovascular risk, incident anxiety and depression during 12 months' follow-up. During lockdown (April-May 2020), 534 subjects, aged 50-89 years, were included in the PSYCOV-CV study (NCT04397835) and followed for up to 12 months post-lockdown. We found that participants with symptoms of depression during lockdown were more likely to report increased cardiovascular drug treatment (Odds-Ratio (OR) = 5.08 (1.78-14.5), p = 0.002), decreased physical activity (OR = 1.76 (1.10-2.82), p = 0.019) and weight gain (OR = 1.85 (1.08-3.17), p = 0.024) after lockdown. Moreover, changes in sleep patterns (OR = 2.35 (1.13-4.88), p = 0.022) or living in a rural area during lockdown (OR = 1.70 (0.96-3.03, p = 0.069) were associated with higher incident depression, whereas a better relationship with one's partner during lockdown was associated with less incident depression (OR = 0.56 (0.29-1.08), p = 0.084). Finally, we found that continuing to work during lockdown in a role requiring in-person contact with the public (such as cashiers, nurses or physicians) was associated with more incident anxiety after lockdown (OR = 3.38 (1.12-10.2), p = 0.031). Interestingly, decreased consumption of alcohol during lockdown was associated with less incident anxiety (OR = 0.30 (0.10-0.90), p = 0.032). Our study, conducted in a representative sample of an age group at increased risk of both cardiovascular disease and severe COVID-19, increases the understanding of modifiable factors associated with the health impacts of lockdown measures.


Subject(s)
COVID-19 , Cardiovascular Diseases , Aged , Aged, 80 and over , Anxiety/epidemiology , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cohort Studies , Communicable Disease Control , Depression/epidemiology , Heart Disease Risk Factors , Humans , Mental Health , Middle Aged , Risk Factors , SARS-CoV-2
12.
J Cardiol ; 79(4): 501-508, 2022 04.
Article in English | MEDLINE | ID: covidwho-1587218

ABSTRACT

BACKGROUND: Patients with coronavirus disease 2019 (COVID-19) and underlying cardiovascular comorbidities have poor prognoses. Our aim was to identify the impact of serum lactate dehydrogenase (LDH), which is associated with mortality in acute respiratory distress syndrome, on the prognoses of patients with COVID-19 and underlying cardiovascular comorbidities. METHODS: Among 1518 patients hospitalized with COVID-19 enrolled in the CLAVIS-COVID (Clinical Outcomes of COVID-19 Infection in Hospitalized Patients with Cardiovascular Diseases and/or Risk Factors study), 515 patients with cardiovascular comorbidities were analyzed. Patients were divided into tertiles based on LDH levels at admission [tertile 1 (T1), <235 U/L; tertile 2 (T2), 235-355 U/L; and tertile 3 (T3); ≥356 U/L]. We investigated the impact of LDH levels on the in-hospital mortality. RESULTS: The mean age was 70.4 ± 30.0 years, and 65.3% were male. There were significantly more in-hospital deaths in T3 than in T1 and T2 [n = 50 (29.2%) vs. n = 15 (8.7%), and n = 24 (14.0%), respectively; p < 0.001]. Multivariable analysis adjusted for age, comorbidities, vital signs, and laboratory data including D-dimer and high-sensitivity troponin showed T3 was associated with an increased risk of in-hospital mortality (adjusted hazard ratio, 3.04; 95% confidence interval, 1.50-6.13; p = 0.002). CONCLUSIONS: High serum LDH levels at the time of admission are associated with an increased risk of in-hospital death in patients with COVID-19 and known cardiovascular disease and may aid in triage of these patients.


Subject(s)
COVID-19 , Cardiovascular Diseases , Adult , Aged , Aged, 80 and over , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Hospital Mortality , Humans , L-Lactate Dehydrogenase , Male , Middle Aged , Prognosis , Retrospective Studies , SARS-CoV-2
13.
Nutr Res ; 100: 19-32, 2022 04.
Article in English | MEDLINE | ID: covidwho-1586919

ABSTRACT

Persons with underlying noncommunicable diseases (NCDs) are more likely to acquire severe coronavirus disease 2019 disease and to die from coronavirus disease 2019. An urgent need for potential therapy to prevent and control NCDs is critical. We hypothesized that higher intakes of multiple individual nutrients, fruits, or vegetables would be linked with a low risk of NCDs in the Korean population. Thus, we aim to explore the association between NCDs, including cardiovascular diseases, type 2 diabetes mellitus (T2DM), arthritis, depression, and dietary factors. A total of 56,462 adults aged 18 years (2009-2019) were included. Dietary factors, including intakes of multiple individual nutrients, fruits, and vegetables, were assessed. Multivariable-adjusted logistic regression models were used to explore the associations between dietary factors and NCDs. Interactions were found between intakes of multiple individual nutrients and sex for T2DM, hypertension, stroke, myocardial infarction, arthritis, and osteoarthritis. Only in women was a 2-fold increase in daily multiple individual nutrient intake (vitamins A, B1, B2, B3, C; potassium, protein; phosphorus; calcium; iron; monounsaturated fatty acid and polyunsaturated fatty acid; n-3 fatty acid and n-6 fatty acid; and water) associated with a lower prevalence of T2DM, hypertension, stroke, myocardial infarction, arthritis, and osteoarthritis. In both women and men, high fruit or vegetable consumption was linked with a lower risk of T2DM, hypertension, dyslipidemia, osteoarthritis, and depression than low consumption. Our findings found higher intakes of fruits, vegetables, and multiple individual nutrients are linked with a lower risk of NCDs in the Korean adult population. Further work is needed to identify whether interactions between intake of multiple individual nutrients, vegetables, and fruits affect the presence of NCDs.


Subject(s)
Arthritis , COVID-19 , Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Adolescent , Adult , Arthritis/epidemiology , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Depression/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/etiology , Diabetes Mellitus, Type 2/prevention & control , Diet , Female , Fruit , Humans , Male , Nutrients , Republic of Korea/epidemiology , Vegetables
14.
Pharmacol Res ; 176: 106053, 2022 02.
Article in English | MEDLINE | ID: covidwho-1586872

ABSTRACT

BACKGROUND: Administration of glucocorticoids might reduce mortality in patients with severe COVID-19 but have adverse cardiometabolic effects. OBJECTIVES: to investigate the effect of systemic administration of glucocorticoids on cardiovascular complications and all-cause mortality in patients hospitalised with respiratory viral infections, including COVID-19, SARS, MERS and influenza. METHODS: We identified randomised trials published prior to July 28th, 2021. The Mantel-Haenszel random effects method and the Hartung and Knapp adjustment were used to obtain pooled estimates of treatment effect with 95% confidence intervals. RESULTS: No randomised trials of glucocorticoids for SARS, MERS or influenza reported relevant outcomes. We included eleven COVID-19 randomised trials (8109 patients). Overall, compared to placebo or standard care, glucocorticoids were not associated with a reduction of in-hospital mortality (p = 0.09). In a pre-specified sub-analysis, in-hospital mortality was reduced by 19% when follow-up was restricted to 14 days from randomisation (5/11 trials, 1329 patients, p = 0.02). With longer follow-up (9/11 trials, 7874 patients), administration of glucocorticoids was associated with a trend to benefit for those requiring mechanical ventilation (RR 0.86; 95% CI 0.57-1.27) but possible harm for those not receiving oxygen at randomisation (RR 1.27; 95% CI 1.00 - 1.61), an effect that was significantly different amongst subgroups (p = 0.0359). Glucocorticoids reduced the risk of worsening renal function by 37% (4/11 trials); reported rate of other cardiovascular complications was low. CONCLUSIONS: Administration of systemic glucocorticoids to patients hospitalised with COVID-19 does not lower mortality overall but may reduce it in those requiring respiratory support and increase it in those who do not.


Subject(s)
COVID-19/drug therapy , Cardiovascular Diseases/etiology , Coronavirus Infections/drug therapy , Glucocorticoids/therapeutic use , Influenza, Human/drug therapy , Severe Acute Respiratory Syndrome/drug therapy , COVID-19/mortality , Cardiovascular Diseases/mortality , Coronavirus Infections/mortality , Hospitalization , Humans , Influenza, Human/mortality , Randomized Controlled Trials as Topic , SARS-CoV-2/drug effects
15.
Biomolecules ; 12(1)2021 12 24.
Article in English | MEDLINE | ID: covidwho-1581037

ABSTRACT

Coronavirus disease 2019 (COVID-19), the pandemic infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents with an extremely heterogeneous spectrum of symptoms and signs. The clinical manifestations seem to be correlated with disease severity. COVID-19 susceptibility and mortality show a significant sex imbalance, with men being more prone to infection and showing a higher rate of hospitalization and mortality compared to women. Such variability can be ascribed to both sex-related biological factors and gender-related behavioral cues. This review will discuss the potential mechanisms accounting for sex/gender influence in vulnerability to COVID-19. Cardiovascular diseases play a central role in determining COVID-19 outcome, whether they are pre-existent or arose upon infection. We will pay particular attention to the impact of sex and gender on cardiovascular manifestations related to COVID-19. Finally, we will discuss the sex-dependent variability in some biomarkers for the evaluation of COVID-19 infection and prognosis. The aim of this work is to highlight the significance of gendered medicine in setting up personalized programs for COVID-19 prevention, clinical evaluation and treatment.


Subject(s)
COVID-19 , Cardiovascular Diseases , Pandemics , SARS-CoV-2/metabolism , Sex Characteristics , COVID-19/complications , COVID-19/epidemiology , COVID-19/metabolism , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/metabolism , Female , Humans , Male , Risk Factors , Severity of Illness Index , Sex Factors
16.
N Engl J Med ; 385(25): 2325-2335, 2021 12 16.
Article in English | MEDLINE | ID: covidwho-1575626

ABSTRACT

BACKGROUND: Among patients with chronic kidney disease (CKD), the use of recombinant human erythropoietin and its derivatives for the treatment of anemia has been linked to a possibly increased risk of stroke, myocardial infarction, and other adverse events. Several trials have suggested that hypoxia-inducible factor (HIF) prolyl hydroxylase inhibitors (PHIs) are as effective as erythropoiesis-stimulating agents (ESAs) in increasing hemoglobin levels. METHODS: In this randomized, open-label, phase 3 trial, we assigned patients with CKD who were undergoing dialysis and who had a hemoglobin level of 8.0 to 11.5 g per deciliter to receive an oral HIF-PHI (daprodustat) or an injectable ESA (epoetin alfa if they were receiving hemodialysis or darbepoetin alfa if they were receiving peritoneal dialysis). The two primary outcomes were the mean change in the hemoglobin level from baseline to weeks 28 through 52 (noninferiority margin, -0.75 g per deciliter) and the first occurrence of a major adverse cardiovascular event (a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke), with a noninferiority margin of 1.25. RESULTS: A total of 2964 patients underwent randomization. The mean (±SD) baseline hemoglobin level was 10.4±1.0 g per deciliter overall. The mean (±SE) change in the hemoglobin level from baseline to weeks 28 through 52 was 0.28±0.02 g per deciliter in the daprodustat group and 0.10±0.02 g per deciliter in the ESA group (difference, 0.18 g per deciliter; 95% confidence interval [CI], 0.12 to 0.24), which met the prespecified noninferiority margin of -0.75 g per deciliter. During a median follow-up of 2.5 years, a major adverse cardiovascular event occurred in 374 of 1487 patients (25.2%) in the daprodustat group and in 394 of 1477 (26.7%) in the ESA group (hazard ratio, 0.93; 95% CI, 0.81 to 1.07), which also met the prespecified noninferiority margin for daprodustat. The percentages of patients with other adverse events were similar in the two groups. CONCLUSIONS: Among patients with CKD undergoing dialysis, daprodustat was noninferior to ESAs regarding the change in the hemoglobin level from baseline and cardiovascular outcomes. (Funded by GlaxoSmithKline; ASCEND-D ClinicalTrials.gov number, NCT02879305.).


Subject(s)
Anemia/drug therapy , Barbiturates/therapeutic use , Darbepoetin alfa/therapeutic use , Epoetin Alfa/therapeutic use , Glycine/analogs & derivatives , Hematinics/therapeutic use , Renal Dialysis , Renal Insufficiency, Chronic/complications , Aged , Anemia/etiology , Barbiturates/adverse effects , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/mortality , Darbepoetin alfa/adverse effects , Epoetin Alfa/adverse effects , Female , Glycine/adverse effects , Glycine/therapeutic use , Hematinics/adverse effects , Hemoglobins/analysis , Humans , Hypoxia-Inducible Factor-Proline Dioxygenases/antagonists & inhibitors , Intention to Treat Analysis , Male , Middle Aged , Myocardial Infarction/epidemiology , Renal Insufficiency, Chronic/blood , Renal Insufficiency, Chronic/therapy , Stroke/epidemiology
17.
N Engl J Med ; 385(25): 2313-2324, 2021 12 16.
Article in English | MEDLINE | ID: covidwho-1575625

ABSTRACT

BACKGROUND: Daprodustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor. In patients with chronic kidney disease (CKD) who are not undergoing dialysis, the efficacy and safety of daprodustat, as compared with the conventional erythropoiesis-stimulating agent darbepoetin alfa, are unknown. METHODS: In this randomized, open-label, phase 3 trial with blinded adjudication of cardiovascular outcomes, we compared daprodustat with darbepoetin alfa for the treatment of anemia in patients with CKD who were not undergoing dialysis. The primary outcomes were the mean change in the hemoglobin level from baseline to weeks 28 through 52 and the first occurrence of a major adverse cardiovascular event (MACE; a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke). RESULTS: Overall, 3872 patients were randomly assigned to receive daprodustat or darbepoetin alfa. The mean (±SD) baseline hemoglobin levels were similar in the two groups. The mean (±SE) change in the hemoglobin level from baseline to weeks 28 through 52 was 0.74±0.02 g per deciliter in the daprodustat group and 0.66±0.02 g per deciliter in the darbepoetin alfa group (difference, 0.08 g per deciliter; 95% confidence interval [CI], 0.03 to 0.13), which met the prespecified noninferiority margin of -0.75 g per deciliter. During a median follow-up of 1.9 years, a first MACE occurred in 378 of 1937 patients (19.5%) in the daprodustat group and in 371 of 1935 patients (19.2%) in the darbepoetin alfa group (hazard ratio, 1.03; 95% CI, 0.89 to 1.19), which met the prespecified noninferiority margin of 1.25. The percentages of patients with adverse events were similar in the two groups. CONCLUSIONS: Among patients with CKD and anemia who were not undergoing dialysis, daprodustat was noninferior to darbepoetin alfa with respect to the change in the hemoglobin level from baseline and with respect to cardiovascular outcomes. (Funded by GlaxoSmithKline; ASCEND-ND ClinicalTrials.gov number, NCT02876835.).


Subject(s)
Anemia/drug therapy , Barbiturates/therapeutic use , Darbepoetin alfa/therapeutic use , Glycine/analogs & derivatives , Hematinics/therapeutic use , Renal Insufficiency, Chronic/complications , Aged , Anemia/etiology , Barbiturates/adverse effects , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/mortality , Darbepoetin alfa/adverse effects , Female , Glycine/adverse effects , Glycine/therapeutic use , Hematinics/adverse effects , Hemoglobins/analysis , Humans , Hypoxia-Inducible Factor-Proline Dioxygenases/antagonists & inhibitors , Intention to Treat Analysis , Male , Middle Aged , Myocardial Infarction/epidemiology , Renal Insufficiency, Chronic/blood , Stroke/epidemiology
18.
Biomed Res Int ; 2021: 7073348, 2021.
Article in English | MEDLINE | ID: covidwho-1560583

ABSTRACT

Coronavirus disease 2019 (COVID-19) may lead to acute respiratory disease; cardiovascular, gastrointestinal, and coagulation complications; and even death. One of the major complications is cardiovascular disorders, including arrhythmias, myocarditis, pericarditis, and acute coronary artery disease. The aim of this study was to evaluate the frequency of cardiovascular complications and to determine its association with the prognosis of COVID-19 patients. In a prospective analytic study, 137 hospitalized COVID-19 patients were enrolled. During hospitalization, an electrocardiogram (ECG) was performed every other day, and laboratory tests such as cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) were done 0, 6, and 12 hours after admission. These tests were repeated for patients with chest pain or ECG changes. Patients were categorized into three groups (improved, complicated, and expired patients) and assessed for the rate and type of arrhythmias, cardiac complications, lab tests, and outcomes of treatments. There was no significant relationship among the three groups related to primary arrhythmia and arrhythmias during treatment. The most common arrhythmia during hospitalization and after treatment was ST-T fragment changes. There was a significant age difference between the three groups (P = 0.001). There was a significant difference among the three groups for some underlying diseases, including diabetes mellitus (P = 0.003) and hyperlipidemia (P = 0.004). In our study, different types of arrhythmias had no association with patients' outcomes but age over 60 years, diabetes mellitus, and hyperlipidemia played an important role in the prognosis of COVID-19 cases.


Subject(s)
COVID-19/complications , COVID-19/pathology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/pathology , Adult , Aged , Blood Coagulation/physiology , COVID-19/metabolism , Cardiovascular Diseases/metabolism , Creatine Kinase/metabolism , Electrocardiography/methods , Female , Heart/physiopathology , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Troponin I/metabolism , Young Adult
19.
Curr Opin Anaesthesiol ; 35(1): 5-11, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1537582

ABSTRACT

PURPOSE OF REVIEW: Cardiovascular involvement in coronavirus disease 2019 (COVID-19) is relatively common and portends an increased risk of morbidity and mortality. Manifestations of myocardial injury may exhibit significant overlap and result in diagnostic uncertainty. This review will summarize recent literature around cardiovascular complications of COVID-19. RECENT FINDINGS: Venous thromboembolism, atrial fibrillation, and type II myocardial infarction are observed commonly in COVID-19, while severe acute respiratory syndrome coronavirus 2 viral myocarditis remains quite rare. Although infrequent, COVID-19 vaccination has been associated with myocarditis and pericarditis in young individuals. SUMMARY: Various forms of COVID-19-related myocardial injury have been associated with increased utilization of mechanical ventilation, hemodynamic deterioration, and mortality. Manifestations of myocardial injury in COVID-19 are varied, but share common drivers of illness including sequelae of sepsis, immune-mediated factors, and a prothrombotic state. Understanding the forms of myocardial injury in COVID-19 may aid in rapid diagnosis and treatment.


Subject(s)
COVID-19 , Cardiovascular Diseases , Myocarditis , COVID-19 Vaccines , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Humans , Myocarditis/diagnosis , Myocarditis/epidemiology , Myocarditis/etiology , SARS-CoV-2
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