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3.
J Cardiovasc Med (Hagerstown) ; 22(11): 818-827, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1450783

ABSTRACT

AIMS: Currently, there are few available data regarding a possible role for subclinical atherosclerosis as a risk factor for mortality in Coronavirus Disease 19 (COVID-19) patients. We used coronary artery calcium (CAC) score derived from chest computed tomography (CT) scan to assess the in-hospital prognostic role of CAC in patients affected by COVID-19 pneumonia. METHODS: Electronic medical records of patients with confirmed diagnosis of COVID-19 were retrospectively reviewed. Patients with known coronary artery disease (CAD) were excluded. A CAC score was calculated for each patient and was used to categorize them into one of four groups: 0, 1-299, 300-999 and at least 1000. The primary endpoint was in-hospital mortality for any cause. RESULTS: The final population consisted of 282 patients. Fifty-seven patients (20%) died over a follow-up time of 40 days. The presence of CAC was detected in 144 patients (51%). Higher CAC score values were observed in nonsurvivors [median: 87, interquartile range (IQR): 0.0-836] compared with survivors (median: 0, IQR: 0.0-136). The mortality rate in patients with a CAC score of at least 1000 was significantly higher than in patients without coronary calcifications (50 vs. 11%) and CAC score 1-299 (50 vs. 23%), P < 0.05. After adjusting for clinical variables, the presence of any CAC categories was not an independent predictor of mortality; however, a trend for increased risk of mortality was observed in patients with CAC of at least 1000. CONCLUSION: The correlation between CAC score and COVID-19 is fascinating and under-explored. However, in multivariable analysis, the CAC score did not show an additional value over more robust clinical variables in predicting in-hospital mortality. Only patients with the highest atherosclerotic burden (CAC ≥1000) could represent a high-risk population, similarly to patients with known CAD.


Subject(s)
COVID-19 , Coronary Artery Disease , Coronary Vessels , Hospital Mortality , Vascular Calcification/diagnostic imaging , COVID-19/diagnosis , COVID-19/mortality , Coronary Artery Disease/diagnosis , Coronary Vessels/diagnostic imaging , Coronary Vessels/pathology , Female , Heart Disease Risk Factors , Hospitalization/statistics & numerical data , Humans , Italy/epidemiology , Male , Middle Aged , Predictive Value of Tests , Prognosis , Retrospective Studies , SARS-CoV-2/isolation & purification , Tomography, X-Ray Computed/methods , Vascular Calcification/epidemiology
5.
JMIR Public Health Surveill ; 7(9): e29990, 2021 09 30.
Article in English | MEDLINE | ID: covidwho-1443977

ABSTRACT

BACKGROUND: The COVID-19 pandemic has required clinicians to pivot to offering services via telehealth; however, it is unclear which patients (users of care) are equipped to use digital health. This is especially pertinent for adults managing chronic diseases, such as obesity, hypertension, and diabetes, which require regular follow-up, medication management, and self-monitoring. OBJECTIVE: The aim of this study is to measure the trends and assess factors affecting health information technology (HIT) use among members of the US population with and without cardiovascular risk factors. METHODS: We used serial cross-sectional data from the National Health Interview Survey for the years 2012-2018 to assess trends in HIT use among adults, stratified by age and cardiovascular risk factor status. We developed multivariate logistic regression models adjusted for age, sex, race, insurance status, marital status, geographic region, and perceived health status to assess the likelihood of HIT use among patients with and without cardiovascular disease risk factors. RESULTS: A total of 14,304 (44.6%) and 14,644 (58.7%) participants reported using HIT in 2012 and 2018, respectively. When comparing the rates of HIT use for the years 2012 and 2018, among participants without cardiovascular risk factors, the HIT use proportion increased from 51.1% to 65.8%; among those with one risk factor, it increased from 43.9% to 59%; and among those with more than one risk factor, it increased from 41.3% to 54.7%. Increasing trends in HIT use were highest among adults aged >65 years (annual percentage change [APC] 8.3%), who had more than one cardiovascular risk factor (APC 5%) and among those who did not graduate from high school (APC 8.8%). Likelihood of HIT use was significantly higher in individuals who were younger, female, and non-Hispanic White; had higher education and income; were married; and reported very good or excellent health status. In 2018, college graduates were 7.18 (95% CI 5.86-8.79), 6.25 (95% CI 5.02-7.78), or 7.80 (95% CI 5.87-10.36) times more likely to use HIT compared to adults without high school education among people with multiple cardiovascular risk factors, one cardiovascular risk factor, or no cardiovascular risk factors, respectively. CONCLUSIONS: Over 2012-2018, HIT use increased nationally, with greater use noted among younger and higher educated US adults. Targeted strategies are needed to engage wider age, racial, education, and socioeconomic groups by lowering barriers to HIT access and use.


Subject(s)
Heart Disease Risk Factors , Medical Informatics/statistics & numerical data , Adolescent , Adult , Aged , Cardiovascular Diseases/epidemiology , Cross-Sectional Studies , Female , Health Surveys , Humans , Male , Middle Aged , United States/epidemiology , Young Adult
6.
Int J Environ Res Public Health ; 18(19)2021 Sep 23.
Article in English | MEDLINE | ID: covidwho-1438597

ABSTRACT

The current study assessed performance of the new Veterans Affairs (VA) women cardiovascular disease (CVD) risk score in predicting women veterans' 60-day CVD event risk using VA COVID-19 shared cohort data. The study data included 17,264 women veterans-9658 White, 6088 African American, and 1518 Hispanic women veterans-ever treated at US VA hospitals and clinics between 24 February and 25 November 2020. The VA women CVD risk score discriminated patients with CVD events at 60 days from those without CVD events with accuracy (area under the curve) of 78%, 50%, and 83% for White, African American, and Hispanic women veterans, respectively. The VA women CVD risk score itself showed good accuracy in predicting CVD events at 60 days for White and Hispanic women veterans, while it performed poorly for African American women veterans. The future studies are needed to identify non-traditional factors and biomarkers associated with increased CVD risk specific to African American women and incorporate them to the CVD risk assessment.


Subject(s)
COVID-19 , Cardiovascular Diseases , Veterans , Cardiovascular Diseases/epidemiology , Female , Heart Disease Risk Factors , Humans , Incidence , Information Dissemination , Risk Factors , SARS-CoV-2 , United States/epidemiology , United States Department of Veterans Affairs
7.
Circ J ; 85(11): 2111-2115, 2021 10 25.
Article in English | MEDLINE | ID: covidwho-1435579

ABSTRACT

BACKGROUND: This study aimed to determine whether disease severity varied according to whether coronavirus disease 2019 (COVID-19) patients had multiple or single cardiovascular diseases and risk factors (CVDRFs).Methods and Results:COVID-19 patients with single (n=281) or multiple (n=412) CVDRFs were included retrospectively. Multivariable logistic regression showed no significant difference in the risk of in-hospital death between groups, but patients with multiple CVDRFs had a significantly higher risk of acute respiratory distress syndrome (odds ratio: 1.75, 95% confidence interval: 1.09-2.81). CONCLUSIONS: COVID-19 patients with multiple CVDRFs have a higher risk of complications than those with a single CDVRF.


Subject(s)
COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/mortality , COVID-19/therapy , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/mortality , Cardiovascular Diseases/therapy , Female , Health Status , Heart Disease Risk Factors , Hospital Mortality , Humans , Japan/epidemiology , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Assessment , Severity of Illness Index
8.
Dtsch Med Wochenschr ; 146(19): 1270-1276, 2021 Oct.
Article in German | MEDLINE | ID: covidwho-1434172

ABSTRACT

The recently published guidelines "Sports cardiology and exercise in patients with cardiovascular disease" (2020) are the first of a kind by the European Society of Cardiology (ESC). The guidelines provide comprehensive training recommendations for patients with cardiovascular diseases or risk factors, covering the entire spectrum of cardiovascular diseases with case-specific recommendations for recreational and competitive sports.The ESC recognizes exercise as an essential part of both prevention and therapy of cardiovascular diseases, that - comparable to drug therapies - requires correct prescription.The initial cardiac examination is used for individual risk stratification and is indispensable for individualized training recommendations addressing training frequency, duration and intensity, as well as type of sport.Thus, the question is not whether a patient with cardiovascular disease shall be allowed to exercise, but rather how he can safely perform it. Only in exceptional cases exercise therapy is (temporarily) contraindicated.COVID-19 can lead to cardiovascular complications even in asymptomatic and mild disease courses. Before resuming intense sporting activities, different return-to-sports protocols have been introduced. The current consensus is that the extent of these examinations should be based on symptoms, severity and duration of COVID-19 and that individual return-to-training recommendations should be given.


Subject(s)
COVID-19 , Cardiovascular Diseases , Heart Disease Risk Factors , Sports/physiology , Exercise , Humans , Practice Guidelines as Topic , Return to Sport
9.
Nurs Res ; 70(5S Suppl 1): S3-S12, 2021.
Article in English | MEDLINE | ID: covidwho-1429365

ABSTRACT

BACKGROUND: Black/African American women in the United States are more likely to live in neighborhoods with higher social vulnerability than other racial/ethnic groups, even when adjusting for personal income. Social vulnerability, defined as the degree to which the social conditions of a community affect its ability to prevent loss and suffering in the event of disaster, has been used in research as an objective measure of neighborhood social vulnerability. Black/African American women also have the highest rates of hypertension and obesity in the United States. OBJECTIVES: The purpose of this study was to examine the relationship between neighborhood social vulnerability and cardiovascular risk (hypertension and obesity) among Black/African American women. METHODS: We conducted a secondary analysis of data from the InterGEN Study that enrolled Black/African American women in the Northeast United States. Participants' addresses were geocoded to ascertain neighborhood vulnerability using the Centers for Disease Control and Prevention's Social Vulnerability Index at the census tract level. We used multivariable regression models to examine associations between objective measures of neighborhood quality and indicators of structural racism and systolic and diastolic blood pressure and obesity (body mass index > 24.9) and to test psychological stress, coping, and depression as potential moderators of these relationships. RESULTS: Seventy-four percent of participating Black/African American women lived in neighborhoods in the top quartile for social vulnerability nationally. Women living in the top 10% of most socially vulnerable neighborhoods in our sample had more than a threefold greater likelihood of hypertension when compared to those living in less vulnerable neighborhoods. Objective neighborhood measures of structural racism (percentage of poverty, percentage of unemployment, percentage of residents >25 years old without a high school diploma, and percentage of residents without access to a vehicle) were significantly associated with elevated diastolic blood pressure and obesity in adjusted models. Psychological stress had a significant moderating effect on the associations between neighborhood vulnerability and cardiovascular risk. DISCUSSION: We identified important associations between structural racism, the neighborhood environment, and cardiovascular health among Black/African American women. These findings add to a critical body of evidence documenting the role of structural racism in perpetuating health inequities and highlight the need for a multifaceted approach to policy, research, and interventions to address racial health inequities.


Subject(s)
/ethnology , Heart Disease Risk Factors , Social Segregation/psychology , Adult , /statistics & numerical data , COVID-19/prevention & control , COVID-19/psychology , Female , Humans , Middle Aged , Ohio , Socioeconomic Factors
11.
Int J Environ Res Public Health ; 18(16)2021 08 23.
Article in English | MEDLINE | ID: covidwho-1367842

ABSTRACT

Background: The COVID-19 pandemic is a serious global health problem. In Italy, to limit the infections, the government ordered lockdown from March 2020. This measure, designed to contain the virus, led to serious limitations on the daily life of the individuals it affected, and in particular in the limitation of physical exercise. The aim of this study was to evaluate the effects of reduced physical activity on the lipid profile in patients with high cardiovascular risk. Methods: We enrolled 38 dyslipidemic patients, 56% male, with an age range of 44-62 years, considered to be at high cardiovascular risk. All patients were prescribed statin drug therapy (atorvastatin 40 mg) and a vigorous physical activity program four times a week, 1 h per session. In addition, a personalized Mediterranean diet was prescribed to all the patients. Total cholesterol, LDL, HDL and triglycerides were measured in patients at T0 before lockdown and at T1 during lockdown. Results: Data showed a significant increase (p < 0.01) in total cholesterol (+6,8%) and LDL (+15,8%). Furthermore, the analysis of the data revealed a reduction in HDL (-3%) and an increase in triglycerides (+3,2%), although both were not significant (p > 0.05). Conclusions: Our study showed that the reduction in physical activity during lockdown led to an increase in LDL levels, and therefore, in the risk of ischemic heart disease in dyslipidemic patients with high cardiovascular risk.


Subject(s)
COVID-19 , Cardiovascular Diseases , Adult , Cardiovascular Diseases/epidemiology , Cholesterol, HDL , Cholesterol, LDL , Communicable Disease Control , Exercise , Female , Heart Disease Risk Factors , Humans , Lipids , Male , Middle Aged , Pandemics , Risk Factors , SARS-CoV-2
12.
Hamostaseologie ; 41(5): 366-370, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1356592

ABSTRACT

Diagnosing myocarditis is still challenging due to its varying presentation ranging from none or mild symptoms to sudden cardiac death. Clinical presentation, electrocardiography, and cardiac biomarkers seem not to be sufficient for a reliable diagnosis. In fact, an unequivocal myocardial characterization is needed, applying endomyocardial biopsy (EMB) and cardiac magnetic resonance (CMR), a technique which demonstrates high accuracy to histology. Besides the assessment of functional parameters (volumes, ejection fraction), established late gadolinium enhancement and recent T1 and T2 mapping techniques including the calculation of extracellular volume fraction allow distinct myocardial tissue analysis by a noninvasive approach without the need of radiation. However, EMB is the only method which allows the identification of the underlying etiology of cardiac inflammation. Since myocardial damage and inflammation seem to be prevalent in a considerable number of patients even in the mid-term range after COVID-19, CMR and EMB seem to be adequate tools to further investigate these findings. In this article, we will (1) review current knowledge about the role of CMR in the COVID-19 pandemic and (2) report about our own EMB findings in COVID-19 patients in the Cardiopathology Center of our University Hospital.


Subject(s)
COVID-19/complications , Myocarditis/diagnosis , Myocarditis/etiology , SARS-CoV-2 , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy/methods , Endocardium/pathology , Female , Heart Disease Risk Factors , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Myocarditis/diagnostic imaging , Myocardium/pathology , Pandemics , SARS-CoV-2/pathogenicity , Young Adult
13.
Int J Environ Res Public Health ; 18(16)2021 Aug 13.
Article in English | MEDLINE | ID: covidwho-1354970

ABSTRACT

Preceding coronavirus outbreaks resulted in social isolation, which in turn is associated with cardiovascular consequences. Whether the current COVID-19 pandemic negatively impacts cardiovascular health is unclear. The aim of the rapid review was to investigate, whether COVID-19 lockdown influences modifiable cardiovascular risk factors (i.e., physical inactivity, sedentary behaviour, smoking, alcohol use, unhealthy diet, obesity, bad blood lipids, and hypertension) in the general population. Medline and EMBASE were searched until March 2021. Title, abstracts, and full texts were screened by one reviewer and 20% by a second reviewer. Only studies using probability sampling were included in order to ensure the representativeness of the target population. Data extraction and critical appraisal were done by one reviewer and double-checked by another reviewer. We identified 32 studies that fulfilled our inclusion criteria. Findings show that physical activity decreased, and sedentary behaviour increased among all age groups during the COVID-19 lockdown. Among adults, alcohol consumption increased, dietary quality worsened, and the amount of food intake increased. Some adults reported weight gain. Studies on children and adolescents were sparse. This rapid review found a high number of epidemiological studies on the impact of COVID-19 lockdown measures on modifiable cardiovascular risk factors, but only a few used probability sampling methods.


Subject(s)
COVID-19 , Cardiovascular Diseases , Adolescent , Adult , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Child , Communicable Disease Control , Heart Disease Risk Factors , Humans , Pandemics , Quarantine , Risk Factors , SARS-CoV-2
14.
Hamostaseologie ; 41(5): 350-355, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1351995

ABSTRACT

COVID-19 bezeichnet eine der schlimmsten Krisen unserer Generation und stellt (nicht nur) für das Gesundheitssystem eine schwer bewältigbare Herausforderung dar. Mortalität und Morbidität sind im Vergleich zu anderen saisonalen Erkrankungen wie der Influenza deutlich erhöht. COVID-19 bedroht allerdings nicht die gesamte Bevölkerung in gleichem Maße. Hochrisikopatienten sind älter und leiden an kardiovaskulären Erkrankungen wie Bluthochdruck, Diabetes mellitus oder einer koronaren Herzerkrankung. Um das Risiko für einen schweren Erkrankungsverlaufs zu quantifizieren bedarf es einer multimodalen Herangehensweise. Verschiedene Risikostratifizierungssysteme stehen zu Verfügung um ungünstige Verläufe wie Intensivbehandlung oder Gesamtmortalität vorauszusagen. Biomarker wie Troponin-I, D-Dimere und NT pro-BNP kombiniert mit echokardiographischen Parametern wie links- und rechtsventrikulärer Pumpfunktion sowie pulmonalarteriellem Druck können hilfreich sein um Hochrisikopatienten zu identifizieren, die ein intensiviertes Monitoring und eine stringentere Behandlung benötigen. Da kardiovaskuläre Risikofaktoren und Komorbiditäten von großer Bedeutung zur Abschätzung des Verlaufs einer SARS-CoV-2 Infektion sind, könnten alle hospitalisierten COVID-19 Patienten von einer routinemäßigen kardiologischen Betreuung durch ein COVID-19-Heart-Team profitieren. Ein frühzeitiges Erkennen von (kardiovaskulären) Hochrisikopatienten könnte das Management erleichtern sowie die Prognose einer schweren SARS-CoV-2 Infektion verbessern.


Subject(s)
COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , SARS-CoV-2 , Biomarkers/analysis , COVID-19/therapy , Cardiovascular Diseases/diagnostic imaging , Cardiovascular Diseases/physiopathology , Comorbidity , Echocardiography , Heart Disease Risk Factors , Humans , Models, Cardiovascular , Pandemics , Prognosis , Risk Assessment , SARS-CoV-2/pathogenicity , Severity of Illness Index
15.
Cir Cir ; 89(4): 435-442, 2021.
Article in English | MEDLINE | ID: covidwho-1339796

ABSTRACT

INTRODUCCIÓN: en la actual pandemia de COVID-19, existe evidencia creciente que ha identificado el neurotropismo del virus SARS-CoV-2 y sus complicaciones neurológicas, incluida la enfermedad cerebrovascular isquémica y escasamente hemorragia cerebral (HC). OBJETIVO: describir las características clínicas, radiológicas, de laboratorio y pronósticas de los pacientes con HC asociada al SARS-CoV-2. MÉTODOS: se incluyeron pacientes consecutivos con prueba de PCR confirmatoria para infección por SARS-CoV-2 y HC. RESULTADOS: en un período de 90 días, en un centro de referencia COVID-19 en México, de 1108 pacientes con infección por SARS-CoV-2, se encontraron 4 pacientes (0.36%) con HC. Tenían una edad de 71(±12.2) años, 2 eran mujeres. Se encontró que dos tenían factores de riesgo cardiovascular previos. En dos casos se encontró el origen en el núcleo dentado mientras que los otros dos correspondieron al tálamo. Tres de los cuatro pacientes murieron. Postulamos que el descontrol hipertensivo, coagulopatía, trombocitopenia y la respuesta inmune inducida por el virus SARS-CoV-2 podrían desencadenar HC en un paciente con riesgo previo. CONCLUSIONES: la HC se asocia a la infección por SARS-CoV-2 con mal pronóstico cuando se presenta. Los equipos de neurocirugía deben estar preparados para el tratamiento oportuno de estos pacientes. INTRODUCTION: In the current COVID-19 pandemic, there is a growing body of evidence that has identified the neurotropism of the SARS-CoV-2 virus and its neurological complications, including cerebrovascular disease, focusing mainly in ischemic and scarcely about hemorrhagic stroke (HS). OBJECTIVE: The objective of the study was to describe clinical, radiological, laboratory tests, and prognostic characteristics of patients with SARS-CoV-2 associated HS. METHODS: Consecutive patients with a confirmatory PCR test for SARS-CoV-2 infection and a HS demonstrated by head CT were included in the study. RESULTS: Over a period of 90 days, in a COVID-19 reference center in Mexico, out of a total of 1108 patients with SARS-CoV-2 infection, it found 4 patients (0.36%) who meet criteria. They had an age of 71 (±12.2) years, 2 were women. It was found that two had prior cardiovascular risk factors. Two of the HS originated in the dentate nucleus while the other two corresponded to the thalamus. Three of the four patients died. We suggest that catastrophic uncontrolled blood pressure, coagulopathy, thrombocytopenia, and immune response induced by SARS-CoV-2 could in a specific patient trigger HS. CONCLUSIONS: HS is associated to SARS-CoV-2 infection with poor prognosis when it presented. Neurosurgery teams should prepare for the timely and appropriate treatment of this patients.


Subject(s)
COVID-19/complications , Hemorrhagic Stroke/etiology , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19 Nucleic Acid Testing , Fatal Outcome , Female , Heart Disease Risk Factors , Hemorrhagic Stroke/diagnosis , Hemorrhagic Stroke/diagnostic imaging , Hospitals, General , Humans , Male , Mexico/epidemiology , Middle Aged , Prognosis , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
16.
Contemp Clin Trials ; 108: 106520, 2021 09.
Article in English | MEDLINE | ID: covidwho-1330680

ABSTRACT

BACKGROUND: Near highway residents are exposed to elevated levels of traffic-related air pollution (TRAP), including ultrafine particles, which are associated with adverse health effects. The efficacy of using in-home air filtration units that reduce exposure and potentially yield health benefits has not been tested in a randomized controlled trial. METHODS: We will conduct a randomized double-blind crossover trial of portable air filtration units for 200 adults 30 years and older who live in near-highway homes in Somerville, MA, USA. We will recruit participants from 172 households. The intervention periods will be one month of true or sham filtration, followed by a one-month wash out period and then a month of the alternate intervention. The primary health outcome will be systolic blood pressure (BP); secondary outcome measures will include diastolic and central BP, C-Reactive Protein (CRP) and D-dimer. Reasons for success or failure of the intervention will be evaluated in a subset of homes using indoor/outdoor monitoring for particulate pollution, personal monitoring, size and composition of particulate pollution, tracking of time spent in the room with the filter, and interviews for qualitative feedback. RESULTS: This trial has begun recruitment and is expected to take 2-3 years to be completed. Recruitment has been particularly challenging because of additional precautions required by the COVID-19 pandemic. DISCUSSION: This study has the potential to shed light on the value of using portable air filtration in homes close to highways to reduce exposure to TRAP and whether doing so has benefits for cardiovascular health.


Subject(s)
COVID-19 , Cardiovascular Diseases , Adult , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Cross-Over Studies , Heart Disease Risk Factors , Humans , Pandemics , Risk Factors , SARS-CoV-2
18.
BMC Cardiovasc Disord ; 21(1): 327, 2021 07 03.
Article in English | MEDLINE | ID: covidwho-1295438

ABSTRACT

BACKGROUND: The relative association between cardiovascular (CV) risk factors, such as diabetes and hypertension, established CV disease (CVD), and susceptibility to CV complications or mortality in COVID-19 remains unclear. METHODS: We conducted a cohort study of consecutive adults hospitalised for severe COVID-19 between 1st March and 30th June 2020. Pre-existing CVD, CV risk factors and associations with mortality and CV complications were ascertained. RESULTS: Among 1721 patients (median age 71 years, 57% male), 349 (20.3%) had pre-existing CVD (CVD), 888 (51.6%) had CV risk factors without CVD (RF-CVD), 484 (28.1%) had neither. Patients with CVD were older with a higher burden of non-CV comorbidities. During follow-up, 438 (25.5%) patients died: 37% with CVD, 25.7% with RF-CVD and 16.5% with neither. CVD was independently associated with in-hospital mortality among patients < 70 years of age (adjusted HR 2.43 [95% CI 1.16-5.07]), but not in those ≥ 70 years (aHR 1.14 [95% CI 0.77-1.69]). RF-CVD were not independently associated with mortality in either age group (< 70 y aHR 1.21 [95% CI 0.72-2.01], ≥ 70 y aHR 1.07 [95% CI 0.76-1.52]). Most CV complications occurred in patients with CVD (66%) versus RF-CVD (17%) or neither (11%; p < 0.001). 213 [12.4%] patients developed venous thromboembolism (VTE). CVD was not an independent predictor of VTE. CONCLUSIONS: In patients hospitalised with COVID-19, pre-existing established CVD appears to be a more important contributor to mortality than CV risk factors in the absence of CVD. CVD-related hazard may be mediated, in part, by new CV complications. Optimal care and vigilance for destabilised CVD are essential in this patient group. Trial registration n/a.


Subject(s)
COVID-19 , Cardiovascular Diseases , Diabetes Mellitus/epidemiology , Hospital Mortality , Hypertension/epidemiology , Venous Thromboembolism , Age Factors , Aged , COVID-19/mortality , COVID-19/physiopathology , COVID-19/therapy , Cardiovascular Diseases/complications , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Cohort Studies , Female , Heart Disease Risk Factors , Humans , Male , Mortality , Outcome and Process Assessment, Health Care , Risk Assessment/methods , Risk Assessment/statistics & numerical data , SARS-CoV-2/isolation & purification , United Kingdom/epidemiology , Venous Thromboembolism/diagnosis , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology
19.
Can J Cardiol ; 37(7): 1112-1116, 2021 07.
Article in English | MEDLINE | ID: covidwho-1293650

ABSTRACT

The supply limitations of COVID-19 vaccines have led to the need to prioritize vaccine distribution. Obesity, diabetes, and hypertension have been associated with an increased risk of severe COVID-19 infection. Approximately half as many individuals with a cardiovascular risk factor need to be vaccinated against COVID-19 to prevent related death compared with individuals without a risk factor. Adults with body mass index ≥ 30, diabetes, or hypertension should be of a similar priority for COVID-19 vaccination to adults 10 years older with a body mass index of 20 to < 30, no diabetes, and no hypertension.


Subject(s)
COVID-19 Vaccines/supply & distribution , COVID-19/mortality , COVID-19/prevention & control , Health Priorities/organization & administration , Heart Disease Risk Factors , Needs Assessment , Adult , Aged , Aged, 80 and over , Canada , Female , Humans , Male , Middle Aged
20.
Glob Heart ; 16(1): 8, 2021 01 28.
Article in English | MEDLINE | ID: covidwho-1285507

ABSTRACT

Although the attention of the world and the global health community specifically is deservedly focused on the COVID-19 pandemic, other determinants of health continue to have large impacts and may also interact with COVID-19. Air pollution is one crucial example. Established evidence from other respiratory viruses and emerging evidence for COVID-19 specifically indicates that air pollution alters respiratory defense mechanisms leading to worsened infection severity. Air pollution also contributes to co-morbidities that are known to worsen outcomes amongst those infected with COVID-19, and air pollution may also enhance infection transmission due to its impact on more frequent coughing. Yet despite the massive disruption of the COVID-19 pandemic, there are reasons for optimism: broad societal lockdowns have shown us a glimpse of what a future with strong air pollution measures could yield. Thus, the urgency to combat air pollution is not diminished, but instead heightened in the context of the pandemic.


Subject(s)
Air Pollution/adverse effects , Cardiovascular Diseases/physiopathology , Global Health , Acute Disease , American Heart Association , COVID-19 , Cardiology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/metabolism , Chronic Disease , Environmental Health , Europe , Heart Disease Risk Factors , Humans , Inflammation , Oxidative Stress , SARS-CoV-2 , Societies, Medical , United States
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