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The number of people with long-term consequences of COVID-19 is increasing worldwide. The long-term prognosis for patients remains poorly understood. Objective. To study cardiometabolic and psychocognitive features in comorbid elderly patients with atrial fibrillation (AF), de-pending on the presence of post-COVID syndrome (PCS). Material and methods. The observational analytical cohort study included 223 patients with AF and comorbidity (coronary artery disease, hypertension, obesity, type 2 diabetes mellitus) aged 60-74, who were divided into two groups: group 1 included 123 patients without COVID-19 and group 2 included 110 patients with a history of COVID-19 and the presence of PCS. The study evaluated laboratory and instrumental tests, and a general clinical study assessing psychocognitive disorders using the SPMSQ and HADS questionnaires was conducted. Results and discussion. In COVID-19 survivors, compared with patients of group 1, there were more pronounced atherogenic changes in total cholesterol (TC) (p=0.003), low-density lipoprotein cholesterol (p<0.001), and triglycerides (p=0.011). Lower dia-stolic blood pressure was found in COVID-19 survivors (p<0.001). In addition, patients in group 2 had higher median pulse pressure (p<0.001) and heart rate (p<0.001). In group 2 patients, a larger ascending aorta diameter was observed (p<0.001). The anx-iety-depressive syndrome was more common in COVID-19 survivors with comorbidities, and a statistically significant difference was found in clinical anxiety (24%, p=0.041) and subclinical depression (21%, p=0.015). When assessing cognitive function, mod-erate cognitive impairment was detected in 22% (p=0.005) of patients with PCS and severe cognitive impairment in 2% (p=0.007). Conclusion. In comorbid elderly patients with the post-COVID syndrome, a high prevalence of psychocognitive disorders and adverse cardiometabolic changes were observed, supporting the need for long-term monitoring of the general clinical condition and psychocognitive status of COVID-19 survivors.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
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Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.
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The number of people with long-term consequences of COVID-19 is increasing worldwide. The long-term prognosis for patients remains poorly understood. Objective. To study cardiometabolic and psychocognitive features in comorbid elderly patients with atrial fibrillation (AF), de-pending on the presence of post-COVID syndrome (PCS). Material and methods. The observational analytical cohort study included 223 patients with AF and comorbidity (coronary artery disease, hypertension, obesity, type 2 diabetes mellitus) aged 60-74, who were divided into two groups: group 1 included 123 patients without COVID-19 and group 2 included 110 patients with a history of COVID-19 and the presence of PCS. The study evaluated laboratory and instrumental tests, and a general clinical study assessing psychocognitive disorders using the SPMSQ and HADS questionnaires was conducted. Results and discussion. In COVID-19 survivors, compared with patients of group 1, there were more pronounced atherogenic changes in total cholesterol (TC) (p=0.003), low-density lipoprotein cholesterol (p<0.001), and triglycerides (p=0.011). Lower dia-stolic blood pressure was found in COVID-19 survivors (p<0.001). In addition, patients in group 2 had higher median pulse pressure (p<0.001) and heart rate (p<0.001). In group 2 patients, a larger ascending aorta diameter was observed (p<0.001). The anx-iety-depressive syndrome was more common in COVID-19 survivors with comorbidities, and a statistically significant difference was found in clinical anxiety (24%, p=0.041) and subclinical depression (21%, p=0.015). When assessing cognitive function, mod-erate cognitive impairment was detected in 22% (p=0.005) of patients with PCS and severe cognitive impairment in 2% (p=0.007). Conclusion. In comorbid elderly patients with the post-COVID syndrome, a high prevalence of psychocognitive disorders and adverse cardiometabolic changes were observed, supporting the need for long-term monitoring of the general clinical condition and psychocognitive status of COVID-19 survivors.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
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Background and aims: The impact of the COVID-19 pandemic on mental health and well-being is a matter of significant concern. Besides the depression associated with diabetes mellitus (DM) diagnosis and management, the COVID-19 pandemic has also imposed significant distress among people with DM. Method(s): This is a narrative review of the interplay between DM management and depression amid the COVID-19 pandemic. Electronic databases, namely;PubMed, CINAHL, EMBASE and Google Scholar were searched for literature. Search terms were "diabetes", "depression", and ''corona virus", "COVID-19","diabetes self-care","diabetes self-care in low income countries and diabetes management in Zimbabwe". Result(s): This paper discusses the interaction between DM and depression, amid the COVID-19 pandemic. We further explain the implications on DM management, screening and elaborate on possible solutions to effective prevention and management of depression. Conclusion(s): We have made recommendations for prevention and management of depression such as collaborative practice, early and routine screening, meticulous self-care and use of non-pharmacological strategies.Copyright © 2020 FSG Communications Ltd. All rights reserved.
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Background: Dyslipidemias and essential fatty acid deficiencies (EFADs) are well established complications of cystic fibrosis (CF). In the general population, a diet high in saturated fat is associated with hyperlipidemia and greater risk of cardiovascular disease and type 2 diabetes. Increasing life expectancy in CF brings concern about the risks of the "legacy" high-fat CF diet. The impact of CFTR modulators on CF-related dyslipidemia and EFAD is not known. Previous studies reported dyslipidemia in people with CF (PwCF) using traditional lipid measures. This study aimed to evaluate the lipoprotein and fatty acid profiles in children and adolescents with CF and to correlate biochemical results with clinical and molecular findings. Plasma and red blood cell (RBC) samples were studied to compare the ability of each method to identify EFAD markers. Method(s): Blood samples (n = 171) were obtained from 142 (78 female) children with CF aged 9.8 +/- 4.7 (range 4 months to 18 years) during routine laboratory draws at pediatric CF center clinic visits. Pancreatic insufficiency was present in 92% and glucose intolerance or diabetes in 14%. Body mass index percentile (BMI%ile) for age z-scorewas 0.23 +/- 0.89 (range -2.4-2.6). F508del mutation was homozygous for 56% and heterozygous for 41%. CFTR modulator therapy had been initiated 3 or more months before for 62% of samples. Sample collection began in September 2019, paused during the COVID-19 pandemic, and resumed in July 2021. An accredited, regional laboratory with expertise in fatty acid analysis processed all samples. Serum was separated and refrigerated for lipoprotein analysis, plasmawas separated and frozen, and RBCs were washed and frozen for fatty acid analysis. Nuclear magnetic resonance lipoprotein assayswere conducted to determine particle number and size of lipoprotein classes. Triglyceride, total cholesterol, and high-density lipoprotein cholesterol (HDL-C) were measured directly (Roche). Low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) were calculated. To correlate laboratory results with clinical findings, medical records were reviewed, and a CF clinic dietitian conducted 24-hour dietary recalls concurrent with study labs. Result(s): Of PwCF homozygous F508del/F508del, 43% tested positive for EFAD biomarkers (RBC linoleic acid, RBC mead acid, RBC triene/tetraene ratio), compared with 13% of PwCF heterozygous F508del ( p <=0.01) (Figure 1). There was no significant difference in concentrations of fatty acid and EFAD biomarkers between those who had or had not initiated CFTR modulator therapy. Lipoprotein abnormalities were identified in 69% of samples with low HDL-C and 39% with large HDL-C, 87% with large VLDL-C particle size and 52% with large VLDL-C particle number, and 5% with high LDL-C or small LDL-C particle numbers. High total cholesterol was found in 15% and high triglycerides in 17%. HDL-C was low in 24%, and 3% had high LDL-C. (Figure Presented) Figure 1. Differences in concentrations of red blood cell (RBC) linoleic and mead acids and triene/tetraene (T/T) ratio between F508del homozygous and F508del heterozygous individuals Conclusion(s): Despite clinical advances and use of CFTR modulator therapy, EFAD remains prevalent and underrecognized in the pediatric CF population. Of PwCF, those homozygous for f508del may have a higher risk of EFAD. Limitations of this study (four different CFTR modulator therapies and small sample sizes in each group) may have precluded significant findings for EFAD and lipid profiles, but PwCF receiving modulator therapy appear to have healthier lipid profiles than those not receiving therapy. Lipids and fatty acid are not routinely evaluated in PwCF, but evaluation should be included in the standard of care for timely dietary interventionsCopyright © 2022, European Cystic Fibrosis Society. All rights reserved
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Background: Most patients with heterozygous familial hypercholesterolemia (FH) do not achieve current LDL-C goals proposed by European guidelines with conventional lipid-lowering therapy (LLT). Chronic use of PCSK9 inhibitors (PCSK9i) have shown to reduce LDL-C levels up to 61% on top of statins. Persistence to chronic LLT is important to reduce the burden of atherosclerotic cardiovascular disease (ASCVD). Purpose(s): To analyze persistence and effectiveness of PCSK9i in clinical practice setting in FH patients from the SAFEHEART register with longterm follow-up. Method(s): SAFEHEART is an open, long-term prospective study of a cohort of subjects with molecular diagnosis of FH. Follow-up is carried out every year through a standardized phone-call to collect clinical conditions, persistence to medications, lipid profile, and cardiovascular events. This study analyses subjects >=18 years of age on stable LLT who have received PCSK9i. Result(s): 696 individuals (46% females), median age 56.4 years (IQR 49- 66) started with PCSK9i (49% alirocumab and 51% evolocumab). Out of them 38% had history of ASCVD, and 89% were on maximum LLT. Median LDL-C at the moment of starting PCSK9i was 145 mg/dL (IQR, 123- 177), representing a poor 2016 & 2019 ESC/EAS guidelines achievement (3% and 0.1% respectively). After a median follow-up of 3.7 years (IQR, 2.3-4.8), 669 patients (96%) remained on PCSK9i treatment during entire follow-up. Only 27 patients (4%) discontinued, 5 temporarily (0.7%) and 22 permanently (3.2%). Most common reasons for PCSK9i treatment interruption were medical decision (n=6), adverse event (AE) (n=5), patient decision not related with AE (n=5) and comorbidity (n=5). Median time to permanent discontinuation was 15 months (IQR, 4-33). Median LDL-C levels observed and % of LDL-C reduction obtained after 1 year of treatment and in the last follow-up visit were: 63 mg/dL (IQR, 43- 88), 61 mg/dL (IQR, 44-82), 57.6% (IQR, 39.5-69) and 58% (IQR, 44-68), respectively. 2016 ESC/EAS guidelines LDL-C goals was achieved by 70% of patients at year 1 and 77% in the last follow-up visit after the introduction of PCSK9i (p<0.001). 2019 ESC/EAS goals were achieved by 44.5% and 48% (p=0.1). Conclusion(s): Long-term persistence to PCSK9i treatment in FH patients is very high (96%) and reasons for discontinuation are diverse. This study shows that COVID-19 pandemic did not affected persistence to treatment. Effectiveness in LDL-C reduction and LDL-C goal achievement improved significantly with introduction of PCSK9i in clinical practice setting.
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Background: Telemedicine based on wearable intelligent health devices becomes increasingly promissing for the elderly due to the accelerated aging population. Especially during COVID-19 pandemic, more elderly coronary heart disease patients with chronic comorbidities are in less secondary prevention management at home. Objective(s): To explore the prevention effect on main cardiovascular risk factors and repeated hospitalization in elderly comorbidities patients by telemedicine intervention based on multi-parameter wearable monitoring devices. Method(s): Total of 337 patients with comorbidities of coronary heart disease, hypertension and diabetes, with age more than 65 years old were recruited in the study from October 2019 to January 2021. They were randomly divided into control group and telemedcine intervention group. The latter used remote multi-parameter wearable devices to measure blood pressure, glycemic and electrocardiograph at home every day. A real-time monitoring platform would alarm any abnormal data to the doctors. Both doctors and patients can read the measurement results on a real-time mobile phone APP and interact with each other remotely twice a week routinely. A medical team remotely indicated the medications, while offering guidance on lifestyle. In contrast, the control group adopted traditional outpatient medical strategy to manage diseases. Result(s): A total of 306 patients were enrolled in the follow-up experiment finally: 153 in the intervention group and 153 in the control group. Patient characteristics at baseline were balanced between two groups. After 12 months, compared with the control group, the intervention group saw the following metrics significantly reduced: Systolic blood pressure (SBP) (131.66+/-9.43 vs 137.20+/-12.02 mmHg, P=0.000), total cholesterol (TC) (3.65+/-0.79 vs 4.08+/-0.82 mmol/L, P=0.001), low density lipoprotein cholesterol (LDL-C) (2.06+/-0.53 vs 2.38+/-0.61 mmol/L, P=0.002), and fasting blood glucose (FBG) (6.26+/-0.75 vs 6.81+/-0.97 mmol/L, P=0.000), while the following metrics went up significantly: Blood pressure control rate (77.3% vs 59.1%, P=0.039), blood lipid control rate(39.4% vs 21.2%, P=0.037), glycemic control rate (71.2% vs 51.5%, P=0.031), and medication adherence score (7.10+/-0.77 vs 6.80+/-0.73, P=0.020). Linear regression model analysis indicates that when interaction frequency >=1.53, 2.47 and 1.15 times/week, the SBP, LDL-C and FBG levels would be controlled, respectively. Cox survival analysis finds that the hospitalization rate of intervention group is significantly lower than that of the control group (24.18% vs 35.29%, P=0.031). Conclusion(s): The telemedicine interactive intervention based on multiparameter wearable devices provides effectively improvement of cardiovascular risk controlling, medication adherence, while reducing the hospitalization rate of patients. A frequency of doctor-patient interactions more than 2 times/week is beneficial for disease management the elderly at home. (Figure Presented) .
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Background: The SWEDEHEART quality index of hospitals' adherence to the evidence-based (EB) guidelines for myocardial infarction (MI) patients has been continuously used for several decades in Sweden. The grading protocol is based on the consensus among hospitals. The hospitals are awarded points (0, 0.5, 1) for each of the 11 indicators depending on the proportion of patients who received EB treatment and achieved treatment goals. The 11 indicators at present are reperfusion treatment in STEMI (yes/no), time to-reperfusion treatment in STEMI, time to revascularisation in NSTEMI, P2Y12 antagonists at discharge, ACE-inhibitor/ARB at discharge, the proportion of patients at follow-up, smoking cessation at oneyear, participation in a physical exercise program, target LDL-cholesterol and target blood pressure at one year. Purpose(s): To evaluate whether the SWEDEHEART quality index predicts mortality in patients with MI. Method(s): We used data for all MI patients reported to the SWEDEHEART registry from 72 hospitals in Sweden between 2015-2021. We calculated the difference in quality index between 2021 and 2015. The hospitals were divided into quintiles based on the difference in the score. Logistic regression with log-time offset was used to adjust for confounders (age, gender, diabetes, hypertension, hyperlipidemia, STEMI/NSTEMI, cardiac arrest before admission, occupation status, history of heart failure, prior MI, prior PCI, prior CABG, cardiogenic shock). Result(s): We identified 98,635 patients with MI, 32,608 (33.1%) were women and 34,198 (34.7%) had STEMI. The average age was 70.8+/-12.2 years. The median follow-up time was 2.7 years (IQR 1.06-4.63). The crude all-cause mortality rate was 5.5% at 30-days and 22.3% after longterm follow-up. Most hospitals (72.1%) improved their quality index on average by 3.4% per year (P<0.001). The increase in the quality index continued during COVID-19 pandemic (2020-2021) with average increase of 8.6%, 95% CI, 0.97-1.02;P<0.001. The median change in SWEDEHEART quality index score among the quintiles were -1.5 (Q1), 0,5 (Q2), 2,5 (Q3), 3 (Q4), and 4 (Q5). We found no difference in mortality between the quintiles at 30-days (OR 0.99;95% CI 0.97-1.02;p=1.02) and longterm (OR 1.01;95% CI 0,99-1.02;p=0.850). Conclusion(s): The SWEDEHEART quality index provides valuable descriptive information about hospitals' adherence to the guidelines. However, the index, in its current form, does not predict mortality in patients with MI.
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Introduction: IL-6 is the key molecule of cytokine storm in COVID-19. Dyslipidemia is a common complication in patients with Coronavirus disease 2019 (COVID-19), but the association of dyslipidemia with the severity of COVID-19 is still unclear. In this study, we aimed to investigate the biochemical alterations of High-Density Lipoprotein Cholesterol (HDL-C), and Interleukin-6 (IL-6) in COVID-19 patients and their relationships with the disease severity. Material(s) and Method(s): We conducted a retrospective single-institutional study of 99 consecutive confirmed cases of COVID-19. Serum IL-6 and HDL-C concentrations, demographic and clinical profile were collected during hospital stay. Duration of study was from September 2020 to August 2021. Descriptive statistics were applied to summarize the demographic data. Results are reported as mean with standard deviation. Receiver operating characteristic curve (ROC) analysis was used to compare biochemical markers. Result(s): Serum HDL-C levels had a significant positive correlation with SpO2 with correlation coefficient r = 0.589. Serum IL-6 had a negative correlation with SpO2 with correlation coefficient r =-0.632. The AUC for IL6 and HDL-C in predicting COVID severity is 0.982 and 0.985 respectively. Conclusion(s): HDL-C is decreased and IL-6 is increased with the disease severity.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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Background: During the pandemic, not only SARS-CoV-2 infections and their complications have an impact on public health. The management of non-communicable diseases such as diabetes mellitus can be affected too. Patients may not receive the same quality of care because of pandemic. Research question: To determine the impact of the pandemic on quality and outcome of diabetes care. Method(s): Retrospective comparison of two cohorts in a primary care setting in Switzerland. Adult patients (>=18 years) with a diagnosis of diabetes mellitus and with at least one consultation with a general practitioner, between 17 March 2018 and 16 March 2019 (cohort 1) and 17 March 2019 and 16 March 2020 (cohort 2), were included and observed for two years (until 16 March 2020 and 16 March 2021, respectively). Quality indicators and outcomes of diabetes care at patient and practitioner level, were compared before and during the COVID-19 pandemic. Result(s): A total of 27,043 patients and 191 practices were included, 23,903 in cohort 1 and 25,092 in cohort 2. The fraction of patients lost to follow-up attributable to the pandemic was 28% [95% Confidence Interval: 25%, 30%]. At patient level, regular measurements of weight, Hemoglobin A1c (HbA1c), blood pressure and serum creatinine were less frequent during the pandemic. At the practitioner level, fewer patients reached the target of an HbA1c value <=7% and a blood pressure value of <140/90mmHg during the pandemic. However, more patients had an LDL-cholesterol value of <2.6 mmol/l. Although higher HbA1c values were observed in the months after lockdown, values converged to the same level for both cohorts by the end of the follow-up period. Conclusion(s): A considerable quality drop in diabetes mellitus care could be observed during the pandemic (17 March 2020-16 March 2021). However, HbA1c values converged to the same level for both cohorts at the end of the observation period. Thus, the long-term effect on relevant outcomes has not yet been visible.
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Aim: Biochemical monitoring of COVID-19 patients is essential for assessing disease diagnosis, severity and progression, as well as monitoring therapeutic intervention. In this study, we aimed to investigate the clinical and laboratory characteristics of the cases followed up with the diagnosis of COVID-19. Material(s) and Method(s): The study included 110 patients who admitted to Kastamonu State Hospital between 1-30 April, 2020 and diagnosed with COVID-19. Demographic, clinical and laboratory data of the patients were evaluated retrospectively. Result(s): According to the presence of pneumonia, an increase in neutrophil, ALT and creatinine values, and a decrease in the leukocyte count were found to be statistically significant. When we took the cut-off value of 28.49 for CRP, 1.45 for NLR and 111.12 for PLR in our ROC analysis, all three values were found to be associated with pneumonia. In the logistic regression analysis, female gender, age over 50 years, and an NLR value above 1.45 increased the risk of pneumonia 2.6, 4.9, and 8.3 times, respectively. Discussion(s): High NLR, CRP and PLR values were found to be associated with the presence of pneumonia.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Metabolic associated fatty liver disease (MAFLD) is a chronic liver disease with the highest incidence in the world, which affects 1/4-1/3 of the world population and has a serious effect on people's health. As is a multi-systemic disease, MAFLD is closely related to the occurrence and prognosis of many diseases. Studies have shown that MAFLD is associated with viral infectious diseases, and their interaction affects the prognosis of the disease. This paper reviews the research progress in this field in recent years.Copyright © The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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To mark World Obesity Day on 4th March 2021 an online survey was conducted between 4th and 8th March 2021 as part of the project "Be fit during the pandemic!". The aim was to analyze changes in eating habits, physical activity and health indicators in adults during the Covid-19 pandemic caused by the coronavirus SARS-CoV-2 from March 2020 until March 2021. The survey involved 1,035 respondents from Slovakia (50.5% women and 49.5% men) with a mean age of 44.93 +or- 61.19 years (aged 20 to 73 years). Of those asked 70.9% lived in an urban area while 29.1% in the countryside. We assessed the lifestyle changes of the respondents using an anonymous questionnaire during the pandemic, based on whether they had Covid-19 and separated them by gender. We evaluated changes in health parameters (changes in glycaemia, total cholesterol, HDL, LDL, triacylglycerol's, blood pressure, body mass index-BMI, and waist-to-hip ratio-WHR indices). We used the statistical software Statistica 10.0 (StatSoft Inc., USA) for statistical evaluation with differences considered significant at p < 0.05.15% of the adults asked recovered from Covid-19. In the respondents' diet, we confirmed a significant difference (p < 0.01) in the consumption of meat and meat products, which were mainly consumed by men (37.97%, 9.49% more than women). During the pandemic, more women (p < 0.01) (44.30%) used vitamin D nutritional supplements than men (by 17.08%). When evaluating physical activity, more men (p < 0.01) used the stairs (33.76%, 10.76% more than women). In summary, to a greater or lesser extent, physical activity was predominantly performed by men (82.67% of men, 23.63% more than women, p < 0.05). Based on the online survey analyses, it is vital to raise people's awareness about positive lifestyle changes and their beneficial impact on health during a pandemic.
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Aim: Coronavirus disease 2019 (COVID-19) has caused thrombotic disease. In this study, we aimed to determine the demographic and clinical characteristics of acute coronary syndrome (ACS) patients infected with COVID-19 and to investigate whether they differ from patients with ACS without COVID-19 in terms of these characteristics. Material(s) and Method(s): The study was designed as a single-center retrospective study. Thirty-three COVID-19 infected ACS patients (Group 1) and 100 ACS patients without COVID-19 infection (Group 2) were included in the study. Result(s): The groups were compared in terms of coronary angiographic data. Twenty-eight (84.8%) patients in Group 1 and 74 (74%) patients in Group 2 were presented as non-ST elevation myocardial infarctus. Patients were compared in terms of baseline Thrombolysis in Myocardial Infarctus (TIMI) flow, thrombus stage, myocardial blush (end), using of thrombus aspiration catheter, stent thrombosis, and TIMI flow after percutaneous coronary intervention, and it was observed that there was no statistical difference between the groups (p> 0.05). Discussion(s): COVID-19 infection can cause plaque rupture, myocardial damage, coronary spasm and cytokine storm by triggering the coagulation and inflammation process. The fact is that we did not encounter an increased thrombus load in this study.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Background: In this study, we aimed to investigate the pathological alterations of LDL-cholesterol, HDL-cholesterol, total cholesterol and triglycerides in COVID-19 patients during the acute phase of infection, and after recovery. Method(s): A retrospective study was performed to examine serum levels of LDL-cholesterol, HDL-cholesterol, total cholesterol and triglycerides on 55 COVID-19 patients who were hospitalized in our center between February and April 2020. The lipid profile and the hematological parameters were analyzed in the same group of patients before (Group before) and after clinical management (Group after). The laboratory tests results were compared between these two groups, as well as with a group of healthy subjects (Healthy controls), matched for age and sex and selected among the blood donors. Result(s): LDL-cholesterol, HDL-cholesterol, total cholesterol levels were significantly lower in COVID-19 patients (Group before) as compared with normal subjects (P<0.0001). Comparing healthy controls and the group after, statistically significant differences were observed for all parameters except for total cholesterol (P=0.9006). Total cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride were found to be significantly higher after recovery than during the acute phase of infection (P<0.0001). C-reactive protein levels were found to be inversely correlated with those of LDL-cholesterol (rs =-0573, P<0.0001), total cholesterol (r=-0.732, P<0.0001), and HDL-cholesterol (r=-0.700, P<0.0001). Conclusion(s): The results of our study seemingly attest that lipids, especially cholesterol, may play an important role in viral replication, internalization and immune activation in patients with COVID-19 infection. Moreover, lipid abnormalities observed during and after this infection could be used for assessing indirectly the response to clinical treatment.Copyright © Journal of Laboratory and Precision Medicine. All rights reserved.
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Background Low-density lipoprotein cholesterol (LDL-C) is used to guide lipid-lowering treatment following hospitalization for myocardial infarction (MI). Lack of LDL-C testing may represent a missed opportunity to prevent recurrent events. Methods We conducted a retrospective cohort study to estimate the cumulative incidence of Medicare beneficiaries, 66 years or older in the Optum Medicare Advantage (MA) or Medicare fee-for-service (FFS) population, who had LDL-C measured post-MI hospital discharge between January 1, 2016, and December 31, 2020. Results LDL-C testing at 30-, 90-, and 365-days post MI was 9.7%, 27.4%, and 66.7%, respectively, among MA patients (n=228,104), and 10.7%, 29.9%, and 65.7%, respectively, among FFS patients (n=532,767). LDL-C testing varied by state (Figure). Among those with MA and FFS, the 90-day LDL-C testing was 34.2% and 33.9% respectively among Hispanic patients, 32.7% and 32.5% respectively among Asian patients, 26.4% and 30.0% respectively among White patients, and 26.4% and 26.1% respectively among Black patients. There was no difference in LDL-C testing from before to after the start of the COVID pandemic. Conclusion LDL-C testing was low following hospital discharge for MI among Medicare beneficiaries with substantial geographic and race disparities. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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A 35-year-old woman with history of cardiovascular disease presented with shortness of breath, lightheadedness, fatigue, chest pain, and premature ventricular contractions 3 weeks after her second COVID-19 vaccine. Symptoms subsided following catheter ablation and ibuprofen except for chest pain and fatigue, which persisted following ablation and subsequent SARS-CoV-2 infection. The case suggests causal associations between COVID-19 vaccine/infection and recurrence of cardiovascular disease, including long-COVID-like symptoms. (Level of Difficulty: Advanced.).
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Background: Diabetes is one of the main non-communicable diseases with alarming prevalence in the world, including in Algeria. Diabetes is characterized by chronic hyperglycemia accompanied by a metabolic disorder of carbohydrates, lipids and proteins. A level of glycated hemoglobin (HbA1c) ≥ 6.5% was included as a diagnostic criterion for diabetes. The altered lipid profile is commonly present in type 2 diabetes. Patients with type 2 diabetes (T2DM) have an increased prevalence of dyslipidemia, which contributes to their high risk of cardiovascular disease (CVD). Aim: This study is an attempt to determine the correlation between the serum lipid profile and blood glucose and to assess the importance of HbA1c as an indicator of dyslipidemia. Method: This descriptive and analytical cross-sectional study was carried out during this Covid pandemic, at the level of the diabetic house and the Khemis Meliana hospital (North Algerian) over a period of 9 months. A total of 384 patients with T2DM aged 30 to 89 years were selected for this purpose. Dyslipidemia was defined according to the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Diabetes has been defined according to the criteria of the American Diabetes Association. The levels of fasting blood sugar, total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG) and glycated hemoglobin (HbA1c) were evaluated. Statistical analysis was performed by R studio software (Package for Social science software). The significance test was calculated by the unpaired Student “t” test. Correlation studies (Pearson correlation) have been performed between glycated hemoglobin (HbA1c) and lipid ratios and individual lipid indices. Significance was set at p <0.05. Results: The mean age ± standard deviation of the patients was 61.28 ± 10.04 years with a mean duration of diabetes was 14.32 ± 6.24 years. Significant positive correlations were observed between HbA1c and serum total cholesterol (p-value <10-6), triglyceride (p-value <10-3) and LDL-C (p-value = 0.002). In contrast, the correlation between HbA1c and HDL-C was negative and insignificant. Thus, the association between HbA1c and the atherogenicity index, especially the LDL-C / HDL-C ratio has been well established. Discussion: The study concluded that the HbA1c value correlated well with the lipid profile of diabetic patients. Thus, HbA1c can also be used as a predictor of dyslipidemia and therefore early diagnosis of dyslipidemia can be used as a preventive measure for the development of CVD in patients with T2DM.
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Background: The COVID-19 pandemic has raised concerns for worsening cardiometabolic health in children. Methods: Retrospective chart review to analyze patients who had visits to a pediatric lipid clinic in both the year prior to (3/18/2019- 3/17/2020) and during (3/18/2020-3/17/2021) the COVID-19 pandemic. Laboratory markers of cardiometabolic health (lipid panel, insulin resistance, and transaminases), physical exam findings (BMI, waist circumference (WC), and blood pressure), self-reported exercise time, and lipid-lowering medications (LLM) were compared via paired t-tests. Results: 303 patients met inclusion criteria. Among patients prescribed no LLM (metformin, statin, omega-3 fatty acids, fenofibrate) or on stable doses of LLM (n=244), there was a significant increase in BMI and WC (see Table). All changes in lipid panels were statistically, but likely not clinically, significant. Among patients with changes in prescribed LLM between pre-pandemic and pandemic intervals (n=62), there was an increase in HgbA1c and TG, a trend towards increased fasting insulin and ALT, and no changes in LDL-C or HDL-C. During the pandemic, patients showed increased BMI and trended towards increased WC (see Table). Neither group had a statistically significant change in exercise time. The incidence of newly prescribed LLM increased during the pandemic. This included statistically significant increases in prescriptions for statins (P= 0.003), metformin (P= 0.001), and omega-3 fatty acids (P= 0.001). Conclusion: Pediatric patients in a lipid clinic demonstrated increases in BMI and WC in the year of the COVID-19 pandemic compared to the year prior, despite few clinically significant changes in their lipid panels. In patients who required changes in LLM, increases in HgbA1c, TG, ALT and fasting insulin are consistent with reports of higher rates of pediatric type 2 diabetes during the pandemic. The increase in medication prescriptions further supports this, and indicates the need to diagnose and treat new onset dyslipidemia, insulin resistance, and diabetes in children.
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Lead Author's Financial Disclosures: Nothing to disclose. Study Funding: None. Background/Synopsis: Extensive evidence exists in support of a causal association of elevated triglyceride-rich lipoprotein (TRL) levels with the risk of atherosclerosis progression. Hypertriglyceridemia has been established as a risk factor for venous thrombosis, including a 2- fold increase in the risk of venous thrombosis in postmenopausal women. However, there is limited data on the role of hypertriglyceridemia in the arterial thrombosis. Objective/Purpose: Not Applicable. Methods: Case description: A 51-year-old white female with hypertension and type 2 diabetes (hemoglobin A1C, 7.4%) was transferred for further management of newly diagnosed bilateral renal and splenic infarcts. No risky habits were elicited except for the use of combined hormonal contraceptives over the past two years to control menorrhagia. Family history was significant for hypertriglyceridemia. Her physical exam was unremarkable. Testing for COVID-19 was negative. An extensive hypercoagulable and autoimmune work-up was unremarkable. Fasting lipid profile was significant for elevated levels of triglycerides, 1,274 mg/dL (replicated on two separate occasions), very low-density lipoprotein-cholesterol, 255 mg/dL, and non-high-density lipoprotein-cholesterol, 214 mg/dL, directly measured low-density lipoprotein cholesterol, 39 mg/dL and lipoprotein(a), 6 mg/dL. There was no structural pathology on the echocardiogram, including no interatrial shunt or intracardiac thrombus. Her whole-body computed tomography angiography revealed a focal calcified protruding thrombus in the distal thoracic aorta. No significant plaque was seen elsewhere in the aorta. Results: Decision-making. The posterior thrombus in the distal thoracic and proximal abdominal aorta was determined as a culprit for the visceral organ infarcts. Over the course of the hospital stay her abdominal pain gradually resolved. Treatment with low dose aspirin and therapeutic dose of low-molecular weight heparin was initiated followed by apixaban and aspirin on discharge. She was started on atorvastatin 40 mg, fenofibrate 145 mg, icosapent ethyl 4 g, resulting in a 70% reduction in the triglycerides levels (306 mg/dL). In 3 months, her repeat CT angiography showed significant resolution of the aortic atherothrombosis with no signs of aortic wall inflammation. At the 6-month follow-up visit she was switched to dual antiplatelet therapy with a plan to repeat imaging in 6 months. Conclusions: This case illustrates challenges in managing patients with arterial thrombosis in the setting of familial hypertriglyceridemia. Apart from severely elevated triglycerides no other etiology was evident. We propose further investigation of the prothrombotic properties of TRL and the role of targeted triglyceride-lowering therapies on atherothrombotic outcomes.