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1.
Diabetes Research and Clinical Practice ; 186, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2004007

RESUMO

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.

2.
Pediatrics ; 149, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2003410

RESUMO

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.

3.
Archives of Razi Institute ; 77(3):1303-1310, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1998136

RESUMO

This case-control study aimed to assess pathologic alteration in the serum levels of the atherogenic index, cholesterol to high-density lipoprotein (HDL) ratio, HDL cholesterol, total cholesterol, triglyceride, HbA1c, and glucose in 158 COVID-19 patients who were hospitalized in Erbil international hospital, Erbil, Iraq, between January and May 2020, in the early stage of infection. The patients were confirmed for SARS-CoV-2 on admission. The laboratory test results were compared between this group and a group of healthy individuals (n=158). A statistically significant difference was found between the studied factors in healthy controls and COVID-19 patients, except for low-density lipoprotein (LDL) cholesterol (P=0.13). In the case of COVID-19 patients, total levels of cholesterol and HDL cholesterol were significantly lower than controls (P<0.003). Triglyceride, VLDL cholesterol, atherogenic index, and total cholesterol to HDL ratio were found to be significantly higher in COVID-19 patients, compared to controls (P<0.005). Atherogenic index were found to be positively correlated with triglyceride (r=0.88, P=0.00), HbA1C (r=0.6, P=0.05), and glucose index (r= 0.62, P= 0.05), and the ratio of cholesterol to HDL (r=0.64, P=0.04). In contrast, no correlation was found between atherogenic index and cholesterol to HDL ratio in controls. The results of the current study indicated that risk factors for the cardiovascular disease increased in patients with COVID-19 infection, which included atherogenic index, cholesterol to HDL ratio, as well as the association between atherogenic index, and all were organized in one cluster. Therefore, lipids can perform a vital physiological function in patients infected with COVID-19.

4.
Journal of Clinical Lipidology ; 16(3):e41-e42, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1996301

RESUMO

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.

5.
NeuroQuantology ; 20(6):1192-1197, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1988587

RESUMO

Background:The current coronavirus disease 2019 (COVID-19) pandemic, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has posed a significant public health concern throughout the world, putting millions of people at risk in an increasing number of nations.Due to the development of endothelial dysfunction, coagulopathy, cytokine storm, and plaque instability, COVID-19 is recognized as an independent risk factor for cardiovascular illnesses.The goal of this study was to look at blood levels of interleukin 6 (IL-6), lipid profiles, ferritin, C-reactive protein (CRP), D-dimer, lymphocytes, and neutrophils in COVID-19 patients, as well as the relationship between IL-6 and biochemical predictor values for COVID-19 severity. Materials andMethods: In this case-control study,total of 60 COVID 19 patients within 1 week of displaying COVID19 symptoms and SARS-CoV-2 specific RT-PCR was verified. of Nasopharyngeal (NP) swab specimen were recruited.ageranged between(30-50 years)To compare the results, (60) apparently healthy persons of the same ages and sexes were included in this study ascontrol group.All of the patents and healthy persons were made to suffer to the estimation of serume IL-6, D-Dimer, CRP, ferritin,lipid profiles, andanthropometric data were analyzed. Results:Serum IL-6 level was higher in covid-19 patients group compared to healthy control group (812.32± 147.76vs. 148.95± 51.59ng/ mLp = 0.0001). Ferritin,CRP, and D-dimer serum levels were also higher in covid-19 patients compared to control group (p = 0.0001). as well as TC,LDL-C,and VLDL-C When compared to healthy controls, COVID-19 patients exhibited a substantial reduction in the levels studied in this study. We also discovered that IL-6 levels were higher significantly associated with the serum ferritin,D-dimer,TC, LDL-C, and CRP levels. Conclusion:The level of IL-6 was shown to be the most important predictor of outcome and a useful tool for prognostic assessment. The prevalence of atherogenic dyslipidaemia during infection was linked to a poorer COVID-19 infection outcome in a robust and independent way. Low HDL cholesterol and high triglyceride levels seen in covid-19 patients are strong indicators of the disease's severity. 1.

6.
Journal of Hepatology ; 77:S14, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1967492

RESUMO

Background and aims: Approval of a drug therapy for NASH requires a very good safety/tolerability profile and acceptable therapeutic index. MAESTRO-NAFLD-1 (NCT04197479) is a randomized doubleblind (DB) Phase 3 clinical trial of placebo (PBO) versus resmetirom (RES), a once-a-day oral selective thyroid hormone receptor β agonist, in >1100 patients with NAFLD with safety as the primary end point. Method: Enrollment was Dec 2019 to Oct 2020 at 79 US sites. Requirements included 3 metabolic risk factors, fibroscan (FS) ≥5.5 kPa/CAP≥280 dBm, MRI-PDFF≥8%. Randomization was 1:1:1:1 to 3 DB arms, PBO, 80 or 100 mg RES (n = 972) or an 100 mg open label (OL) arm (n = 171). The primary objective was to evaluate the safety and tolerability of 80 or 100 mg RES versus PBO measured by the incidence of adverse events (AEs). Results: At baseline the DB safety population (n = 969) was age 55.9 (11.8);female, 54.4%, white 88.6%;hispanic 34.7%;BMI 35.3 (6.0) type 2 diabetes 49%, hypertension 76.1%, dyslipidemia 87.9%;FS 7.4 (4.7) kPa. Discontinuations (22.5%) did not differ by treatment, most patient decision (pandemic related). DB compliancewas impacted by COVID drug kit delays. AE withdrawals were 80 mg, 2.4%;100 mg, 2.8%;PBO, 1.3%. The primary objective was met. TEAEs were 80 mg, 88.4%;100 mg, 86.1%;PBO, 81.8%. TEAEs ≥grade 3 severity were 80 mg, 7.6%;100 mg, 9.0%;PBO, 9.1%. AEs in excess of PBOwere grade 1–2 AEs of diarrhea (80 mg, 23.5%;100 mg, 31.2%;PBO, 13.8%) and nausea (80 mg, 11.9%;100 mg, 18.2%;PBO, 7.9%), in the first few weeks. ALT increases ≥3XULN were 80 mg, 0.61%;100 mg, 0.31%;PBO,1.6%. Therewere no changes in bodyweight or HR. BP decreased by 2–3 mmHg in the RES arms. Key 2o end points were met (Table). Comparative mean reduction in FS VCTE was not significant;a responder analysis of FS and MRE showed significant reductions with RES treatment. Conclusion: RES achieved the primary safety end point in this 52- week Phase 3 NAFLD clinical trial that identified patients by metabolic risk and non-invasive imaging. Key 2o end points were met including LDL-C, ApoB, triglycerides, MRI-PDFF, FS (CAP).(Table Presented) 1MRE combined RES groups.

7.
Rational Pharmacotherapy in Cardiology ; 18(3):282-288, 2022.
Artigo em Russo | EMBASE | ID: covidwho-1957626

RESUMO

Aim. To study the dynamics of the lipid profile of hypertensive patients with dyslipidemia who underwent COVID-19. Material and methods. Hypertensive patients with dyslipidemia who underwent COVID-19 [n=126;58 men and 68 women;median age 60 (56.0;65.5) years] examined. Patients were included into two groups: group 1 (n=64) received a single pill combination of lisinopril + amlodipine + rosuvastatin;2 groups (n=62) continued the previous drug treatment. Clinical, demographic, office blood pressure (BP), total cholesterol (TC), low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol, triglycerides, C-reactive protein (CRP) levels were assessed in all patients in 3 visits within 24 weeks. Results. The groups did not differ in prior antihypertensive therapy (except for more frequent use of angiotensin II receptor blockers in group 2, p<0.05), lipid profile and blood pressure parameters at study entry. A decrease in systolic (by 9.5%) and diastolic blood pressure (by 12.1%) after 24 weeks was found in group 1 compared with 4.29% and 5.56%, respectively, in group 2 (p<0.05). A decrease in the level of total cholesterol by 14.5% and LDL-c by 31.4% after 24 weeks was found in group 1 compared with 11.2% and 9.7%, respectively, in group 2 (p<0.05). The level of CRP during the observation period decreased by 53.7% in group 1 versus 43.4% in patients of group 2 (p<0.05). Conclusion. The single pill combination of lisinopril/amlodipine/rosuvastatin in hypertensive patients with dyslipidemia who underwent COVID-19 led to an improvement in lipid profile and blood pressure control.

8.
Journal of Hypertension ; 40:e269-e270, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1937755

RESUMO

Objective: To study the contribution of a COVID-19 to endothelial dysfunction in hypertensive patients with obesity or normal body weight. Design and method: 59 hypertensive patients, male and female, aged 20-50 years (40.2 ± 6.7 years), with blood pressure (BP) under control, without diabetes, non-smokers were included in the study. All of them were divided into three groups: I (n = 13) - patients with obesity (body mass index (BMI) > 30 kg/m2) and 1 month after COVID-19;II (n = 11) - patients with normal body weight (BMI < 25 kg/m2) and 1 month after COVID-19;III (n = 25) - patients with obesity (BMI > 30 kg/m2) without COVID-19. Patients of Ith and IIIth groups were comparable in BMI and BP levels. LDL-cholesterol and triglycerides levels, office systolic BP and diastolic BP, flow-mediated dilation (FMD) study to assessed endothelial function, were performed in all groups. Calculation was done with software STATISTICA 6.0. Results: Post-COVID-19 patients with obesity had significantly higher levels LDL-cholesterol and triglycerides, systolic BP and diastolic BP then in post- COVID-19 patients with normal body weight: 3.5 ± 0.7 mmol/l vs 3.02 ± 0.62 mmol/l (p < 0.05), 3.5 ± 2.9 mmol/l vs 1.10 ± 0.3 mmol/l (p < 0.05), 141 ± 9.6 mmHg vs 123 ± 10.3 mmHg (p < 0.05), 89.5 ± 10.01 mmHg vs 76 ± 8.8 mmHg (p < 0.05) respectively. FMD were significantly lower in patients with obesity and COVID-19 (3.6 ± 2.9%, p < 0.05) then in patients with normal body weight and COVID-19 (8.7 ± 3.4%, p < 0,05) and in patients with obesity without COVID-19 (4.2 ± 3.6%, p < 0.05). Conclusions: Our study highlights that chronic impairment of systemic vascular endothelial function in patients with obesity, when intensified by the detrimental effects of SARS-CoV-2 over the endothelium, may explain their worse outcomes in COVID-19. However, obesity itself is one of important factors contributing to deterioration of endothelial function.

9.
Journal of Hypertension ; 40:e148, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1937701

RESUMO

Objective: The purpose is to identify the peculiarities of the parameters of red blood cells (RBC) and hemostasis in patients with strokes associated with coronavirus infection. Design and method: A total of 124 patients (48.5 + 1.9 years) with impairments of cerebral circulation due to COVID-19 (confirmed by positive PCR test) had been examined. Among them, 74 patients had ischemic stroke, 25- transient ischaemic attack, 17- intracerebral hemorrhage, 8- subarachnoid hemorrhage. The parameters of hemostasis were measured by standard methods, electrical, viscoelastic parameters of RBC - by dielectrophoresis. Results: 71 patients (the 1st group) showed signs of intravascular coagulation and thrombosis: accelerated platelet-leukocyte aggregation, increased levels of coagulation products, reduced fibrinolysis activity (p = 0.001-0.04). The levels of D-dimer, fibrinogen, ESR, platelet count were higher in this group compared to the second one (p < 0.01). A moderate increase of RBC summarized rigidity, viscosity was noted. The level of RBC hemolysis was associated with platelet count (r = 0.735,p = 0.03), D-dimer (r = 0.482, p < 0.05), fibrinogen level (r = 0.374, p = 0.04). In 2nd group (53 persons), the markers of thrombosis had moderate deviations. Sharply reduced RBC deformability with increased summarized rigidity, viscosity was dominant coupled with the background of high electrical conductivity of cell membranes compared to the indicators in the 1st group (p < 0.01). There was a decrease of membrane capacity, surface charge, cell dipole moment, polarizability than those in the 1st group (p = 0.0001-0.05). A sharp decrease of RBC deformability creates obstacles to overcoming small-diameter capillaries, leading to violations of microcirculatory blood flow. RBC deformability was associated with levels of ferritin (r = 0.451, p = 0.02), HbA1c (r = 0.480, p = 0.03), uric acid (r = -0.371, p < 0.05), LDL cholesterol (r = 0.461, p = 0.02). Incubation of blood samples in vitro for 10 min with riboflavin, nicotinamide, inosine, which ensures RBC energy metabolism, restored the reduced RBC deformability (p < 0.01), altered cell morphology (p = 0.04), decreased RBC aggregation (p < 0.001). Conclusions: The revealed features of parameters of RBC hemostasis in stroke patients with coronavirus infection are associated with two independent pathogenetic mechanisms: thrombotic and hemorheologic. The thrombotic variant is due to procoagulant state and an activity of inflammation. The hemorheologic variant is caused by decrease of RBC energy metabolism, activity of enzymes.

10.
Journal of Clinical and Diagnostic Research ; 16(6):BC28-BC32, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1928863

RESUMO

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has spread rapidly, infecting more than 194 million and killing more than 4 million people worldwide. Algeria has not escaped this scourge;according to World Health Organization (WHO), 162,155 confirmed cases and 4,063 deaths have been recorded from 3rdJanuary 2020 to 26thJuly 2021. Recent studies have indicated the critical role of an altered immune system, and oxidative stress in the pathological process contributing to several complications during COVID-19 disease. Aim: To determine blood markers, oxidant/antioxidant status and biochemical parameters in patients highly recovered from COVID-19 and compare with those who have never contracted COVID-19;considered as controls. Materials and Methods: The present case-control study was conducted in Tiaret, Algeria, between May 2021 and June 2021. Thirty healthy volunteers who had never contracted COVID-19 and 16 volunteers who recovered from COVID-19 in the last six months were included in the study. Blood samples were taken after 8 to 12 hours of fasting, the blood markers and biochemical parameters were evaluated. The participant with chronic diseases (diabetes, hypertension, cardiovascular diseases, kidney disease) was excluded. Student's t-test was performed for statistical comparison between the two groups. Statistical analysis was performed using Excel Microsoft 2010 software. Results. The control group consisted of 46.7% male (n=14) and 53.3% females (n=16). While, the case group consisted of 62.5% males (n=10) and 37.5% females (n=6). The plasma levels of Low Density Lipoprotein-Cholesterol (LDL-C), p-value=0.004∗∗and creatinine increased very significantly in the cases compared to the controls. While, total cholesterol, p-value=0.04∗and Glutamate Pyruvate Transaminase (GPT), p-value=0.03∗ increased significantly in the case group on comparision to the control group. On the other hand, erythrocyte Malondialdehyde (MDA) levels, p-value=0.009∗∗increased very significantly in the case group compared to controls. The erythrocyte activity catalase decreased highly significantly in the case group compared to the controls. But erythrocyte Reduced glutathione (GSH) decreased very significantly in group cases compared to controls. Conclusion: The findings in the present study confirmed the persistence of metabolic alterations and oxidative stress in COVID-19 patients after recovery. Antioxidant supplementation is recommended to improve redox status and reduce oxidative stress after recovery.

11.
European Journal of Preventive Cardiology ; 29(SUPPL 1):i359, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1915600

RESUMO

Background & Aim: COVID 19 has accelerated the uptake and acceptance of digital health tools for the prevention and management of Cardiovascular Disease. With health systems being urged to learn from the pandemic and to reassess how they will deliver services in future, robust audit and evaluation of digital interventions are required to inform best practice. This study aims to evaluate the clinical outcomes of a digital CVD prevention and rehabilitation programme which was established during COVID 19 to provide cardiac patients with efficient and timely access to a home-based, structured, comprehensive programme of care. Methods: Developed and delivered by an interdisciplinary team (Nurse Prescriber, Physiotherapist, Dietitian, Cardiologist), the core components of this 12 week programme included, behavioural change support, lifestyle modification, medical risk factor management and electronic prescribing of cardio-protective medication. To support self-management, patients were provided with a Fitbit, blood pressure monitor and a workbook to support goal setting and overall tracking of progress. Patients were given access to a bespoke web-based platform and invited to attend weekly (2hr) group-based sessions, which included an exercise component and an interactive educational workshop. Results: Over a 4 month period, 105 patients were referred with an uptake rate of 73% (n=77). Of these, 97% (n=75) enrolled in the programme, with an 85% (n=64) completion rate. Significant improvements in CVD risk factors were observed between initial and end of programme assessment. The proportion of patients meeting guideline-recommended physical activity targets increased from 14 to 82% (p<0.001), mean BMI (kg/m2) reduced from 28.7 to 27.7 (p<0.001), mean Mediterranean diet score improved from 5.2 to 7.3 (p<0.001), and anxiety and depression levels ≥8 (Hospital Anxiety and Depression score) both reduced by more than 50% (p<0.001). The proportions achieving the recommended blood pressure (<130/80 mmHg) and LDL cholesterol targets (<1.4 mmol/L) increased from 24 to 68% (p<0.001) and 14 to 41% (p<0.001), respectively. Conclusion: Outcomes from this programme demonstrate that digital CVD prevention and rehabilitation programmes can achieve the recommended lifestyle, medical and therapeutic targets associated with reduced CVD events and improved health outcomes. This programme represents a scalable, accessible and effective option to deliver vital CVD preventive care in the patient's home.

12.
European Journal of Preventive Cardiology ; 29(SUPPL 1):i80, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1915576

RESUMO

Background: Low-density lipoprotein-cholesterol (LDL-C) is a well-accepted causal risk factor for atherothrombotic cardiovascular disease. Several randomized controlled trials and meta-analyses have shown that lipid-lowering therapies reduce cardiovascular events and have a positive effect in reducing vulnerable plaques. In particular, the recommended target for LDL-C has become more and more stringent, moving to 1.4 mmol/l (55 mg/dl) for very high-risk patients. According to the 2019 ESC/EAS Guidelines, the current paradigm for lipid management favors a stepwise approach consisting of early initiation of high-intensity statin, followed by subsequent addition of ezetimibe, and ultimately a consideration of PCSK9 inhibitor treatment if LDL-C levels remain elevated. Methods: We recruited 307 patients admitted for acute coronary syndrome (ACS) during the COVID-19 pandemic from March 2020 to December 2020. Baseline LDL-C concentration and prescribed hypolipemiant treatment at hospital admission and discharge were registered. Therefore, we included all consecutive patients identified as very-high cardiovascular risk, according to 2019 ESC guidelines. We stratified our population through variables independently associated with non-attainment of LDL-cholesterol such as hypertension, diabetes, peripheral arterial disease, clinical manifestations of ACS, number of main vessels treated, and complexity of the atherosclerotic disease. Results: 274 patients were included. Mean age was 69,9 years (SD 11,4), 20,8%were women, 23,7%had diabetes, 16,4%had PAD and 32,1 % suffered from valvular disease, mainly with mitral regurgitation or aortic stenosis no more than mild or moderate. Of 25.1% with a previous history of acute myocardial infarction, the 33,3% of whom didn't have statin therapy pre-ACS index (p =0,001). At admission, medium cholesterol levels of patients that underwent previous coronary revascularization (25,5% of the total population) were 84,21 ± 31,2 mg/dL, not in range according to both 2016 and 2019 ESC guidelines. At discharge, 77,37 % of all the patients included received only statin therapy VS 22,63% with statin plus ezetimibe. In the subpopulation of patients with recurring ACS events with LDL pre-admission > 100 mg/dL,despite high dose statin, only 25% of this population were discharged adding ezetimibe (VS 75% who kept on the treatment of high dose statin without up-titration). Conclusions: Management of dyslipidemia is frequently suboptimal and the gap between guidelines and clinical practice for lipid management across Europe has been exacerbated by the 2019 guidelines. A greater utilization of non-statin lipid-lowering therapies is likely needed to reach the LDL-C optimal target. A correct stratification of the risk class would help to identify, in a personalized perspective of treatment, patients at very high risk that would take advantage of more aggressive therapy to reach the lowest target of LDL-C ('the lower is better'). (Figure Presented).

13.
Topics in Antiviral Medicine ; 30(1 SUPPL):379-380, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1880551

RESUMO

Background: Routine medical care was drastically affected by the overwhelming irruption of COVID-19 pandemic. We comprehensively assessed the impact of the COVID-19 pandemic on the prevention and care for HIV and other sexually transmitted infections at a large reference hospital providing preventive and clinical services for HIV infection and other sexually transmitted infections. Methods: We retrospectively compared clinical and laboratory data from March to December 2020 (first ten months of the SARS-CoV-2 epidemics in Spain) vs. the same period 2019 in the setting of Hospital Clínic of Barcelona which provides preventive and clinical services for HIV infection and other sexually transmitted infections for the region of Catalonia and is the largest of its kind in Spain. Monthly clinical data on HIV pre-exposure and post-exposure prophylaxis users and on adults with HIV infection were retrieved from the administrative hospital database. Monthly tests for HIV, hepatitis B and C, Treponema pallidum, Neisseria gonorrhoeae, and Chlamydia trachomatis, and plasma lipids and glucose were recovered from the laboratory database. De novo HIV, hepatitis B, or hepatitis C diagnosis were considered whenever a person had a first known positive laboratory test. Results: There were less (28% reduction) but more advanced (mean [SD] CD4 cell counts per mm3 at HIV diagnosis 305 [167] vs. 370 [170], P<0.001;26 (18%) persons had AIDS-defining conditions at HIV diagnosis vs. 20 (10%), P=0.03) HIV cases and more gonorrhea (39% increase, P<0.001) and chlamydia (37% increase, P<0.001) infections in 2020 vs. 2019. In people with HIV, rates of viral load above the level of detection remained stable (11% vs 11%, P=0.147) despite less scheduled visits (25% reduction, P<0.001). However, they had less antiretroviral prescription changes (10% reduction, P=0.018), worse plasma lipids (mean total cholesterol 190 vs 185 mg/dL, P<0.001;mean LDL cholesterol 114 vs 110 mg/dL, P<0.001;mean triglycerides 136 vs 125 mg/dL, P<0.001;mean HDL cholesterol 47 vs 48 mg/dL, P=0.006), and an excess of mortality (29 deaths vs 11, 264% increase, P=0.006) due in great part to COVID-19 (n=11) but also to other non-COVID-19 causes. Conclusion: In the setting of a large Spanish reference hospital, SARS-CoV-2 epidemics was associated with an increase of some prevalent sexually transmitted infections, with less but more advanced de novo HIV infections, and with worse non-virologic healthcare outcomes and higher mortality in people living with HIV.

14.
Drug Topics ; 165(4):24-26, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1865973
15.
Journal of Cardiovascular Disease Research ; 13(1):646-651, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1791333

RESUMO

Introduction: Aims of this study were to investigate the pathological alterations in LDL-cholesterol, HDLcholesterol, total cholesterol, and triglycerides in individuals with COVID-19 infection. Methods:Between February and April 2020, a total of 80 COVID-19 patients admitted to our hospital and 80 patient recovered from COVID-19 were evaluated for their LDL- and HDL-cholesterol levels. 80 age and sex matched individual were included in the study for comparision. Lipid level were compared among the COVID-19 patient, patient recovered from COVID-19 and healthy control. Results:Over eighty percent of the covid-19 patients had cholesterol levels that were much lower than the normal person. Only total cholesterol indicated significant differences between healthy controls and COVID-19. There was a considerable increase in the levels of HDL, LDL (bad), and triglyceride levels after recovery compared to the acute stage of sickness. Low density lipoprotein (LDL) cholesterol and total cholesterol had a negative relationship with C-reactive protein (CRP). It is possible that lipids such as cholesterol are important in viral multiplication, internalisation and immunological activation in COVID-19 infected individuals, according to our data. Conclusions: In addition, it is possible to use lipid abnormalities discovered during and after infection as a proxy for assessing the effectiveness of therapeutic treatment.

16.
Journal of Clinical Lipidology ; 16(1):e25, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1778237

RESUMO

Lead Author's Financial Disclosures: Nothing to disclose. Study Funding: Piper Biosciences. Background/Synopsis: The effectiveness of a plant sterol gummy supplement was studied in a South-Asian (SA) patient population with low to moderate cardiovascular disease (CVD) risk as defined by an Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score of < 7.5%, and a low density lipoprotein (LDL)-C level of 120-189 mg/dl. Statin therapy is often not recommended to patients with ASCVD score < 7.5% even in the presence of risk accelerators such as SA ethnicity, to which the 2018 National Lipid Association (NLA) guidelines call attention. Objective/Purpose: Phytosterols are known to lower LDL-C and are included in NLA and other global guidelines. This study aimed to establish their impact on LDL-C levels in 'borderline' risk SAs. Methods: 50 SAs were recruited during the COVID 19 pandemic, mainly from a preventive cardiology clinic dedicated to reducing SA heart disease risk. Eligible subjects had a 10-year CV risk score (ASCVD) <7.5% and LDL-C level of 120-193mg/dl at study enrollment. Subjects intolerant of or refusing statins were also recruited. The study was administered with a fully decentralized design, leveraging mailed supplements, televisits, remote lab collection, and SMS-based communications. Upon completing baseline labs and surveys, subjects were provided a 90-day supply of 1400mg phytosterol gummy supplements in individual packets (Piper Biosciences, Los Altos, CA) to be ingested twice daily. Subjects were instructed to continue current lifestyle habits and report major dietary pattern deviations. The primary endpoint was LDL-C reduction at 3 months. Pre- and post-study surveys were administered to assess diet and lifestyle. Results: 33 of the 50 subjects successfully completed the protocol. A significant overall reduction in LDL-C of 5.8% was observed (p=0.03) (Table 1, Figure 1). Subgroup A (n=27) completed the protocol with no significant dietary variation, demonstrating a significant LDL-C reduction of 6.5% (p=0.002), as well as a total cholesterol (TC) reduction of 4.4% (p=0.01). There was no significant change in other metrics, including BMI, fasting glucose, or HbA1C. Patients who completed the protocol but reported worsening dietary habits (Subgroup B, n=6) showed an average increase in LDL-C of 6% (p=0.2) and in TC of 8% (p=0.002). Survey responses indicate that 94% of subjects would be interested in long-term supplementation if recommended by physician and 80% would prefer taking it proactively to manage cholesterol levels. Conclusions: Plant sterols are an effective and sustainable means to lower LDL-C in middle-aged SAs, whose CV risk is often underestimated. To our knowledge this study represents the first demonstration of phytosterol effectiveness in the highest coronary disease risk population globally.

17.
Genetics in Medicine ; 24(3):S176-S177, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1768094

RESUMO

Introduction: Acid sphingomyelinase deficiency (ASMD), also historically known as Niemann-Pick disease A (OMIM #257200) and B (OMIM#607616), is a rare and debilitating lysosomal storage disease caused by pathogenic variants in SMPD1 gene. Deficient activity of the lysosomal enzyme acid sphingomyelinase (ASM) leads to sphingomyelin accumulation in various organs. Visceral manifestations of ASMD include interstitial lung disease and pulmonary dysfunction, splenomegaly, hepatomegaly, dyslipidemia, thrombocytopenia, and anemia and are present across ASMD phenotypes (ASMD type A, B and A/B). In more severe cases of ASMD (ASMD type A), there are also central nervous system manifestations. No disease-specific treatment is currently approved for patients with ASMD. Olipudase alfa, an intravenous-recombinant-human ASM, is in late-stage development (Sanofi Genzyme) for the non-central-nervous-system manifestations of ASMD in children and adults. Two open-label trials, a phase 1b trial in 5 adults (NCT01722526) and a phase 1/2 trial in 20 children with chronic ASMD (ASCEND-Peds, NCT02292654) demonstrated improvement of pulmonary function, reduction of liver and spleen volume, reversal of dyslipidemia, decreased disease biomarkers, and in children, improved growth. A phase 2/3 placebo-controlled trial, the ASCEND study (NCT02004691) in 36 adults with ASMD who had splenomegaly and pulmonary dysfunction, has completed its primary analysis. Olipudase-alfa-treated patients compared to placebo-treated patients (1:1 randomization) had statistically significant increases in percent-predicted diffusing capacity of carbon monoxide (DLCO) and statistically significant decreases in spleen and liver volume after 1 year of placebo or olipudase alfa. Thirty-five of 36 patients continued in an open-label trial extension including 17 of the 18 patients who initially received placebo in the first year and all 18 patients who received olipudase alfa. Here we report Year 2 results of the ASCEND trial for the former placebo group after 1 year of olipudase alfa treatment and for the initial olipudase alfa group after 2 years of olipudase alfa treatment. Methods: All patients underwent gradual dose-escalation to 3.0 mg/kg every 2 weeks for approximately 14 weeks when starting olipudase alfa. Efficacy outcomes include percent-predicted DLCO, spleen volume, liver volume, lung high-resolution computerized tomography (HRCT) scores for ground glass appearance, histopathologic clearance of sphingomyelin in the liver, platelet count, plasma lyso-sphingomyelin, liver function, and lipid profile. Change from baseline results are presented as least-square mean (analysis of covariance [ANCOVA]) percent change ± standard error of the mean (SEM), except for ground glass appearance, which is the least-square mean ANCOVA absolute change from baseline, and percent liver tissue area occupied by sphingomyelin and plasma lyso-sphingomyelin, which are presented as mean changes ± standard deviation (SD). Absolute values at Baseline, Year 1, and Year 2 are presented as mean ± SD (Table). Results: Overall, 33 of 35 patients completed Year 2 of ASCEND;one former placebo patient withdrew due to COVID-19 travel restrictions, and one continuing olipudase alfa patient withdrew consent. COVID-19 travel restrictions also resulted in at least one missed assessment in six patients. In Year 2, improvements for patients in the former placebo group paralleled the olipudase alfa group in the primary analysis while clinical improvement continued for patients who received 2 years of olipudase alfa (Table). For patients in the former placebo group, percent-predicted DLCO increased by 28.0 ±6.2% (n=10);spleen volume decreased by 36.0 ±3.0% (n=11);liver volume decreased by 30.7 ±2.5% (n=11), and platelet count increased by 21.7 ±6.4% (n=15). In patients with 2 years of olipudase alfa treatment, percent-predicted DLCO increased by 22.2 ±3.4% (n=17) at Year 1 and 28.5±6.2% at Year 2 (n=10);spleen volume decreased by 39.5 ±2.4% (n=17) at Year 1 and 47.0 ±2.7% (n=14) at Year 2 liver volume decreased by 27.8 ±2.5% (n=17) at Year 1 and 33.4 ±2.2% (n=14) at Year 2, and platelet count increased by 16.6 ±4.0% at Year 1 (n=18) and 24.9 ±6.9% (n=13) at Year 2. HRCT ground glass appearance score decreased 0.30 ±0.5 (n=14) at Year 2 for patients in the former placebo group and decreased by 0.45 ±0.13 (n=18) at Year 1 and 0.48 ±0.07 (n=16) at Year 2 for patients continuing to receive olipudase alfa. Liver sphingomyelin clearance at Year 2 was 93.3 ±5.0% (n=10) for patients in the former placebo group and 92.7 ±5.8% at Year 1 (n=13) and 98.4 ±2.0% at Year 2 (n=10) for patients continuing to receive olipudase alfa. Plasma lyso-sphingomyelin decreased by 79.4 ±11.3% (n=14) for patients in the former placebo group and by 78.0 ±11.1% (n=18) at Year 1 and 64.4 ±28.5% (n=15) at Year 2 for patients continuing to receive olipudase alfa;several patients had transient increases due to missed infusions. Alanine aminotransferase decreased by 45.2 ±34.4% (n=15) for patients in the former placebo group, and by 36.5 ±8.4% (n=18) in Year 1 and 32.0 ±10.2% (n=12) in Year 2 for patients continuing to receive olipudase alfa. For patients in the former placebo group, high-density lipoprotein cholesterol (HDL-C) increased by 59.7 ±9.7% (n=14) and low-density lipoprotein cholesterol (LDL-C) decreased by 27.5 ±6.8% (n=13) in Year 2. For patients continuing to receive olipudase alfa, HDL-C increased by 40.0 ±6.8% (n=18) in Year 1 and 64.4 ±10.5% (n=12) in Year 2 and LDL-C decreased by 25.8 ±4.8% (n=18) in Year 1 and 23.0 ±7.1% (n=12) in Year 2. Overall, 99% of treatment-emergent adverse events were mild or moderate, with one treatment-related serious adverse event (extrasystoles in patient with previously documented cardiomyopathy). No patient discontinued due to an adverse event. Conclusion: During Year 2 of ASCEND, patients crossing over from placebo to olipudase alfa had the same magnitude and time course of clinical improvement seen in patients receiving olipudase alfa for 1 year, while continuing olipudase-alfa patients had sustained or further improvements. Olipudase alfa reduced sphingomyelin storage in the liver and lyso-sphingomyelin in plasma. Clinically, olipudase alfa improved pulmonary function, reduced splenomegaly and hepatomegaly, and improved liver function and dyslipidemia for up to 2 years. These results are consistent with the published 30- and 42-month data for adults reported in the long-term extension of the open-label Phase 1b study. Treatment with olipudase alfa reduces manifestations of chronic ASMD in adults and has sustained efficacy. [Formula presented]

18.
Indian Journal of Clinical Biochemistry ; 36(SUPPL 1):S154, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1767688

RESUMO

Introduction Coronavirus disease 2019 (COVID-19) caused by the SARS coronavirus 2 has challenged the global healthcare system since 2019. Lipids are integral component of this enveloped virus that play an essential role in in its life cycle starting from fusion of viral membrane to host cell, viral replication and exocytosis. It also disrupts metabolic profile due to the release of pro-inflammatory cytokines leading to systemic inflammation reaction. Aim and Objective Therefore, it was aimed to find association between human host serum lipid levels and its association with inflammatory markers. Materials and Methods It was a retrospective study conducted from June 2020 to December 2020, included 500 COVID-19 admitted patients tested positive by Oral/Nasopharyngeal swab by Real time PCR. Total Cholesterol, Triglycerides (TG), Low Density Lipoprotein (LDL-C), High Density lipoprotein (HDL), Ferritin, Procalcitonin (PCT), High sensitive C Reactive protein (hsCRP) estimated in Vitros XT 7600 Autoanalyzer and Interleukin-6(IL-6) by ELISA. Results A significant increase in Serum Triglycerides(185mg/dL) and decrease in HDLC(30mg/dL) was observed with no remarkable finding in other lipid parameters. A statistically significant (p<0.05)positive correlation was observed between TG and inflammatory markers such as hsCRP, PCT, Ferritin, IL-6. Likewise, a negative correlation was detected between HDL-C and hsCRP, PCT, Ferritin, IL-6. Conclusion Lipid profile and host cell metabolism is altered in COVID 19 patients either by cellular infection or by systemic inflammation. Hence it is important to study lipid profile alterations in synergism with inflammatory markers. It may act as guiding step in management and prognosis of this disease.

19.
Research Journal of Pharmacy and Technology ; 15(1):270-278, 2022.
Artigo em Inglês | Scopus | ID: covidwho-1743256

RESUMO

As cardiovascular diseases are still a major cause of death in most countries, it is still relevant to look into treatment of such diseases. Dyslipidemia is one of the important identified risk factors for cardiovascular diseases. As this is largely driven by lifestyle and diet, it may be difficult to control it with lifestyle modifications alone. Currently, Statins remains to be the mainstay therapy for dyslipidemia but this is also met by problems within certain patient population. The drug may be contraindicated in certain patient groups;some patients tend to not respond to Statins;while certain patients may not tolerate the adverse events. This study looked into available literature on studies done on dyslipidemia using plant-based formulations using randomized clinical trial. Based on the review conducted, there are several plant-based formations with potential to be similar in efficacy to Statins. Some of the plants used are abundant or may be easily sourced. With the increasing popularity of food supplements or nutraceuticals, exploration on the potential of plant-based products is attractive. Despite the promising results of some studies, these will need further investigations and targeting a larger population size. Formulation options may need to be explored also focused on its stability. © RJPT All right reserved.

20.
Circulation ; 144(SUPPL 1), 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1630153

RESUMO

Introduction: We validated the “Familial Hypercholesterolemia (FH) Decision Aid” to promote shared decision making (SDM) about lipid lowering therapy, based on patient-clinician encounters. Methods: Validation of the DA included an assessment of whether the content and design of the tool facilitated SDM and patient engagement and to determine how well the tool integrated with clinical workflow. Validation was conducted during patient-clinician encounters in the Mayo preventive cardiology clinic. As inclusion criteria we considered an upcoming appointment in the clinic, an LDL-C level ≥ ∼160 mg/dL, and no prior diagnosis of FH. Prior to the encounters, each clinician viewed a demonstration of the online, interactive DA. During the encounters, the DA was shared with patients using the clinic room computer screen, either in-person or virtually. Patientclinician encounters were video recorded for further analysis by two design researchers and experts in SDM. Results: Ten patients were enrolled in the study (7 male;average age 51 years). The average patient LDL-C level was 207 mg/dL, range 157 - 248 mg/dL. Review and qualitative analysis of the encounter recordings yielded 4 key findings: i) clinicians primarily used the cardiovascular risk estimate in the DA to guide conversation with patients;ii) highly trained specialists needed to change their usual approach to care and conversation to integrate the DA with their clinical workflows;iii) as clinicians became more familiar with the DA, they moved through the tool at a more efficient pace;and iv) each clinician developed his/her own style of navigating the DA, either moving through it one screen at a time or focusing on one specific section for the duration of the conversation. The DA effectively guided conversation and facilitated active patient engagement in 6 of 10 encounters. Social distancing and use of telemedicine encounters, due to the COVID-19 pandemic, limited patient engagement in 2 of 10 encounters. Overall, the DA promoted SDM regarding FH management in 9 of 10 encounters. Conclusion: Using patient-clinician encounters, we found the FH DA to facilitate SDM regarding lipid-lowering therapy. The tool has potential to improve care of FH patients and increase patient engagement and knowledge.

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