Cardiovascular therapy use, modification, and in-hospital death in patients with COVID-19: A cohort study.

AIMS: To assess the associations of exposure and modifications in exposure (i.e., discontinuation on admission, initiation during hospitalization) to eight common cardiovascular therapies with the risk of in-hospital death among inpatients with coronavirus disease 2019 (COVID-19). METHODS: In this observational study including 838 hospitalized unvaccinated adult patients with confirmed COVID-19, the use of cardiovascular therapies was assessed using logistic regression models adjusted for potential confounders. RESULTS: No cardiovascular therapy used before hospitalization was associated with an increased risk of in-hospital death. During hospitalization, the use of diuretics (aOR 2.59 [1.68-3.98]) was associated with an increase, and the use of agents acting on the renin-angiotensin system (aOR 0.39 [0.23-0.64]) and lipid-lowering agents (aOR 0.41 [0.24-0.68]) was associated with a reduction in the odds of in-hospital death. Exposure modifications associated with decreased survival were the discontinuation of an agent acting on the renin-angiotensin system (aOR 4.42 [2.08-9.37]), a ß-blocker (aOR 5.44 [1.16-25.46]), a lipid-modifying agent (aOR 3.26 [1.42-7.50]) or an anticoagulant (aOR 5.85 [1.25-27.27]), as well as the initiation of a diuretic (aOR 5.19 [2.98-9.03]) or an antiarrhythmic (aOR 6.62 [2.07-21.15]). Exposure modification associated with improved survival was the initiation of an agent acting on the renin-angiotensin system (aOR 0.17 [0.03-0.82]). CONCLUSION: In hospitalized and unvaccinated patients with COVID-19, there was no detrimental association of the prehospital use of any regular cardiovascular medication with in-hospital death, and these therapies should be continued as recommended.

Symptoms and quality of life at 1-year follow up of patients discharged after an acute COVID-19 episode.

AIM OF THE STUDY: Patients surviving COVID-19 have been described as being at risk of developing sequelae. We aimed to investigate and elicit persistent symptoms, emotional status and quality-of-life in patients discharged after an acute COVID-19 episode. METHODS: Patient-reported outcome measures were collected during a telephone interview 30 days and 1 year after discharge. Patients' general health status was evaluated using questions based on their symptoms, emotional status was assessed using the items 9 to 12 of the HeartQoL questionnaire and quality of life was assessed at 1 year through the EQ-5D-5L. In patients with a history of cardiovascular disease, all 14 items of the HeartQoL questionnaire were completed to derive the HeartQoL global score. RESULTS: Among 687 patients who survived after being hospitalised for COVID-19 at the University Hospitals of Geneva between 26 February and 26 April 2020, 184 (27%) and 165 (24%), respectively, participated in the follow-up at 30 days and 1 year. Of these 184 participants, 62% were male, median age was 58 years and 21% had a past medical history of cardiovascular disease. At one month after discharge, 61% (113/184) of patients presented fatigue and 28% (52/184) dyspnoea. One year after discharge, the main complaints were persistent fatigue in 27% (45/165) of patients, neurological problems in 17% (28/165) and dyspnoea in 14% (23/165). Eight percent (14/184) of patients declared being significantly worried 1 month after discharge and 5% (9/184) feeling depressed. The number of patients reporting being significantly worried or depressed at 1 year was lower. Regarding the quality of life at 1 year, the median EQ-5D-5L visual analogue scale score was 80 (interquartile range 70-90). CONCLUSIONS: Approximately half of patients reported some symptoms 1 year after discharge following an acute episode of COVID-19. The predominant symptom was persistent fatigue both at 1-month and at 1-year follow-up. Emotional status and quality of life appeared satisfactory.

[Long-lasting LDL-C lowering: silence at last]. / Une baisse du cholestérol LDL de longue durée : enfin le silence.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) is responsible for the degradation of the LDL-receptor. Inclisiran is a new synthetic interfering ribonucleic acid (siRNA) lowers LDL-cholesterol (LDL-C) levels in the blood by using RNA silencing technology to reduce the production of PCSK9. Inclisiran administered subcutaneously at 0 and 3 months, and then every 6 months has been shown to reduce LDL-C by approximately 50 % in patients at high and very-high cardiovascular risk, or with a diagnosis of familial hypercholesterolemia, but also in patients intolerant to statins. New data are expected, in particular with cardiovascular clinical endpoints, as well as safety for use in adolescents.

La proprotéine convertase subtilisine/kexine de type 9 (PCSK9) est responsable de la dégradation du LDL (Low Density Lipoprotein)-récepteur. L'inclisiran est un nouveau petit ARN interférent synthétique qui baisse les taux de LDL-cholestérol (LDL-C) circulant en utilisant la technologie de silençage ARN pour réduire la production de PCSK9. Administré par voie sous-cutanée à 0 et 3 mois, puis tous les 6 mois, l'inclisiran a démontré une réduction du LDL-C d'environ 50 % chez des patients à haut et très haut risque cardiovasculaire ou avec un diagnostic d'hypercholestérolémie familiale, mais aussi chez des patients intolérants aux statines. De nouvelles données sont attendues, notamment sur les critères de jugement cliniques cardiovasculaires, ainsi que la sécurité d'emploi chez les adolescents.