Risk of cardiovascular events following COVID-19 in people with and without pre-existing chronic respiratory disease

BACKGROUND: COVID-19 is associated with cardiovascular outcomes in the general population, but it is unknown whether people with chronic respiratory disease (CRD) have a higher risk of cardiovascular events post-COVID-19 compared with the general population and, if so, what respiratory-related factors may modify this risk in these people.METHODS: Primary and secondary care data from the National Health Service England were used to define a population of adults in England with COVID-19 (index date) between 1 January 2020 and 30 November 2021. Adjusted Cox proportional hazard regression was used to quantify the association between CRD, asthma-related factors, chronic obstructive pulmonary disease (COPD)-related factors, and risk of cardiovascular events. Asthma-specific factors included baseline asthma control, exacerbations, and inhaled corticosteroid (ICS) dose. COPD-specific risk factors included baseline ICS and exacerbations. Secondary objectives quantified the impact of COVID-19 hospitalisation and vaccine dose on cardiovascular outcomes.RESULTS: Of 3 670 455 people, those with CRD had a higher risk of cardiovascular events [adjusted hazard ratio (HRadj), 1.08; 95% confidence interval (CI) 1.06-1.11], heart failure (HRadj, 1.17; 95% CI, 1.12-1.22), angina (HRadj, 1.13; 95% CI, 1.06-1.20) and pulmonary emboli (HRadj, 1.24; 95% CI, 1.15-1.33) compared with people without CRD. In people with asthma or COPD, baseline exacerbations were associated with a higher risk of cardiovascular outcomes (HRadj, 1.36; 95% CI, 1.27-1.00 and HRadj, 1.35; 95% CI, 1.24-1.46, respectively). Regardless of CRD, the risk of cardiovascular events was lower with increasing COVID-19 vaccine dose.CONCLUSIONS: Higher risk of cardiovascular events post-COVID-19 might be explained by the underlying severity of the CRD, and COVID-19 vaccines were beneficial to both people with and those without CRD with regards to cardiovascualr events.</p

the Cardiovascular Manifestations of COVID-19: A Review of the Literature and Institutional Experience

The cardiovascular health of those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) plays a major role in rates of hospitalization, mortality risk, and rates of mechanical ventilation. In patients with COVID-19, acute myocardial injury and history of cardiovascular disease are both independently established risk factors for poor patient prognosis. In addition to myocardial injury, numerous acute cardiovascular manifestations of COVID-19 disease have been identified. Previous work on this topic typically focused either upon a general description of the acute cardiovascular manifestations and sequalae of COVID-19, or upon broad-based clinical outcomes associated with COVID-19 in patients with history of cardiovascular and/or metabolic disease. However, the role of pre-existing cardiovascular and metabolic disease in predicting the development and severity of COVID-19-related cardiovascular complications remains unclear. We queried our institutional COVID-19 patient registry, extracting data on all patients who were tested for the presence of SARS-CoV-2 and myocardial injury from 3 March 2020 – 30 July 2020. We identified a total of 5,451 patients from our institutional COVID-19 registry who met our criteria, including 734 (13.5%) subjects ultimately confirmed to be COVID-19 positive, and 4,717 subjects confirmed to be COVID-19 negative. Those with a prior history of cardiovascular disease can have increased frequency of cardiovascular manifestations. Cardiovascular events in COVID-19 include acute myocardial injury, myocardial infarction, myocarditis, pericarditis, electrocardiogram abnormalities, acute thrombosis, and acute heart failure. Identifying underlying cardiovascular disease and evidence of myocardial injury may predict which patients should be prioritized or potentially require more aggressive management and treatment strategies

COVID-19 severity and thrombo-inflammatory response linked to ethnicity

Although there is strong evidence that SARS-CoV-2 infection is associated with adverse outcomes in certain ethnic groups, the association of disease severity and risk factors such as comorbidities and biomarkers with racial disparities remains undefined. This retrospective study between March 2020 and February 2021 explores COVID-19 risk factors as predictors for patients&rsquo; disease progression through country comparison. Disease severity predictors in Germany and Japan were cardiovascular-associated comorbidities, dementia, and age. We adjusted age, sex, body mass index, and history of cardiovascular disease comorbidity in the country cohorts using a propensity score matching (PSM) technique to reduce the influence of differences in sample size and the surprisingly young, lean Japanese cohort. Analysis of the 170 PSM pairs confirmed that 65.29% of German and 85.29% of Japanese patients were in the uncomplicated phase. More German than Japanese patients were admitted in the complicated and critical phase. Ethnic differences were identified in patients without cardiovascular comorbidities. Japanese patients in the uncomplicated phase presented a suppressed inflammatory response and coagulopathy with hypocoagulation. In contrast, German patients exhibited a hyperactive inflammatory response and coagulopathy with hypercoagulation. These differences were less pronounced in patients in the complicated phase or with cardiovascular diseases. Coagulation/fibrinolysis-associated biomarkers rather than inflammatory-related biomarkers predicted disease severity in patients with cardiovascular comorbidities: platelet counts were associated with severe illness in German patients. In contrast, high D-dimer and fibrinogen levels predicted disease severity in Japanese patients. Our comparative study indicates that ethnicity influences COVID-19-associated biomarker expression linked to the inflammatory and coagulation (thrombo-inflammatory) response. Future studies will be necessary to determine whether these differences contributed to the less severe disease progression observed in Japanese COVID-19 patients compared with those in Germany

Is hypertension without any other comorbidities an independent predictor for COVID-19 severity and mortality?

Early reports from China found that both established cardiovascular disease and its risk factors, such as hypertension and diabetes mellitus, were common pre-existing conditions in patients with COVID- 19. The high prevalence of these comorbidities was confirmed in subsequent studies. Remarkably, the prevalence of these pre-existing conditions was higher in critically ill patients and in those who died. In the analysis performed by Wu and McGoogan, including 44 672 patients with confirmed COVID-19, the overall case fatality rate was 2.3%, and increased with comorbid conditions: 10.5% for cardiovascular disease, 7.3% for diabetes, and 6% for hypertension. The connections between cardiovascular disease, hypertension, age, and vascular aging are complex. The association between hypertension and COVID-19 mortality or severity could be explained in part by the increased age and higher prevalence of cardiovascular disease, both well-known risk factors for mortality in critical patients. Therefore, in order to identify independent predictors of COVID-19 mortality or severity, models should be properly adjusted to exclude potential confounding effects.Facultad de Ciencias Médica

Risk factors for COVID-19 severity and mortality among inpatients in Southern Iran

Introduction: COVID-19 is a highly contagious respiratory disease and many factors can affect its severity and mortality. This study aimed to investigate the risk factors associated with the severity and mortality of COVID-19. Methods: In this study, 311 cases with COVID-19 approved by the CORONA database in the Center for Disease Control and Prevention (CDC) of Shiraz University of Medical Sciences were selected using a random systematic sampling method. The study data were collected through interviews and phone calls. Results: The mean age of the participants was 45.82±17.92 years, and the male to female ratio was 1.57:1. In addition, the Case Fatality Rate (CFR) was 4.50%, and the disease was severe in 47.5% of the cases. The most common clinical symptoms were cough (39.22%), fever (31.83%), and dyspnea (24.76%). The severity of COVID-19 was significantly associated with age and history of Cardiovascular Disease (CVD). Besides, the mortality of COVID-19 was significantly related to age, gender, hypertension, CVD, and Chronic Kidney Disease (CKD). The mean interval between the onset of the first symptom and referral to health center was 3.02±2.82 days. Additionally, the mean interval between the referral to health centers and testing was 0.88±2.20 days. Conclusion: Older patients and those who had CVD needed more careful healthcare and early intervention to prevent the exacerbation of COVID-19. Furthermore, the interval between the onset of the first symptom and testing was relatively long. Overall, early diagnosis, isolation, and treatment of patients were found to be essential to control COVID-19

Disparities by Social Determinants of Health: Links Between Long COVID and Cardiovascular Disease

Long COVID has been defined by the World Health Organisation as “continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation.” Cardiovascular disease is implicated as a risk factor, concomitant condition, and consequence of long COVID. As well as heterogeneity in definition, presentation, and likely underlying pathophysiology of long COVID, disparities by social determinants of health, extensively studied and described in cardiovascular disease, have been observed in 3 ways. First, underlying long-term conditions, such as cardiovascular disease and its risk factors, are associated with incidence and severity of long COVID, and previously described socioeconomic disparities in these factors are important in exacerbating disparities in long COVID. Second, socioeconomic disparities in management of COVID-19 may themselves lead to distal disparities in long COVID. Third, there are socioeconomic disparities in the way that long COVID is diagnosed, managed, and prevented. Together, factors such as age, sex, deprivation, and ethnicity have far-reaching implications in this new postviral syndrome across its management spectrum. There are similarities and differences compared with disparities for cardiovascular disease. Some of these disparities are in fact, inequalities, that is, rather than simply observed variations, they represent injustices with costs to individuals, communities, and economies. This review of current literature considers opportunities to prevent or at least attenuate these socioeconomic disparities in long COVID and cardiovascular disease, with special challenges for research, clinical practice, public health, and policy in a new disease which is evolving

The Effects of Preexisting Health Conditions and Vaccination on the COVID-19 Complications

In recent years, the coronavirus pandemic disease has been more fatal in the world. The presence of several comorbidities, particularly asthma, cardiovascular problems, diabetes, and kidney disease, has been linked to a worse prognosis of COVID-19 infection. This paper examined the progression of the disease, significant health risks, effects of vaccination and COVID-19 complications rates among people with comorbidities. A cross-sectional study has been conducted with direct interviews of 1002 patients in different parts of Bangladesh following a well-organized questionnaire. This study clearly shows that pre-existing health problems are extremely high-risk factors for long-term major health complications such as shortness of breath, hypertension, loss of taste and appetite, mental depression, dementia, uncontrolled blood pressure, and sugar levels during and after recovery from COVID-19 infection. Among them, almost 70% of asthma and cardiovascular disease patients were suffering from severe health complications, including shortness of breath, hypertension, and mental health problems, after getting the COVID-19 infection. Moreover, it also revealed that vaccination can significantly reduce the severity of COVID complications up to 50% compared to unvaccinated people. The overall finding of this study can be useful for the prediction of possible ways to avoid the life-threatening risk of COVID-19 infection for people who are already suffering from various preexisting health problems

Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis.

Objective This sequential, prospective meta-analysis sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to disease severity, maternal morbidities, neonatal mortality and morbidity, and adverse birth outcomes. Data Sources We prospectively invited study investigators to join the sequential, prospective meta-analysis via professional research networks beginning in March 2020. Study Eligibility Criteria Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area. Methods We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a 2-stage meta-analysis. Results We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (preexisting diabetes mellitus, hypertension, cardiovascular disease) vs those without were at higher risk for COVID-19 severity and adverse pregnancy outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% confidence interval, 1.12–2.71) more likely to be admitted to the intensive care unit. Pregnant women who were underweight before pregnancy were at higher risk of intensive care unit admission (relative risk, 5.53; 95% confidence interval, 2.27–13.44), ventilation (relative risk, 9.36; 95% confidence interval, 3.87–22.63), and pregnancy-related death (relative risk, 14.10; 95% confidence interval, 2.83–70.36). Prepregnancy obesity was also a risk factor for severe COVID-19 outcomes including intensive care unit admission (relative risk, 1.81; 95% confidence interval, 1.26–2.60), ventilation (relative risk, 2.05; 95% confidence interval, 1.20–3.51), any critical care (relative risk, 1.89; 95% confidence interval, 1.28–2.77), and pneumonia (relative risk, 1.66; 95% confidence interval, 1.18–2.33). Anemic pregnant women with COVID-19 also had increased risk of intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.25–2.11) and death (relative risk, 2.36; 95% confidence interval, 1.15–4.81). Conclusion We found that pregnant women with comorbidities including diabetes mellitus, hypertension, and cardiovascular disease were at increased risk for severe COVID-19–related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly known risk factors, including HIV infection, prepregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.post-print1293 K

Importance of Magnesium Status in COVID-19

A large amount of published research points to the interesting concept (hypothesis) that magnesium (Mg) status may have relevance for the outcome of COVID-19 and that Mg could be protective during the COVID disease course. As an essential element, Mg plays basic biochemical, cellular, and physiological roles required for cardiovascular, immunological, respiratory, and neurological functions. Both low serum and dietary Mg have been associated with the severity of COVID-19 outcomes, including mortality; both are also associated with COVID-19 risk factors such as older age, obesity, type 2 diabetes, kidney disease, cardiovascular disease, hypertension, and asthma. In addition, populations with high rates of COVID-19 mortality and hospitalization tend to consume diets high in modern processed foods, which are generally low in Mg. In this review, we review the research to describe and consider the possible impact of Mg and Mg status on COVID-19 showing that (1) serum Mg between 2.19 and 2.26 mg/dL and dietary Mg intakes &gt; 329 mg/day could be protective during the disease course and (2) inhaled Mg may improve oxygenation of hypoxic COVID-19 patients. In spite of such promise, oral Mg for COVID-19 has thus far been studied only in combination with other nutrients. Mg deficiency is involved in the occurrence and aggravation of neuropsychiatric complications of COVID-19, including memory loss, cognition, loss of taste and smell, ataxia, confusion, dizziness, and headache. Potential of zinc and/or Mg as useful for increasing drug therapy effectiveness or reducing adverse effect of anti-COVID-19 drugs is reviewed. Oral Mg trials of patients with COVID-19 are warranted

Systemic impact of the post-Coronavirus disease syndrome in Brazil: Impacto sistêmico da síndrome da doença pós-Coronavírus no Brasil

Background: Symptom persistence following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been recognized as the post-coronavirus disease (post-COVID-19) syndrome. We aimed to assess the long-term sequelae of COVID-19 in a local Brazilian population, and to identify risk factors for the onset and severity of this syndrome.Methods: This cross-sectional study was conducted in a tertiary-care hospital. Participants who had recovered from COVID-19 underwent a clinical evaluation and completed a questionnaire on post-COVID-19 symptoms that they had experienced.Results: In a sample of 141 patients, the most prominent post-COVID-19 symptoms were associated with the cardiovascular, respiratory, and neurological systems. Participants aged over 40 years had a significantly higher mean number of symptoms than those aged 40 years or younger (14.6 vs. 11.1). Patients with more severe disease in the acute phase, had significantly more symptoms than those with mild or moderate disease. Most post-COVID-19 symptoms were associated with diabetes mellitus (21.8) and renal failure (21.8), but without a significant difference in the number of associated symptoms according to the presence of preexisting comorbidities.Conclusions: Post-COVID-19 syndrome was more common and comprised more symptoms in participants aged over 40 years and in participants with severe disease during the acute phase. Future studies should assess the duration of post-COVID-19 syndrome symptoms and evaluate the impact of COVID-19 vaccination on post-COVID-19 syndrome