COVID-19: Urgent questions for estimating morbidity, prevalence, case fatality rate and mortality rate

During epidemics, the usual statistical approaches will not allow determining the readiness of the public health system to take urgent measures to counteract the increase in morbidity, spread and mortality of the population. The quality of the medical, socio-economic and managerial decisions at all levels will depend on the accuracy of statistical data and the possibility of creating adequate prognostic models. However, there are still problems with the identification of COVID-19 cases and the diagnostic accuracy of the methods used. Complex analytical efforts require in order to determine the COVID-19 impact on the health status and case fatality rate/mortality rate. © 2020 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved

Debatable points of using angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists in patients with COVID-19

The COVID-19 pandemic is a serious threat to global health. The infection mechanism is the binding of SARS-CoV-2 to angiotensin-converting enzyme 2 (ACE2) and internalization of the complex by the host cell. ACE inhibitors/angiotensin receptor antagonists (ARA) are known to increase ACE2 expression and are recommended for the treatment of many cardiovascular diseases (CVD). Thus, it has been suggested that treatment with renin-angiotensin-aldosterone system blockers (RAAS) increases the viral load and the risk of severe acute respiratory distress syndrome. However, ACE2 also converts angiotensin II into substances with cardioprotective effects. In addition, there is no evidence that RAAS inhibitors increase the severity of COVID-19 infection, while the risks of withdrawal of ACE inhibitors/ARA in patients with CVD are proven. There is also no evidence to support the idea that the administration of ACE inhibitors/ARA promotes the coronavirus's penetration by increasing the ACE2 expression. According to the guidelines of the Russian Society of Cardiology and the consensus statements of international cardiology societies, it is necessary to continue taking RAAS inhibitors in high-risk patients with COVID-19. This review provides an analysis of foreign articles revealing the pathophysiological pathways and recommendations for using ACE inhibitors/ARA in patients with CVD and COVID-19 infection. © 2020 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved

Health promotion and prevention of chronic non-communicable diseases in the context of the COVID-19 pandemic. Consensus of experts of the National society of evidence-based pharmacotherapy and the Russian society of the prevention of non-communicable diseases

Health promotion and prevention of chronic non-communicable diseases in the context of the COVID-19 pandemic. Consensus of experts of the National society of evidence-based pharmacotherapy and the Russian society of the prevention of non-communicable diseases. © 2020 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved

Prospective in-hospital registry of patients with suspected or documented COVID-19 infection and community-acquired pneumonia (TARGET-VIP): characteristics of patients and assessment of in-hospital outcomes [Проспективный госпитальный регистр больных с предполагаемыми или подтвержденными коронавирусной инфекцией COVID-19 и внебольничной пневмонией (ТАРГЕТ-ВИП): характеристика включенных больных и оценка исходов стационарного этапа лечения]

Aim. To characterize patients admitted to hospital with suspected or documented COVID-19 infection and community-acquired pneumonia (CAP) and to assess the prevalence of concomitant cardiovascular, non-cardiac diseases, prehospital cardiovascular therapy and outcomes of in-hospital treatment. Material and methods. The TARGET-VIP registry includes patients admitted to the N.I. Pirogov National Medical and Surgical Center with suspected or documented COVID-19 infection and/or CAP for the period from April 6, 2020 to July 2, 2020. COVID-19 infection was diagnosed using polymerase chain reaction (PCR) tests and chest computed tomography (CT). Comorbid conditions and pre-hospital therapy were assessed. Results. A total of 1,130 patients were included in the registry (mean age, 57,5±12,8 years; men, 579 (51,2%)). Using PCR test, COVID-19 infection was established in 686 (60,7%) patients; using chest CT — 334 (29,6%) patients. The most numerous were the group with a combination of COVID-19 and CAP (n=662; 58,6%) and the group with CAP without positive PCR (n=402; 35,6%). The group of patients with COVID-19 without CAP was the smallest (n=24; 2,1%); in 3,7% of patients (n=42), CAP was not confirmed and PCR were negative. The proportion of people with cardiovascular diseases (CVD) according to the survey, in comparison with data of medical records, was higher by 2% (52,2 vs 50,2%); the proportion of persons with chronic non-cardiac diseases — higher by 6,7% (50,8 vs 44,1%). Among patients with CVD (n=598), compared with patients without CVD (n=532), following diseases was diagnosed significantly more often: diabetes (odds ratio (OR), 5,66; 95% confidence interval (CI), 3,52-9,12), respiratory disease (OR, 2.,7; 95% CI, 1,43-4,27), chronic kidney disease (OR, 3,32; 95% CI, 1,97-5,59), obesity (OR, 15,35; 95% CI, 6,62-35,59). Hospital mortality was 4,2% and significantly differs (4,7 times) in patients with and without COVID-19 according to PCR (6,6 vs 1,4%, p=0,0001), including among patients with CAP and positive or negative PCR (6,0 vs 1,2%, p=0,0002). Conclusion. COVID-19 infection was diagnosed in 60,7% of patients according to PCR and in 90,3% of patients according to the combination of PCR and chest CT. Among patients with CVD, the proportion of people with chronic noncardiac diseases was significantly higher (regardless of age and sex), in particular, with diabetes, chronic kidney disease and obesity. Questionnaires provided important data on the history of noncommunicable diseases and prehospital cardiovascular therapy. The mortality rate of patients with documented COVID-19 infection was 4,7 times higher than with undocumented. © 2020 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved

Place of vitamin D in the prevention of premature aging and the development of age-associated diseases

There is an ongoing search for the molecular and biochemical mechanisms underlying the development of aging and age-associated diseases. At the same time there is growing evidence geroprotective properties of vitamin D. In this review, described in detail the possible mechanisms by which vitamin D affects differentiation, cell proliferation and apoptosis, and describes the potential benefits of this vitamin in the fight against aging and age-related diseases

Т1-картирование в оценке факторов риска развития диффузного фиброза миокарда при гипертонической болезни

Background: The assessment of diffuse myocardial fibrosis is necessary to plan the management of patients with various cardiovascular disorders, including hypertensive heart disease. The development of imaging techniques has enabled a non-invasive detection of left ventricular myocardial fibrosis by magnetic resonance imaging (MRI) with T1 mapping.Aim: By cardiac MRI, to identify risk factors for diffuse left ventricular myocardial fibrosis in patients with hypertensive heart disease.Materials and methods: This was a cross-sectional observational study in 50 outpatients with hypertensive heart disease, aged 46 to 82 years (median, 68 [64; 72] years) and bodyweight of 52 to 120 kg (median, 91 [80; 98] kg). Standard cardiac MRI with delayed contrast enhancement was performed with Optima MR450w GEM 1.5T (General Electric, USA). For assessment of diffuse myocardial fibrosis MRI mapping by 2D MOLLI (3-3-5) technique was used. The results were analyzed with Cvi42 software (Circle Cardiovascular Imaging Inc., USA). The potential risk factors included patients’ age, gender, bodyweight, and diastolic heart failure.Results: The mean time of T1 relaxation without contrast enhancement was 1122.64 ±63.67 ms, indicating the presence of myocardial fibrosis in 100% of the patients. Female patients had more advanced diffuse myocardial abnormalities (p 0.001). In the elderly patients, there was a direct correlation between their age and degree of fibrosis (p = 0.006). There was an inverse correlation between higher bodyweight and increased extracellular volume. Heart rhythm disorders and diastolic heart failure had no impact on the changes in the mapping parameters of the left ventricular myocardium and MRI-assessed cardiac output values. No correlation between the myocardial fibrosis and dyslipidemia/hyperlipidemia was found. There was a direct correlation between the native T1 mapping values and extracellular volume fraction (p = 0.004) and an inverse correlation between low values of post-contrast T1 mapping and increased extracellular volume fraction (p = 0.05).Conclusion: Т1 mapping in patients with essential arterial hypertension allows for detection of diffuse myocardial fibrosis of the left ventricle, which is recognised as a major indicator of myocardial remodeling. Female gender, older age, and bodyweight were the factors associated with more advanced myocardial fibrosis.Актуальность. Оценка диффузного фиброза миокарда левого желудочка имеет большое значение для определения тактики лечения пациентов с различными заболеваниями сердечно-сосудистой системы, в том числе при гипертонической болезни. С развитием технологий визуализации стало возможным неинвазивное определение фиброза миокарда левого желудочка по данным магнитно-резонансной томографии (МРТ) с применением методики 11-картирования.Цель - определить факторы риска развития диффузного фиброза миокарда левого желудочка по данным МРТ у пациентов с гипертонической болезнью.Материал и методы. В рамках поперечного наблюдательного исследования проведено амбулаторное обследование 50 пациентов с гипертонической болезнью в возрасте от 46 до 82 лет (медиана возраста составила 68 [64; 72] лет) и массой тела от 52 до 120 кг (медиана массы тела - 91 [80; 98] кг). МРТ сердца выполняли на аппарате Optima MR450w GEM 1,5 Тл (General Electric, США) по стандартной программе до и после отсроченного контрастного усиления. Оценку диффузного фиброза проводили при помощи последовательности 2D MOLLI. Данные анализировали с использованием программного обеспечения cvi42 (Circle Cardiovascular Imaging Inc., США). Среди факторов риска оценивали возраст, пол, массу тела, наличие сердечной недостаточности по диастолическому типу.Результаты. Среднее значение бескон-трастного времени Т1-релаксации составило 1122,64 ±63,67 мс, что указывает на развитие диффузного фиброза у 100% пациентов. Более выраженное развитие диффузных изменений миокарда отмечено у пациентов женского пола (p 0,001). У пациентов в старшей возрастной группе наблюдается прямая зависимость роста показателей фиброза от возраста (p = 0,006). Выявлена обратная связь между увеличением массы тела и внеклеточного объема. Наличие нарушений ритма и диастолической сердечной недостаточности никак не повлияло на изменение параметров картирования миокарда левого желудочка и значений, характеризующих сердечный выброс по данным МРТ. Не было обнаружено статистически значимого влияния наличия дислипидемии/гиперлипидемии на состояние миокарда левого желудочка. Определена прямая связь увеличения значений нативного Т1-картирования миокарда с фракцией внеклеточного объема (p = 0,004) и обратная связь уменьшения значений постконтрастного Т1 -картирования с увеличением показателей фракции внеклеточного объема (p = 0,05).Заключение. Т1-картирование у пациентов с гипертонической болезнью позволяет выявить диффузный фиброз миокарда левого желудочка, признанный основным показателем ремоделирования миокарда. Факторами, связанными с более выраженным проявлением фиброза миокарда, оказались женский пол, старший возраст пациента, масса тела пациента

Sex features of cutaneous microvasculature in healthy workingage people [Гендерные особенности микроциркуляторного русла кожи у здоровых лиц трудоспособного возраста]

Aim. To study sex characteristics of cutaneous microvascular structure and function in a cohort of healthy workingage people without cardiovascular diseases. Material and methods. The study included 35 healthy men (42±4 years) and 34 women (41±5 years). The cardiovascular system was assessed in all patients. The microcirculatory bed of the skin was investigated by the following noninvasive methods: 1) computerized video capillaroscopy; 2) laser Doppler flowmetry; 3) photoplethysmography. Results. According to computerized video capillaroscopy in men, compared with women, there was a smaller number of both functioning capillaries (78 vs 86 capillaries/mm2, respectively (p<0,05)) and their total number (100 vs 120 capillaries/mm2, respectively (p<0,001)). Against the background of a decrease in capillary density in men, there was a higher skin interstitial hydration ' 113 vs 96 μm (p<0,005) in men than in women. At the level of precapillary arterioles, where humoral tone regulation prevails. Laser Doppler flowmetry revealed lower pulse amplitude in men than in women ' 0,87 vs 1,02 pf, respectively (p<0,05), which indicates a lower arterial blood inflow to exchange microvessels. Against this background, the constrictor response of precapillary arterioles to a sympathetic nervous system stimulation in men is higher than in women ' 45% vs 40%, respectively (p<0,05). At the level of large arterioles, where neural tone regulation prevails, photoplethysmography revealed lower augmentation index standardized at a heart rate in men (4,6 vs 1,7%, respectively, p<0,05), which indicates lower rigidity of muscular vessels in men. Conclusion. In workingage healthy people, sex differences are noted at all cutaneous microvascular levels, which must be taken into account when planning studies. © 2022 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved

Eating behavior patterns in overweight and obese males

Disorders of eating behavior (EB) are now considered one of the possible overweight causes. Objective. To evaluate EB patterns in deemed healthy overweight and obese males. Material and methods. The study included 170 deemed healthy males aged 26 to 69 years (mean age 43.8±8.5 years), who were divided into three groups according to body mass index (BMI): normal body weight — 38 (22.4%) patients, overweight — 83 (48.8%) patients; obesity class I—II — 49 (28.8%) patients. All patients were assessed for anthropometric measures. The Dutch questionnaire (DEBQ) was used to assess EB patterns. Autonomic status was assessed using the autonomic dysfunction scale. Results. EB changes were observed in 89.2 and 84.3% of males with normal body weight and overweight, respectively, and in 89.8% of patients with obesity class I—II. In males with normal body weight, the restrictive type of EB prevailed, in overweight and obesity class I—II the external and emotiogenic types prevailed. Conclusions. It is necessary to assess EB types and adjust them properly to prevent overweight and obesity promptly. In overweight and obese individuals, EB assessment can help select more effective therapy. © 2022, Media Sphera Publishing Group. All rights reserved