Impact of the COVID-19 pandemic on hospital admission rates for arterial hypertension and coronary heart disease: a German database study

BackgroundDuring the SARS-CoV-2 pandemic it was speculated that the virus might be associated with a persistent increase of cardiovascular risk. The present study compares pre- and post-pandemic hospital admission rates for hypertension and coronary artery disease.MethodsSystematic multicentric retrospective cohort analysis of 57.795 hospital admissions in an urban region in Germany during two different periods (pre-pandemic 01–06/2019 vs. post-pandemic era 01–06/2023). Information on hospital admissions for arterial hypertension, chronic coronary syndrome, unstable angina pectoris and acute myocardial infarction were extracted from the hospitals data systems. Additionally, six comorbidities and performed coronary interventions were monitored.ResultsCompared to the pre-pandemic era, there was no increase in hospitalizations for arterial hypertension (516 vs. 483, −6.8%, p = 0.07) or myocardial infarction (487 vs. 349, −23.8%, p < 0.001), but the total number of patient admissions with chest pain as the presenting symptom increased (chronic coronary syndrome: 759 vs. 943, +24.2%, p < 0.001; unstable angina pectoris: 270 vs. 451, +67.0%, p < 0.001). At the same time, the number of performed coronary angiographies increased, but less patients underwent percutaneous interventions. Patients admitted with chest pain in the post-pandemic era were in general healthier with less comorbidities.ConclusionThe present multicenter cohort study found no evidence for an increase in hospitalizations for arterial hypertension or coronary artery disease after the end of the pandemic. However, further studies with larger sample sizes are needed to confirm our results

Lipoprotein(a) as a risk factor for atherosclerotic cardiovascular disease in patients in non-metropolitan areas of Brandenburg, Germany

Background and aimsIn the non-metropolitan region of Brandenburg (Germany), which is characterized by high rates of cardiovascular diseases and underserved medical care, there is a lack of awareness regarding lipoprotein(a) [Lp(a)] as a risk factor. In addition, data from patients with atherosclerotic cardiovascular disease (ASCVD) in diverse regional backgrounds, including the understudied Brandenburg cohort, and various healthcare statuses remain insufficient.MethodsIn this WalkByLab study, Lp(a) levels were monitored in a non-metropolitan cohort (n = 850) in Brandenburg, Germany, comprising 533 patients at high cardiovascular risk and 317 healthy controls. Patients underwent a comprehensive angiological screening, which included blood serum analysis, assessment of medical and family history, cardiovascular risk, and disease status, and evaluation of lifestyle and quality of life. All parameters were evaluated with regard to two groups based on Lp(a) levels: low (<50 mg/dl) and high (≥50 mg/dl).ResultsBrandenburg patients with cardiovascular diseases showed higher Lp(a) levels than healthy controls (24.2% vs. 14.8%, p = 0.001). Logistic regression analysis with different characteristics revealed that Lp(a) was an independent risk factor significantly associated with ASCVD (OR 2.26, 95% CI 1.32–3.95, p = 0.003). The high-Lp(a) group showed a higher proportion of patients with coronary artery disease, peripheral artery disease, or cerebrovascular disease compared to the low-Lp(a) group (50% vs. 36.8%; 57.7% vs. 45.8%; 17.6% vs. 9.2%; p = 0.004); also, a higher percentage of patients in the high-Lp(a) group had heart failure (72.8% vs. 53.2%, p = 0.014) and myocardial infarction (24.7% vs. 13.9%, p = 0.001). The high-Lp(a) group exhibited higher rates of statins (63.1% vs. 50.4%, p = 0.003), ezetimibe (14.8% vs. 5.5.%, p = 0.001), and beta-blockers (55.7% vs. 40.7%, p = 0.001) use. Lp(a) levels were found to be independent of physical activity or smoking behavior and did not change over time (12 months).ConclusionsOur study highlights the significance of elevated Lp(a) levels in Brandenburg cardiovascular patients and identifies them as an independent risk factor for ASCVD, which has implications for addressing cardiovascular health of non-metropolitan populations

Leukocyte telomere length and mitochondrial DNA copy number associate with endothelial function in aging-related cardiovascular disease

BackgroundWe investigated the association between leukocyte telomere length, mitochondrial DNA copy number, and endothelial function in patients with aging-related cardiovascular disease (CVD).MethodsIn total 430 patients with CVD and healthy persons were enrolled in the current study. Peripheral blood was drawn by routine venipuncture procedure. Plasma and peripheral blood mononuclear cells (PBMCs) were collected. Cell-free genomic DNA (cfDNA) and leukocytic genomic DNA (leuDNA) were extracted from plasma and PBMCs, respectively. Relative telomere length (TL) and mitochondrial DNA copy number (mtDNA-CN) were analyzed using quantitative polymerase chain reaction. Endothelial function was evaluated by measuring flow-mediated dilation (FMD). The correlation between TL of cfDNA (cf-TL), mtDNA-CN of cfDNA (cf-mtDNA), TL of leuDNA (leu-TL), mtDNA-CN of leuDNA (leu-mtDNA), age, and FMD were analyzed based on Spearman's rank correlation. The association between cf-TL, cf-mtDNA, leu-TL, leu-mtDNA, age, gender, and FMD were explored using multiple linear regression analysis.Resultscf-TL positively correlated with cf-mtDNA (r = 0.1834, P = 0.0273), and leu-TL positively correlated with leu-mtDNA (r = 0.1244, P = 0.0109). In addition, both leu-TL (r = 0.1489, P = 0.0022) and leu-mtDNA (r = 0.1929, P < 0.0001) positively correlated with FMD. In a multiple linear regression analysis model, both leu-TL (β = 0.229, P = 0.002) and leu-mtDNA (β = 0.198, P = 0.008) were positively associated with FMD. In contrast, age was inversely associated with FMD (β = −0.426, P < 0.0001).ConclusionTL positively correlates mtDNA-CN in both cfDNA and leuDNA. leu-TL and leu-mtDNA can be regarded as novel biomarkers of endothelial dysfunction

Prognostic Value of Urinary Calprotectin, NGAL and KIM-1 in Chronic Kidney Disease

Background/Aims: Urinary biomarkers like neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) do not only allow an early diagnosis of acute kidney injury, but also provide prognostic information in this setting. The present prospective study investigates, whether the urinary biomarkers NGAL, KIM-1 and calprotectin have prognostic information in chronic kidney disease (CKD) as well. Methods: Urinary calprotectin, NGAL and KIM-1 concentrations were assessed in a study population of 143 patients with stable CKD comprising diabetic and hypertensive nephropathy, glomerulonephritis/vasculitis, and autosomal dominant polycystic kidney disease. An eGFR fluctuation > 5ml/min/1.73m2 in the past 12 months was defined as an exclusion criterion in order to exclude cases with acute on chronic kidney injury. Renal function was monitored for a median follow-up of 37 months. Results: In the overall study population, all the three biomarkers failed to predict DeGFR and DACR from baseline to follow-up in linear regression analysis adjusted for age, gender, and baseline eGFR. Contrarily, baseline ACR was significantly associated with DeGFR (p< 0.001). In the subgroup of patients with vasculitis and glomerulonephritis, all the three biomarkers were significantly associated with DeGFR, with calprotectin having the highest regression coefficient. Conclusion: In contrast to the traditional biomarker “albuminuria”, neither the inflammatory biomarker calprotectin, nor the tubular biomarkers NGAL and KIM-1, provide robust prognostic information on the loss or renal function in a heterogeneous CKD population. All of them, however, are candidate prognostic biomarkers in primarily inflammatory renal diseases

Effekt der externen Gegenpulsation auf das Wachstum von kardialen Kollateralarterien bei Patienten mit stabiler koronarer Herzkrankheit

Arteriogenesis (collateral artery growth) is nature’s rescue mechanism to overcome the fatal consequences of arterial occlusion or stenosis. External counterpulsation is a promising therapy for symptomatic patients who have coronary artery disease (CAD). However, the mechanism of ECP action remains unclear. The goal of this trial was to investigate the effect of external counterpulsation (ECP) on coronary collateral artery growth. Twenty-three patients (mean age of 61 years) who had stable CAD and at least one hemodynamic significant stenosis that was eligible for percutaneous coronary intervention (PCI) were recruited and assigned to ECP and control groups in a proportion of 2:1, respectively. The patients assigned to the ECP group (n=16) underwent 35 1-hour sessions of ECP during a period of seven weeks. The natural course of collateral circulation of the patients who were assigned to the control group (n=7) was evaluated during the seven weeks. All patients underwent a cardiac catheterization at baseline and after seven weeks with invasive measurements of the pressure-derived collateral flow index (CFIp, primary endpoint) and fractional flow reserve (FFR). Angina and dyspnea at exertion were evaluated by the scales of the Canadian Cardiovascular Society (CCS) and New York Heart Association (NYHA). The left ventricular function and structure were evaluated by cardiac magnetic resonance imaging (CMR). In the ECP-group, the CFIp (from 0.08±0.01 to 0.15±0.02; p<0.001) and FFR (from 0.68±0.03 to 0.79±0.03; p=0.001) improved significantly, although no change was observed in the control-group. Only the ECP-group showed a reduction of symptoms in the CCS (p=0.008) and NYHA scales (p<0.001). No change of parameters (ejection fraction, left ventricular end diastolic mass, stroke volume) was detected by the CMR. These data provide for the first time direct functional evidence of the stimulation of coronary arteriogenesis by ECP in patients with stable CAD. The improvement of the myocardial blood flow was accompanied by an alleviation of the patients’ symptoms. Our data might open a novel non-invasive and preventive treatment avenue for patients who have non- acute, vascular, stenotic disease.Die Arteriogenese (Kollateralgefäßwachstum) ist ein natürlicher Rettungsmechanismus um die fatalen Komplikationen einer arteriellen Okklusion oder Stenose zu beseitigen. Die Externe Gegenpulsation (ECP) ist eine vielversprechende Therapie für Patienten mit koronarer Herzkrankheit (KHK). Der Wirkungsmechanismus von ECP ist bisher allerdings unklar. In dieser Studie wurde der Effekt der externen Gegenpulsation auf das Kollateralenwachstum untersucht. In die Studie wurden dreiundzwanzig Patienten (mittleres Alter 61 Jahre) mit stabiler KHK und mindestens einer signifikanten Koronararterienstenose mit Indikation zur Ballondilatation rekrutiert. Die Patienten wurden prospektiv im Verhältins 2:1 in die ECP- und Kontrollgruppe verteilt. Die Patienten der ECP-Gruppe (n=16) wurden für insgesamt 35 Stunden über einen Zeitraum von 7 Wochen mittels ECP behandelt. Bei den Patienten der Kontrollgruppe (n=7) wurde im gleichen Zeitraum der natürliche Verlauf des Kollateralwachstums geprüft. Alle Patienten erhielten zu Beginn und am Ende der Studienzeit (7 Wochen) eine Herzkatheteruntersuchung mit hämodynamischen Messungen des kollateralen Flussindexes (CFIp, primärer Endpunkt) und der fraktionellen Flussreserve (FFR). Die belastungsabhängige Angina und Dyspnoe wurden anhand der CCS (Canadian Cardiovascular Society) und NYHA (New York Heart Association) Skala geprüft. Die Funktion und Struktur des linken Ventrikels wurde mittels der kardialen Magnetresonanztomographie (CMR) untersucht. Die ECP-Patienten zeigten einen signifikanten Anstieg des CFIp (von 0.08±0.01 auf 0.15±0.02; p<0.001) und des FFR (von 0.68±0.03 auf 0.79±0.03; p=0.001) nach der siebenwöchigen Therapie. In der Kontrollgruppe wurde keine Änderung der invasiven Endpunkte festgestellt. Nur die ECP- Patienten zeigten eine Verbesserung der Symptomatik in der CCS (p=0.008) und NYHA Skala (p<0.001). Die geprüften Parameter der CMR (Auswurffraktion, enddiastolische linksventrikuläre Masse, Schlagvolumen) zeigten keine Änderung nach der ECP Therapie. Diese Daten stellen erstmals einen funktionellen Beweis dar, dass die Therapie mit externer Gegenpulsation zur Stimulierung der Arteriogenese bei Patienten mit KHK führt. Die Verbesserung des myokardialen Blutflusses ging mit der Linderung der klinischen Beschwerden der Patienten einher. Unsere Daten könnten neue Wege zu nicht-invasiven und präventiven Behandlungen für Patienten mit chronischen Stenosen eröffnen

Exercise and cardiovascular diseases

Exercise is a physiologic stressor that has multiple beneficial effects on cardiovascular system. Currently exercise training is a class I intervention as part of a multifactorial long-term process that includes: clinical assistance, assessment of global cardiovascular risk, identification of specific objective for each cardiovascular risk factor, formulation of an individual treatment plan with multiple intervention aimed at reduction of the risk, educational programs, planning of long term follow-up. This paper reviews the evidences of benefit of exercise in the most common heart diseases and describes the role of exercise training in the cardiac rehabilitation programs