scholarly journals Pandemic of Fear or What Statistics Hide: Patients with Cardiovascular Disease are at Increased Risk During COVID-19

Author(s):  
Oleg Gaisenok

Insufficient statistical information on the structure of mortality in the era of the pandemic is disclosed in this article. It analyzes the statistics and the causes of death during the COVID-19 pandemic from a new coronavirus infection and cardiovascular disease. Actual international data on a decrease in the hospitalization rate of patients with acute coronary syndrome are presented. A comparative analysis of statistics from European countries and Russia shows that cardiovascular diseases are the leading cause of death in populations, and patients with cardiovascular diseases are at increased risk for morbidity and mortality during the COVID pandemic.

2021 ◽  
pp. 53-57
Author(s):  
N. V. Orlova ◽  
V. V. Lomaichikov ◽  
G. A. Chuvarayan ◽  
Ya. G. Spiryakina ◽  
S. E. Arakelov ◽  
...  

The 2019 coronavirus infection pandemic (COVID-19) is widespread worldwide and is characterized by severe complications from the respiratory system, kidneys, liver, etc. The article presents an analysis of ACS in patients with COVID-19. It was revealed that in patients with coronavirus infection, acute coronary syndrome is characterized by a large number of complications and a high risk of death. The article presents the results of a study conducted by the authors on the study of acute coronary syndrome in patients who have undergone COVID-19. The study compares two groups of patients with ACS, depending on the presence of COVID-19 in the anamnesis. In the comparison groups, the analysis of the prevalence of risk factors for cardiovascular diseases was carried out: smoking, age, diabetes, obesity, dyslipidemia. The results of biochemical blood analysis and coagulogram were analyzed. It was found that patients with acute coronary syndrome who underwent COVID-19 were less likely to have risk factors for cardiovascular diseases. Patients with acute coronary syndrome who underwent COVID-19 had lower blood glucose, cholesterol, VLDL, triglycerides and higher blood clotting rates. As a result of the study, it was revealed that COVID-19 is an independent risk factor for the development of acute coronary syndrome against the background of multiple coronary vascular lesions.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lijiao Yang ◽  
Nan Ye ◽  
Guoqin Wang ◽  
Weijing Bian ◽  
Fengbo Xu ◽  
...  

Abstract Background Atrial fibrillation (AF) is the most common cardiac arrhythmia in patients with chronic kidney disease (CKD) and acute coronary syndrome (ACS). This study aimed to explore the frequency and impact of AF on clinical outcomes in CKD patients with ACS. Methods CKD inpatients with ACS between November 2014 and December 2018 were included based on the improving care for cardiovascular disease in China-ACS (CCC-ACS) project. Included patients were divided into an AF group and a non-AF group according to the discharge diagnosis. Multivariable logistic regression was used to adjust for potential confounders. Results A total of 16,533 CKD patients with ACS were included. A total of 1418 (8.6%) patients had clinically recognized AF during hospitalization, 654 of whom had an eGFR of 45 to < 60 ml/min/1.73 m2, and 764 had an estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73 m2. Compared with the non-AF group, the AF group had a higher risk of in-hospital mortality [OR 1.250; 95% CI (1.001–1.560), P = 0.049] and major adverse cardiovascular events (MACEs) [OR 1.361; 95% CI (1.197–1.547), P < 0.001]. We also found that compared with patients with eGFR 45 to < 60 ml/min/1.73 m2, patients with eGFR < 45 ml/min/1.73 m2 had a 1.512-fold increased risk of mortality and a 1.435-fold increased risk of MACEs. Conclusions AF was a risk factor affecting the short-term prognosis of ACS patients in the CKD population. Furthermore, the lower the eGFR, the higher the risk of in-hospital mortality and MACEs in CKD patients with ACS. Trial registry: Clinicaltrial.gov, NCT02306616. Registered 29 November 2014, https://clinicaltrials.gov/ct2/show/NCT02306616?term=NCT02306616&draw=2&rank=1


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Eyileten ◽  
J Jarosz-Popek ◽  
D Jakubik ◽  
M Wolska ◽  
A Fitas ◽  
...  

Abstract Background Acute coronary syndrome (ACS) remains a leading cause of mortality worldwide [1]. Patients who experienced ACS are at high risk of future cardiovascular events and death [2–4]. Identification of reliable predictive tools could potentially improve the risk stratification [5]. Numerous studies revealed that intestinal microbial organisms (microbiota) and its metabolites, as TMAO (trimethylamine-N-oxide) may play a pathogenic role in a cardiovascular disease (CVD) and ACS [6]. Elevated concentration of circulating TMAO has been associated with increased risk of CVD and major adverse cardiac events (MACE), including myocardial infarction (MI), stroke, major bleeding and all-cause mortality [7]. Purpose To investigate the association of liver metabolite TMAO with cardiovascular disease (CV)-related and all-cause mortality in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention. Methods Our prospective observational study enrolled 292 patients with ACS. Plasma concentrations of TMAO were measured during the hospitalization for ACS. Observation period lasted 7 years in the median. Adjusted Cox-regression analysis was used for prediction of mortality. Results ROC curve analysis revealed that increasing concentrations of TMAO levels assessed at the time point of ACS significantly predicted the risk of CV mortality (c-index=0.78, p&lt;0.001). The cut-off value of &gt;4 μmol/L, labeled as high TMAO level (23% of study population), provided the greatest sum of sensitivity (85%) and specificity (80%) for the prediction of CV mortality and was associated with a positive predictive value of 16% and a negative predictive value of 99%. A multivariate Cox regression model revealed that high TMAO level was a strong and independent predictor of CV death (HR=11.62, 95% CI: 2.26–59.67; p=0.003). High TMAO levels as compared with low TMAO levels were associated with the highest risk of CV death in a subpopulation of patients with diabetes mellitus (27.3% vs 2.6%; p=0.004). Although increasing TMAO levels were also significantly associated with all-cause mortality, their estimates for diagnostic accuracy were low. Conclusions High TMAO level is a strong and independent predictor of long-term CV mortality among patients presenting with ACS. TMAO concentration of 4 μmol/L may be a cut-off value for prognosis of ACS patients. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Kaplan-Meier curves Table 1


Author(s):  
Yu. V. Vakhnenko ◽  
A. V. Korotkikh ◽  
E. A. Bagdasaryan

Introduction. Myocardial damage characteristic of novel coronavirus infection is a confirmed risk factor for its severe course and high mortality. There are biomarkers of this condition correlating with an unfavorable prognosis for the patient. However, the information on the problem of myocardial damage in the available literature is not fully systematic. It concerns pathogenesis, differential diagnosis of its causes, routing of patients with acute coronary syndrome. All the above is very important for choosing the right tactics of examination and treatment of patients, who are often limited in time. Aim. To summarize the data available at the time of writing from domestic and foreign researchers on the problem of myocardial damage and its main causes (acute coronary syndrome, myocarditis, stress cardiomyopathy) in COVID-19. Materials and methods. This review summarizes the data from articles published over the past two years found in PubMed, Google Scholar and eLIBRARY. Results. The authors tried to form a generalized modern understanding of the causes and structure of cardiovascular pathology and risk factors of its destabilization in patients infected with SARS-CoV-2, the markers of increased risk of COVID-infected heart and vascular diseases, the tactics of examination and treatment of this category of patients, routing individuals with acute coronary syndrome and its differential diagnosis with non-coronary heart diseases. The questions of organization and availability of the medical care in the conditions of the pandemic and social aspects of the world cardiology problems in the current situation have been studied. Conclusion. Patients with cardiovascular disease have a more severe prognosis of the severity and outcome of COVID-19, which is explained by its pathogenesis. The group at highest risk of lethal events is composed of individuals with signs of myocardial damage, the causes of which are the above mentioned conditions. Their differential diagnosis is a difficult clinical task, which requires a systematic analysis of the dynamics of clinical syndromes and data of additional diagnostic methods from routine to the most modern (high-tech) and, of course, deep knowledge of the present problem. The correct determination of the cause of myocardial damage and the choice of the right patient’s route through the treatment network determines the effectiveness of treatment and, therefore, the prognosis of the patient’s life. 


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Yoshii ◽  
T Matsuzawa ◽  
H Nakahashi ◽  
R Satou ◽  
E Akiyama ◽  
...  

Abstract Background Although the prognostic value of non-invasive endothelial function test has been reported in several populations including heart failure patients and angina pectoris patients, it is unknown in patients with acute coronary syndrome (ACS). Furthermore, the role of endothelial dysfunction in increased risk for specific causes of death has not been investigated. Purpose To study the relation between endothelial dysfunction and the risk of death in ACS patients, both overall and with regard to the main causes of death. Method Six hundred and ninety-two patients who were hospitalized for ACS from 2010 to 2014 were enrolled. Reactive hyoeremia index (RHI) was measured to assess endothelial function non-invasively in all patients using the peripheral arterial tonometry. RHI values below 1.67 were interpreted as signs of endothelial dysfunction in accordance with the manufacturer. Patients were followed up for a median of 6.5 years. Result A mean age (standard deviation) was 66 (12) years, and 542 patients (78%) were male. The patients in this study consist of 377 ST-elevation myocardial infarction (54%), and 263 non ST-elevation myocardial infarction (38%), and 52 unstable angina (8%). Endothelial dysfunction was detected in 276 patients (40%). During the follow-up period, 84 patients (12%) died (48 from cardiovascular disease, 36 from other causes). Patients with endothelial dysfunction had an increased risk of death (hazard ratio (HR) 1.83, 95% confidence interval (95% CI): 1.19–2.83, p=0.006) compared with those without endothelial dysfunction. Analyses for specific causes of death showed that patients with endothelial dysfunction had a 2.4-fold higher increased risk of cardiovascular death (HR: 2.44, 95% CI: 1.35 ro 4.59, p=0.003) after multivariate adjustment. However there was no significant relation between endothelial dysfunction and non-cardiovascular mortality (HR: 0.69, 95% CI: 0.34 to 1.36, p=0.29). Conclusion Endothelial dysfunction is strongly associated with an increased risk of cardiovascular mortality in ACS patients. Figure 1 Funding Acknowledgement Type of funding source: None


2020 ◽  
Author(s):  
Nan Ye ◽  
Lijiao Yang ◽  
Guoqin Wang ◽  
Weijing Bian ◽  
Fengbo Xu ◽  
...  

Abstract Background The discrepancy between glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) in clinical practice may be related to factors such as acute stress, renal dysfunction, and anemia, and its relationship with in-hospital outcomes is uncertain. The aim of this study is to investigate the association between the type of discrepancy between HbA1c and FPG and in-hospital outcomes in patients with acute coronary syndrome (ACS) and diabetes. Methods The Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) project is a national, hospital-based quality improvement project with an ongoing database. Patients with ACS, diabetes and complete HbA1c and FBG values at admission were included. The consistent group included patients with HbA1c < 6.5% and FBG < 7.0 mmol/L or HbA1c ≥ 6.5% and FBG ≥ 7.0 mmol/L. The discrepancy group included patients with HbA1c ≥ 6.5% and FBG < 7.0 mmol/L (increased HbA1c group) or HbA1c < 6.5% and FBG ≥ 7.0 mmol/L (increased FBG group). Results A total of 7,762 patients were included in this study. The numbers of patients in the consistent group and discrepancy group were 5,490 and 2,272 respectively. In the discrepancy group, increased HbA1c accounted for 77.5% of discrepancies, and increased FPG accounted for 22.5% of discrepancies. After adjusting for confounders, patients in the increased FPG group had a 1.6-fold increased risk of heart failure (OR, 1.62; 95% CI, 1.08–2.44), a 1.6-fold increased risk of composite cardiovascular death and heart failure (OR, 1.63; 95% CI, 1.09–2.43), and a 1.6-fold increased risk of composite major adverse cardiovascular and cerebrovascular events (MACCEs) and heart failure (OR, 1.56; 95% CI, 1.08–2.24). Conclusions Patients with an increased FPG but normal HbA1c had a higher risk of in-hospital adverse outcomes than those with increased HbA1c but normal FPG. This result may indicate that when HbA1c and FPG are inconsistent in patients with ACS and diabetes, the increased FPG that may be caused by stress hyperglycemia may have a more substantial adverse effect than increased HbA1c, which may be caused by chronic hyperglycemia. These high-risk patients should be given more attention and closer monitoring in clinical practice.


2020 ◽  
Author(s):  
Nan Ye ◽  
Lijiao Yang ◽  
Guoqin Wang ◽  
Weijing Bian ◽  
Fengbo Xu ◽  
...  

Abstract BackgroundThe discrepancy between glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) in clinical practice may be related to factors such as acute stress, renal dysfunction, and anemia, and its relationship with in-hospital outcomes is uncertain. The aim of this study was to investigate the association between the type of discrepancy between HbA1c and FPG and in-hospital outcomes in patients with acute coronary syndrome (ACS) and diabetes.MethodsThe Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) project is a national, hospital-based quality improvement project with an ongoing database. Patients with ACS, diabetes and complete HbA1c and FPG values at admission were included. The consistent group included patients with HbA1c < 6.5% and FPG < 7.0 mmol/L or HbA1c ≥ 6.5% and FPG ≥ 7.0 mmol/L. The discrepancy group included patients with HbA1c ≥ 6.5% and FPG < 7.0 mmol/L (increased HbA1c group) or HbA1c < 6.5% and FPG ≥ 7.0 mmol/L (increased FBG group).ResultsA total of 7,762 patients were included in this study. The numbers of patients in the consistent and discrepancy groups were 5,490 and 2,272 respectively. In the discrepancy group, increased HbA1c accounted for 77.5% of discrepancies, and increased FPG accounted for 22.5% of discrepancies. After adjusting for confounders, patients in the increased FPG group had a 1.6-fold increased risk of heart failure (OR, 1.62; 95% CI, 1.08-2.44), a 1.6-fold increased risk of composite cardiovascular death and heart failure (OR, 1.63; 95% CI, 1.09-2.43), and a 1.6-fold increased risk of composite major adverse cardiovascular and cerebrovascular events (MACCEs) and heart failure (OR, 1.56; 95% CI, 1.08-2.24) compared to patients in the increased HbA1c group.Conclusions Patients with an increased FPG but normal HbA1c had a higher risk of in-hospital adverse outcomes than those with increased HbA1c but normal FPG.This result may indicate that when HbA1c and FPG are inconsistent in patients with ACS and diabetes, the increased FPG that may be caused by stress hyperglycemia may have a more substantial adverse effect than increased HbA1c, which may be caused by chronic hyperglycemia. These high-risk patients should be given more attention and closer monitoring in clinical practice.


2020 ◽  
Author(s):  
Nan Ye ◽  
Lijiao Yang ◽  
Guoqin Wang ◽  
Weijing Bian ◽  
Fengbo Xu ◽  
...  

Abstract Background The discrepancy between glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) in clinical practice may be related to factors such as acute stress, renal dysfunction, and anemia, and its relationship with in-hospital outcomes is uncertain. The aim of this study is to investigate the association between the type of discrepancy between HbA1c and FPG and in-hospital outcomes in patients with acute coronary syndrome (ACS) and diabetes. Methods The Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) project is a national, hospital-based quality improvement project with an ongoing database. Patients with ACS, diabetes and complete HbA1c and FPG values at admission were included. The consistent group included patients with HbA1c < 6.5% and FPG < 7.0 mmol/L or HbA1c ≥ 6.5% and FPG ≥ 7.0 mmol/L. The discrepancy group included patients with HbA1c ≥ 6.5% and FPG < 7.0 mmol/L (increased HbA1c group) or HbA1c < 6.5% and FPG ≥ 7.0 mmol/L (increased FBG group).Results A total of 7,762 patients were included in this study. The numbers of patients in the consistent group and discrepancy group were 5,490 and 2,272 respectively. In the discrepancy group, increased HbA1c accounted for 77.5% of discrepancies, and increased FPG accounted for 22.5% of discrepancies. After adjusting for confounders, patients in the increased FPG group had a 1.6-fold increased risk of heart failure (OR, 1.62; 95% CI, 1.08-2.44), a 1.6-fold increased risk of composite cardiovascular death and heart failure (OR, 1.63; 95% CI, 1.09-2.43), and a 1.6-fold increased risk of composite major adverse cardiovascular and cerebrovascular events (MACCEs) and heart failure (OR, 1.56; 95% CI, 1.08-2.24).Conclusions Patients with an increased FPG but normal HbA1c had a higher risk of in-hospital adverse outcomes than those with increased HbA1c but normal FPG. This result may indicate that when HbA1c and FPG are inconsistent in patients with ACS and diabetes, the increased FPG that may be caused by stress hyperglycemia may have a more substantial adverse effect than increased HbA1c, which may be caused by chronic hyperglycemia. These high-risk patients should be given more attention and closer monitoring in clinical practice.Trial registry: Clinicaltrial.gov, NCT02306616. Registered 29 November 2014, https://clinicaltrials.gov/ct2/show/NCT02306616?term=NCT02306616&draw=2&rank=1


2021 ◽  
Author(s):  
Irena Mitevska

We are living and fighting serious COVID-19 pandemic, which is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. Cardiovascular diseases are highly prevalent in the infected individuals, which modifies their treatment and prognosis. The injury of the myocardium is reported in over 15% of hospitalized severely ill patients, mostly presented in the form of acute heart failure, acute coronary syndrome, cardiac arrythmias, myocarditis and thromboembolic complications. All these complications may appear at early in the course of the disease, during the disease progress or in the later stage of the COVID-19 disease. Thromboembolic complications accompany more severe cases, caused by excessive inflammation, platelet activation, endothelial dysfunction, and stasis. This new virus pandemic is a global challenge for health care system where we still have much to learn.


2019 ◽  
Vol 6 (2) ◽  
pp. 77-81
Author(s):  
Larysa Zhuravlyova ◽  
Maryna Filonenko

THE ROLE OF TRACE ELEMENT SELENIUM IN CARDIOVASCULAR DISEASE DEVELOPMENT (review) Zhuravlyova L.V., Filonenko M.V. Balanced levels of trace element selenium are of high importance for many of the body’s regulatory and metabolic functions. Reduction  in selenium supply in humans can lead to an increased risk of various pathologies, including cardiovascular diseases. This article considers the contemporary opinions on the role of selenium in physiology and pathophysiology of the cardiovascular system. A particular attention is payed to the effects of selenium deficiency on the development of acute coronary syndrome, including myocardial damage after ischemia/reperfusion and postinfarction remodeling of the left ventricle. Also, the intrinsic properties of selenium for inhibition of apoptosis are highlighted. Keywords: selenium, selenoproteins, cardiovascular disease.   Резюме РОЛЬ МІКРОЕЛЕМЕНТУ СЕЛЕНУ В РОЗВИТКУ СЕРЦЕВО-СУДИННИХ ЗАХВОРЮВАНЬ Журавльова Л.В., Філоненко М.В. Збалансовані рівні мікроелементу селену мають велике значення для багатьох регуляторних та метаболічних функцій організму. Зниження надходження селену в організм людини може призвести до підвищеного ризику розвитку різних патологій, включаючи серцево-судинні захворювання. В статті розглянуто сучасні погляди на роль селену в забезпеченні функціонування серцево-судинної системи. Особливої уваги приділено впливу дефіциту селену на розвиток гострого коронарного синдрому, включаючи ураження міокарда після ішемії / реперфузії та постінфарктного ремоделювання лівого шлуночка. Також виствітлено аспекти внутрішніх властивостей селену щодо інгібування апоптозу.  Ключові слова: селен, селенопротеїни, серцево-судинні захворювання.   Резюме РОЛЬ МИКРОЭЛЕМЕНТА СЕЛЕНА В РАЗВИТИИ СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ Журавлева Л.В., Филоненко М.В. Сбалансированный уровень микроэлемента селена имеет большое значение для многих регуляторных и метаболических функций организма. Снижение поступления селена в организм может привести к увеличению риска развития различных патологий, в том числе сердечно-сосудистых заболеваний. В данной статье рассмотрены современные взгляды на роль селена в обеспечении функционирования сердечно-сосудистой системы. Особое внимание уделено влиянию дефицита селена на развитие острого коронарного синдрома, включая повреждение миокарда после ишемии / реперфузии и постинфарктного ремоделирования левого желудочка. Также освещены аспекты внутренних свойств селена по ингибированию апоптоза. Ключевые слова: селен, селенопротеины, сердечно-сосудистые заболевания.


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