scholarly journals Latest Evidence on Non-Communicable Disease Management (NCD) during COVID-19 Pandemic

2021 ◽  
Vol 5 ◽  
pp. 10
Author(s):  
Abdul Rashid Abdul Rahman
Keyword(s):  
New York ◽  
Observational Studies ◽  
Communicable Disease ◽  
Angiotensin Receptor Blockers ◽  
Sglt2 Inhibitors ◽  
Diabetic Patients ◽  
Recommended Care ◽  
Increased Risk ◽  
Raas Inhibitors ◽  
The Uk

The year 2020 has been dominated by a communicable disease which most did not see coming and are ill- prepared to handle. While daily headlines the world over are dominated by new cases and death from COVID-19, other major health issues must not take a back seat. As of 30thNovember this year, 357 people have died of COVID-19 in Malaysia,while close to 15,000 Malaysians died of Ischemic Heart Disease (IHD) alone. With IHD and cerebrovascular accident (CVA) being the number 1 and number 3 causes of death (15% and 8% of all death, respectively) our focus on COVID-19 must not distract us from the ‘elephant in the room’. Evidence from UK showed that while hospitalization due to acute myocardial infarction (AMI) has significantly decreased by 50%, out of hospital cardiac arrest has significantly increased by 56%; and in hospital mortality from AMI has increased by at least 35% during the pandemic. Patients are shying away from coming for scheduled follow ups, and there has been a reduction in guideline recommended care for NCD. This is confounded by early scare which suggested that treatment of risk factors for NCDs, especially for hypertension, dyslipidemia, and diabetes, may increase susceptibility to and worsen prognosis for patients with COVID-19. Since COVID-19 is a new entity, latest evidence generated are mainly from observational studies with few clinical trials with the exception of vaccine trials. What do we know about management of NCD in the COVID-era?Since the discovery that SARS-COV-2 virus attached itself to the ACE2 receptors before entering cells, alarm bells were sounded that patients treated with RAAS inhibitors may be susceptible to and have worse prognosis. Withup to 60% of hypertensiveworldwide taking this class of drugs, the concern is understandable. Reassuringly, 6 observational studies from 4 countries and 1 RCT from a 5th country showed this not to be true. Studies from China and Italy showed that those on RAAS inhibitors have better prognosis and this has triggered an RCT which hypothesized that pre-treatment with angiotensin receptor blockers may be beneficial in preventing pulmonary damage in these patients. Another RCT is looking at recombinant human ACE2 as treatment for patients with COVID-19. In diabetic patients, an observational study from New York showed those on statin has reduced mortality compared to non-user and in a large UK based primary care setting there was no increased risk of COVID-19 among patients prescribed SGLT2 inhibitors. The SGLT2 inhibitors have been proven to improve clinical outcome including mortality in diabetics and could be safely used to treat patients during the pandemic. Based on a nationwide retrospective cohort in the UK, overall mortality was higher for diabetics admitted to ICU or HDU and with greatest mortality impact in younger patients.The next few months will see more prospective intervention studies publishedaddressing the various unanswered questions. It is worth remembering that substandard care is responsible for upto 84% of CV death. Hence, we shouldnot let our guards down with NCDs even when the world’s attention is focused on COVID-19.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S10

Circulating Stem/Progenitor Cells as Prognostic Biomarkers in Macro- and Microvascular Disease: A Narrative Review of Prospective Observational Studies

2018 ◽  
Vol 25 (35) ◽  
pp. 4507-4517 ◽  
Author(s):  
Mauro Rigato ◽  
Gian Paolo Fadini
Keyword(s):  
Cardiovascular Disease ◽  
Progenitor Cells ◽  
Cardiovascular Events ◽  
Observational Studies ◽  
English Language ◽  
Microvascular Disease ◽  
Patient Characteristics ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Cell Phenotypes

Background: Circulating progenitor cells (CPCs) and endothelial progenitor cells (EPCs) are immature cells involved in vascular repair and related to many aspects of macro and microvascular disease. <p> Objective: We aimed to review studies reporting the prognostic role of CPCs/EPCs measurement on development of cardiovascular disease and microangiopathy. <p> Methods and Results: We reviewed the English language literature for prospective observational studies reporting the future development of cardiovascular disease or microangiopathy in patients having a baseline determination of CPCs/EPCs. We retrieved 34 studied reporting on cardiovascular outcomes and 2 studies reporting on microvascular outcomes. Overall, a reduced baseline level of CPCs/EPCs was associated with a significant increased risk of cardiovascular events, all-cause death, and onset/progression of microangiopathy. The most predictive phenotypes were CD34+ and CD34+CD133+. The main limitation was related to the high heterogeneity among studies in terms of patient characteristics and cell phenotypes. <p> Conclusion: The present review shows that a reduced level of circulating progenitor cells is a risk factor for the development of future cardiovascular events and death. In addition, low CPCs/EPCs levels predict the onset or worsening of microalbuminuria and retinopathy in diabetic patients.

scholarly journals Competing Effects of Renin Angiotensin System Blockade and Sodium-Glucose Cotransporter-2 Inhibitors on Erythropoietin Secretion in Diabetes

2020 ◽  
Vol 51 (5) ◽  
pp. 349-356 ◽  
Author(s):  
Katerina P. Marathias ◽  
Vaia A. Lambadiari ◽  
Konstantinos P. Markakis ◽  
Vassilios D. Vlahakos ◽  
Dimitra Bacharaki ◽  
...  
Keyword(s):  
Angiotensin Receptor Blockers ◽  
Haemoglobin Concentration ◽  
Renin Angiotensin System ◽  
Sglt2 Inhibitors ◽  
Common Finding ◽  
Diabetic Patients ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Sodium Glucose Cotransporter ◽  
Glucose Reabsorption

Background: Anaemia is a common finding in diabetes, particularly in those patients with albuminuria or renal dysfunction and is associated with impaired erythropoietin (EPO) secretion. This review focuses on mechanisms involved in the regulation of erythropoiesis in diabetic patients in an effort to elucidate the competing effects of the renin angiotensin system (RAS) blockade and sodium-glucose cotransporter-2 (SGLT2) inhibitors on haemoglobin concentration and hematocrit values. Summary: The RAS shows significant activation in diabetic subjects. Angiotensin II, its active octapeptide, causes renal tubulointerstitial hypoxia, which stimulates hypoxia-inducible factors (HIF) and increases EPO secretion and erythropoiesis. As expected, drugs that inactivate RAS, such as angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEi/ARB) are associated with a significant hematocrit-lowering effect and/or anaemia in various clinical conditions, including diabetes. Dual blockade by a combination of ACEi and ARB in diabetic patients achieves a better RAS inhibition, but at the same time a worse drop of haemoglobin concentration. Increased glucose reabsorption by SGLTs in diabetic subjects generates a high-glucose environment in renal tubulointerstitium, which may impair HIF-1, damage renal erythropoietin-producing cells (REPs) and decrease EPO secretion and erythropoiesis. SGLT2 inhibitors, which inhibit glucose reabsorption, may attenuate glucotoxicity in renal tubulointerstitium, allowing REPs to resume their function and increase EPO secretion. Indeed, EPO levels increase within a few weeks after initiation of therapy with all known SGLT2 inhibitors, followed by increased reticulocyte count and a gradual elevation of haemoglobin concentration and hematocrit level, which reach zenith values after 2–3 months. Key Messages: The competing effects of RAS blockade and SGLT2 inhibitors on erythropoiesis may have important clinical implications. The rise of hematocrit values by SGLT2 inhibitors given on top of RAS blockade in recent outcome trials may significantly contribute to the cardiorenal protection attained. The relative contribution of each system to erythropoiesis and outcome remains to be revealed in future studies.

scholarly journals Invasive meningococcal disease among university undergraduates: association with universities providing relatively large amounts of catered hall accommodation

1999 ◽  
Vol 122 (3) ◽  
pp. 351-357 ◽  
Author(s):  
K. R. NEAL ◽  
J. NGUYEN-VAN-TAM ◽  
P. MONK ◽  
S. J. O'BRIEN ◽  
J. STUART ◽  
...  
Keyword(s):  
University Students ◽  
Meningococcal Disease ◽  
Communicable Disease ◽  
Invasive Meningococcal Disease ◽  
Increased Risk ◽  
Structural Risk ◽  
Significant Regression ◽  
The Uk ◽  
University Undergraduates ◽  
Health Districts

The incidence of invasive meningococcal disease (IMD) among UK university students and non-students of similar age was investigated. In addition, we sought to identify structural risk factors associated with high rates of IMD in individual universities. Cases were ascertained via Consultants in Communicable Disease Control (or equivalent officers) between September 1994 and March 1997. Data on individual universities were obtained from university accommodation officers.University students had an increased annual rate of invasive meningococcal disease (13·2/105, 95% CI 11·2–15·2) compared with non-students of similar age in the same health districts (5·5/105, CI 4·7–6·4) and in those health districts without universities (3·7/105, CI 2·9–4·4). This trend was highly significant. Regression analysis demonstrated catered hall accommodation to be the main structural risk factor. Higher rates of disease were observed at universities providing catered hall places for >10% of their student population (15·3/105, CI 11·8–18·8) compared with those providing places for <10% of students (5·9/105, CI 4·1–7·7). The majority of IMD amongst students was caused by serogroup B organisms.University students in the UK are at increased risk of IMD compared with non-students of a similar age. The incidence of IMD tends to be greatest at universities with a high provision of catered hall accommodation.

scholarly journals Cardiac Arrhythmias and Electrocardiogram Modifications in Non-Alcoholic Fatty Liver Disease. A Systematic Review

2019 ◽  
Vol 28 (4) ◽  
pp. 483-493 ◽  
Author(s):  
Abdulrahman Ismaiel ◽  
Horaţiu A. Colosi ◽  
Flaviu Rusu ◽  
Dan L. Dumitrașcu
Keyword(s):  
Systematic Review ◽  
Cardiac Arrhythmias ◽  
Fatty Liver Disease ◽  
Ventricular Arrhythmias ◽  
Observational Studies ◽  
Diabetic Patients ◽  
Qtc Interval ◽  
Alcoholic Fatty Liver ◽  
Increased Risk ◽  
Alcoholic Fatty Liver Disease

Background and Aims: Recent studies have evaluated the relationship associating non-alcoholic fatty liver disease (NAFLD) with several electrocardiogram (ECG) findings, but the results have been inconsistent. The aim of this systematic review is to assess the association between NAFLD with ECG modifications. Methods: We conducted a systematic search on PubMed with predefined keywords identifying observational studies published till 22 February 2019 with NAFLD diagnosed either by biopsy, imaging, surrogate markers or ICD code and ECG findings by either a standard ECG, 24-hour Holter ECG or ICD code. Quality assessment was performed using the quality assessment tools from the National Heart, Lung, and Blood Institute. Results: A total of 20 observational studies (1 case-control, 4 cohort, 15 cross-sectional studies, 401,745 individuals) were included. Twelve studies evaluated cardiac arrhythmias in NAFLD subjects, out of which 10 evaluated atrial fibrillation (AF). Although results were inconsistent, most studies rated as “good” demonstrated that hepatic steatosis was independently associated with an increased risk for prevalent AF in NAFLD patients. Diabetic patients with NAFLD were associated with an increased risk of ventricular arrhythmias in only one study rated as “good”. Two studies rated as “good” demonstrated that hepatic steatosis was associated with a prolonged QTc interval. Four studies supported the association between cardiac conduction abnormalities and NAFLD, out of which two were rated as “good”. Two studies assessed ECG modifications of ischemic heart disease (IHD), but only one having a “good” rating confirmed this independent association. Conclusions: Studies of high quality and with low risk of bias demonstrated that NAFLD is independently associated with AF, a prolonged QTc interval, bundle branch and atrioventricular blocks. Diabetic patients with NAFLD present an increased risk for developing ventricular arrhythmias.

scholarly journals A Review on Drug Related Problems in Type 2 DM with Combination of Sulfonylureas and Biguanides

2021 ◽  
Vol 8 (6) ◽  
pp. 271-276
Author(s):  
Chinju Jose ◽  
Abhishek Pradhan ◽  
A. R Shabaraya
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Lactic Acidosis ◽  
Diabetic Patients ◽  
Drug Related Problems ◽  
Increased Risk ◽  
The 1960S ◽  
The Uk ◽  
The University

Increased drug related problems in diabetic patients treated with combinations of high doses of sulfonylureas and metformin was recently reported. This review article is aimed towards the assessment of drug related problems in patients treated with low-doses of sulfonylureas and biguanides. Sulphonylureas the second most commonly used antidiabetic drugs after metformin; there have been concerns regarding the cardiovascular safety of sulfonylureas. These safety concerns initiated with the University Group Diabetes Program conducted in the 1960s, found a sulfonylurea, tolbutamide, where tolbutamide is a first-generation sulfonylurea and was associated with an increased risk of all-cause and cardiovascular problems compared with placebo. Indeed, sulfonylureas have been associated with known cardiovascular risk factors like weight gain, fluid retention, and hypoglycemia. Phenformin, a biguanide, was related to lactic acidosis and withdrawn from use after causing increased risk factors within the University Group Diabetes Program since then, a more modern biguanide, metformin, has risen to its current place because the leading oral therapy for diabetes supported its relative lack of hazard from lactic acidosis and evidence especially from a subgroup of participants in the UK Prospective Diabetes Study, that it can reduce cardiovascular risk and other drug related problems. But there are certain studies showing that combination treatment with metformin and sulfonylurea is more effective, than drugs alone in enabling glycemic control in type 2 diabetes. However, safety of such combinations deserves further investigation. Keywords: Type2 diabetes mellitus, T2DM, drug related problems, sulfonylureas, biguanides.

scholarly journals COVID-19 and RAAS inhibitors: is there a final conclusion?

2021 ◽  
Author(s):  
Mahshid Talebi-Taher ◽  
Mohammad Hosein Najafi ◽  
Shima Behzad
Keyword(s):  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Final Conclusion ◽  
Viral Pathogen ◽  
Increased Risk ◽  
Receptor Blockers ◽  
Infection Disease ◽  
Raas Inhibitors ◽  
Patient Prognosis ◽  
First Time

Coronavirus disease 2019 (COVID-19), the first pandemic caused by a human infecting coronavirus, has drawn global attention from the first time it appeared in Wuhan city of China in late December 2019. Detection of the responsible viral pathogen, named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by WHO, and its possible pathogenesis lead to the forming of many hypotheses about the factors that may affect the patients’ outcome. One of the SARS-CoV-2 infection concerns was the potential role of angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in COVID-19 patients’ morbidity and mortality. Studies demonstrated that because SARS-CoV-2 uses human ACE2 cell receptors as an entry receptor to invade the cells, there might be an association between antihypertensive drugs such as RAAS inhibitors (specifically ACEIs and ARBs) and the COVID-19 disease. Data are scarce and conflicting regarding ACEI or ARB consumption and how it influences disease outcomes, and a single conclusion has not been reached yet. According to the literature review in our article, the most evidentially supported theory about the use of RAAS inhibitors in COVID-19 is that these medications, including ACEI/ARB, are not associated with the increased risk of infection, disease severity, and patient prognosis. However, further studies are needed to support the hypothesis.

Abstract 211: Long-Term Mortality in Diabetic Patients with Non-Obstructive Coronary Disease Undergoing Coronary Angiography/Cardiac Catheterization

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Wendy Bottinor ◽  
Raveen Chawla ◽  
Kalpesh Patel ◽  
Jeremy S Turlington ◽  
Peter Danyi ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Coronary Disease ◽  
Cardiac Catheterization ◽  
Angiotensin Receptor Blockers ◽  
Diabetic Group ◽  
Diabetic Patients ◽  
Risk Of Death ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Baseline Creatinine

Background: Diabetes mellitus is associated with poorer outcomes in patients with cardiovascular disease and patients with diabetes are at increased risk of death. Several studies with coronary computed tomography have shown that, for equal numbers of severely diseased coronary arteries, the outcomes of patients with diabetes is worse compared to patients without diabetes. However, it is unclear if the outcomes of diabetic patients with non-obstructive coronary disease is different than the outcomes of patients without diabetes and non-obstructive disease. Methods and Results: We studied 901 consecutive, predominantly (98%) male patients undergoing coronary angiography/cardiac catheterization at a veterans’ administration medical center who had normal coronaries or non-obstructive coronary artery disease and we assessed the association between diabetic status and mortality. The mean age of the patients was 64.4 years. One third of the patients (n=311, 34.5%) were diabetic. Diabetic patients were the same age, and had the same baseline creatinine, but were more often hypertensive, and were more often on statins, angiotensin receptor blockers, angiotensin conversion enzyme inhibitors, calcium channel blockers and aspirin therapy compared to the non-diabetic patients. Contrast-induced nephropathy (CIN) occurred in 8 (2.57%) diabetic patients and in 11 (1.86%) non-diabetic patients at 72 hours after the procedure (odds ratio [OR] 1.39; 95% confidence interval [CI] 0.55 - 3.49; P= 0.48). At 3 months, renal dysfunction was seen in 34 (10.93%) diabetic patients versus 32 (5.42%) of the non-diabetic group (OR 2.14, CI 1.29 - 3.54; P=0.0032). After a median follow up of 67 months 59 patients (18.97 %) of the diabetic group had died versus 72 (12.20 %) of the non-diabetic group (OR 1.68, CI 1.16 - 2.45; P=0.0007). On multivariate analysis, after adjustment for age, comorbidities, medical therapy, baseline creatinine and the incidence of CIN, the presence of diabetes was significantly associated with the 5 year mortality (OR= 2.10, 95% CI 1.44 - 3.85, P=0.0006). Conclusion: In this cohort of patients undergoing coronary angiography who had normal coronaries or non-obstructive coronary disease, diabetes was associated with an increased mortality.

scholarly journals Influence of blood pressure on pneumonia risk: Epidemiological association and Mendelian randomisation in the UK Biobank

2020 ◽  
Author(s):  
Seyedeh M. Zekavat ◽  
Michael Honigberg ◽  
James Pirruccello ◽  
Puja Kohli ◽  
Elizabeth W. Karlson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Observational Studies ◽  
Mendelian Randomisation ◽  
List Type ◽  
Uk Biobank ◽  
Increased Risk ◽  
Reduce Risk ◽  
Novel Coronavirus ◽  
The Uk

AbstractObjectivesTo determine whether elevated blood pressure influences risk for respiratory infection.DesignProspective, population-based epidemiological and Mendelian randomisation studies.SettingUK Biobank.Participants377,143 self-identified British descent (54% women; median age 58 years) participants in the UK Biobank.Main outcome measuresFirst incident pneumonia over an average of 8 follow-up years.Results107,310 (30%) participants had hypertension at UK Biobank enrolment, and 9,969 (3%) developed a pneumonia during follow-up. Prevalent hypertension at baseline was significantly associated with increased risk for incident respiratory disease including pneumonia (hazard ratio 1.36 (95% confidence interval 1.29 to 1.43), P<0.001), acute respiratory distress syndrome or respiratory failure (1.43 (1.29 to 1.59), P<0.001), and chronic lower respiratory disease (1.30 (1.25 to 1.36), P<0.001), independent of age, age2, sex, smoking status, BMI, prevalent diabetes mellitus, prevalent coronary artery disease, and principal components of ancestry. Mendelian randomisation analyses indicated that genetic predisposition to a 5 mmHg increase in blood pressure was associated with increased risk of incident pneumonia for SBP (1.08, (1.04 to 1.13), P<0.001) and DBP (1.11 (1.03 to 1.20), P=0.005). Additionally, consistent with epidemiologic associations, increase in blood pressure genetic risk was significantly associated with reduced forced expiratory volume in the first second, forced vital capacity, and the ratio of the two (P<0.001 for all).ConclusionsThese results strongly suggest that elevated blood pressure independently increases risk for pneumonia and reduces pulmonary function. Maintaining adequate blood pressure control, in addition to other measures, may reduce risk for pneumonia. Whether the present findings are generalizable to novel coronavirus disease 2019 (COVID-19) require further study.Summary BoxSection 1: What is already known on this topicHypertension has been associated with pneumonia in small observational studies.Based on early epidemiologic analyses, hypertension is described as a risk factor for SARS-CoV-2 infection and associated novel coronavirus disease 2019 (COVID-19).The influence of hypertension on pneumonia risk is difficult to assess in traditional observational studies.Section 2: What this study addsOur pre-COVID-19 analyses are consistent with a causal relationship between increased blood pressure and increased risk for incident respiratory infections, as well as between increased blood pressure and reduced pulmonary function.These results support hypertension as a pneumonia risk factor; efforts to optimize blood pressure may reduce risk for pneumonia.

scholarly journals NON-WHITE ETHNICITY, MALE SEX, AND HIGHER BODY MASS INDEX, BUT NOT MEDICATIONS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM ARE ASSOCIATED WITH CORONAVIRUS DISEASE 2019 (COVID-19) HOSPITALISATION: REVIEW OF THE FIRST 669 CASES FROM THE UK BIOBANK

2020 ◽  
Author(s):  
Zahra Raisi-Estabragh ◽  
Celeste McCracken ◽  
Maddalena Ardissino ◽  
Mae S Bethell ◽  
Jackie Cooper ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Positive Result ◽  
Body Mass ◽  
Angiotensin Receptor Blockers ◽  
Hospital Setting ◽  
Uk Biobank ◽  
White Ethnicity ◽  
Increased Risk ◽  
Male Sex ◽  
The Uk

Background: Cardiometabolic morbidity and medications, specifically Angiotensin Converting Enzyme inhibitors (ACEi) and Angiotensin Receptor Blockers (ARBs), have been linked with adverse outcomes from coronavirus disease 2019 (COVID-19). This study aims to investigate factors associated with COVID-19 positivity for the first 669 UK Biobank participants; compared with individuals who tested negative, and with the untested, presumed negative, rest of the population. Methods: We studied 1,474 participants from the UK Biobank who had been tested for COVID-19. Given UK testing policy, this implies a hospital setting, suggesting at least moderate to severe symptoms. We considered the following exposures: age, sex, ethnicity, body mass index (BMI), diabetes, hypertension, hypercholesterolaemia, ACEi/ARB use, prior myocardial infarction (MI), and smoking. We undertook comparisons between: 1) COVID-19 positive and COVID-19 tested negative participants; and 2) COVID-19 tested positive and the remaining participants (tested negative plus untested, n=501,837). Logistic regression models were used to investigate univariate and mutually adjusted associations. Results: Among participants tested for COVID-19, non-white ethnicity, male sex, and greater BMI were independently associated with COVID-19 positive result. Non-white ethnicity, male sex, greater BMI, diabetes, hypertension, prior MI, and smoking were independently associated with COVID-19 positivity compared to the remining cohort (test negatives plus untested). However, similar associations were observed when comparing those who tested negative for COVID-19 with the untested cohort; suggesting that these factors associate with general hospitalisation rather than specifically with COVID-19. Conclusions: Among participants tested for COVID-19 with presumed moderate to severe symptoms in a hospital setting, non-white ethnicity, male sex, and higher BMI are associated with a positive result. Other cardiometabolic morbidities confer increased risk of hospitalisation, without specificity for COVID-19. Notably, ACE/ARB use did not associate with COVID-19 status.

Sign in / Sign up

Export Citation Format

Share Document