bluuebunny/crossref_metadata_2025 huggingface dataset:
STRUCTURE AND GENDER DIFFERENCES IN COMORBIDITY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Authors: Kedelbaeva Kamilya , Berkinbaev Salim , Junusbekova Gulnar , Tundybayeva Mira , Kassimova Zarina
Published: April 2021

Objective:

To determine significant gender differences in the detection of comorbid pathology and to assess the role of comorbidity in the course of patients with myocardial infarction.

Design and method:

Statistical processing of the results was carried out using SPSS program using the methods of descriptive, parametric and non-parametric statistics. Numeric variables are generalized to their mean, standard deviation. The results are presented by the confidence interval (x ± confidence) for the average population with a normal distribution.

Results:

We performed a retrospective analysis of 500 patients. There were 325 men (65%); 175 women (35%), whose average age was 64.7 ± 1.03 years.

In the analysis, among patients with MI, comorbidity was revealed: in women, 30.6% had an average (2–3 diseases) and 41.1% high (4 or more diseases) comorbidity, while in men a combination of two or three nosological units was in 101 (30.9%), four - five and more in 90 (27.6%).

In almost all examined patients, 448 (89.6%) AMI developed against the background of arterial hypertension. Grade I hypertension was detected in 28 (6.3%), grade II hypertension - in 90 (20%), grade III hypertension - in 330 (73.7%).

129 (25.8%) patients had diabetes mellitus, CKD - in 118 (23.6%), COPD - in 97 (19.4%), gastrointestinal diseases - in 92 (18.4%), stroke was found in 58 (11.6%). Anemia was detected in 38 (7.6%), PE - in 7 (1.4%), DVT of the lower extremities - in 7 (1.4%).

Conclusions:

The vast majority of patients with a history of acute MI had comorbid pathology, more than half of them had 2–3 nosologies. Considering that 89.6% of patients had concomitant arterial hypertension, the influence of this factor on the clinical course of the disease cannot be excluded. Moreover, more than half of the patients with this concomitant pathology had a high degree of hypertension, which undoubtedly indicates an increase in the number of patients with hypertension and requires rational and timely antihypertensive therapy in this category of patients. The prevalence of comorbidity in women compared with men was determined; in women, more comorbidity in the structure was revealed.
ANALYSIS OF INTERRELATION BETWEEN COMORBID PATHOLOGY AND ANGIOGRAPHIC FEATURES OF CORONARY STREAM IN PATIENTS WITH MYOCARDIAL INFARCTION IN ALMATY CITY CARDIOLOGY CENTER
Authors: Kedelbaeva Kamilya , Oralbekova Zhanar , Berkinbayev Salim , Dzhunusbekova Gulnar , Tundybayeva Mira , Toilybaeva Madina
Published: April 2021

Objective:

The goal of the study is to determine the interrelation between comorbid pathology and angiographic features of the coronary stream.

Design and method:

Retrospective analysis of 500 clinical records of patients hospitalized at the Cardiology Center. The estimation of clinical diagnoses was carried out according to the rules of formulation and in accordance with ICD-10 revision. Statistical processing of results was performed in Microsoft Excel and Statistica Soft programs. The dependence of a parameter on one or more independent variables was revealed by means of regression analysis, where R-square (determination coefficient) and coefficients were taken into account. The higher the determination coefficient is, the higher the dependence is.

Results:

The age structure of the patients was determined: from 25 to 44 years old - 27,6% (138), from 44 to 60 years old, mainly about 2/3 of patients were over 60 years old.

Single vessel disease was found in 216 patients (43.2%), double vessel disease - in 111 patients (22.2%), three-vessel disease - in 66 patients (13.2%) and trunk disease - in 4 patients (0.8%). Taking into account the angiographic results, myocardial revascularization (balloon angioplasty and coronary artery stenting) was performed in 57.4% patients (287), coronary bypass surgery - 22% patients (110), and optimal medication therapy was recommended for 10.2% patients (51).

It was established that all patients with three-vessel coronary artery disease had comorbid pathology: 2–3 diseases were found in 32 patients (48.5%), comorbidity of 4–5 diseases – in 26 patients (39.4%), comorbidity of more than 5 diseases – in 8 patients (12.1%). The main structure of comorbidity in MI was determined: most frequently - 95.5% (63) arterial hypertension, 35% (23) - diabetes mellitus, 13.6% (9) - chronic obstructive pulmonary disease, 12% (8) - acute cerebrovascular event.

The data of linear regression analysis has revealed a reliable correlation between the combination of comorbid pathology and multivessel coronary artery disease among the investigated patients (R2 = 1).

Conclusions:

The correlation between the combination of comorbid pathology and multivessel coronary artery disease in patients with acute myocardial infarction in the cardiology center was established.
ASSOCIATION OF HYPERTENSION WITH QUALITY OF LIFE AND MEASURES OF MENTAL AND PHYSICAL HEALTH IN PATIENTS WITH RHEUMATIC DISEASES
Authors: Anyfanti Panagiota , Gavriilaki Eleni , Nikolaidou Barbara , Triantafyllou Areti , Papadopoulos Nikolaos , Aslanidis Spyros , Douma Stella , Gkaliagkousi Eugenia
Published: April 2021

Objective:

Increased prevalence of hypertension has been reported among patients with rheumatic diseases implicating autoimmune pathways and chronic inflammation. However, these patients commonly present mental health disorders, physical disability and impaired quality of life, which may as well interfere with hypertension. In the present study, we investigated the association of hypertension with quality of life and measures of mental and physical health in a large cohort of patients with rheumatic diseases.

Design and method:

Among consecutive patients attending the outpatient Rheumatology Clinic, health-related quality of life and anxiety were evaluated using the EuroQol 5D (EQ-5D) utility index and the Hamilton Anxiety Scale (HAM-A), respectively. The Health Assessment Questionnaire Disability Index (HAQ-DI), and the HAQ Pain Visual Analogue Scale (VAS-Pain) were used as measures of physical disability and arthritis-related pain, respectively. Hypertension was defined according to the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines.

Results:

A total of 464 individuals (81.7% females) with a mean age of 55.5 ± 13.8 years were included. Rheumatoid arthritis was the most common rheumatic disease (32.8%), followed by osteoarthritis (17.0%) and seronegative spondyloarthropathies (11.4%). Mean systolic/diastolic blood pressure (BP) was 130.3 ± 19.9/79.5 ± 10.5 mmHg and prevalence of hypertension reached 58.6% and. Patients with hypertension presented significantly higher HAM-A levels [16 (10–23) vs 13 (9–20.5), p = 0.014), higher HAQ-DI score (0.94 ± 0.79 vs 0.60 ± 0.61, p < 0.001), lower EQ-5D score (0.50 ± 0.24 vs 0.59 ± 0.24, p < 0.001), and higher VAS-pain [50 (25–75) vs 44.5 (10–70) %, p = 0.017], compared to normotensive patients. Multivariate analysis accounting for cardiovascular risk factors and disease-related parameters revealed an independent inverse association between systolic BP and quality of life (beta = –0.224, p = 0.022).

Conclusions:

Patients with rheumatic diseases and comorbid hypertension presented increased levels of anxiety, disability and pain and diminished quality of life compared to their normotensive counterparts. The association between BP and quality of life remained significant even after adjustment for other factors, revealing the complexity of the psycho-physical mode. Whether hypertension negatively affects quality of life in patients with chronic rheumatic disorders or vice versa impaired quality of life leads to increased BP, warrants further investigation.
ROS MEDIATED MYOCARDIAL ISCHEMIA-REPERFUSION INJURY ATTENUATION BY MORIN: REGULATION OF RISK/SAPK PATHWAYS
Authors: Verma Vipin Kumar , Arya D.S.
Published: April 2021

Objective:

Morin, a bioflavonoid, has demonstrated anti-oxidant, anti-inflammatory and other diverse pharmacological protective activities in various experimental models. Oxidative stress plays an important role in the pathogenesis of myocardial ischemia reperfusion (IR) injury. Thus, this study aimed to evaluate the effect of Morin in Myocardial IR injury model and its underlying mechanism.

Design and method:

Male albino Wistar rats were divided into 5 groups. Sham; IR-Control; 2 Morin pre-treated groups (40 and 80 mg/kg; p.o.) and Morin perse group. The morin were administered for 28 days in respective group. On 29th day, rats were experienced 45 min myocardial ischemia following 60 min reperfusion except Sham and Morin perse groups. The cardioprotective potential was investigated via hemodynamic, biochemical, inflammatory marker investigations, cytokines levels, morphological analysis, immuno-histochemical analysis and protein expression estimation through multiplexed Immuno-blotting. The apoptotic markers were also investigate to analysed the programmed cell death due to oxidative stress.

Results:

With respect to IR-control group, Morin pre-treatment significantly normalized hemodynamic parameters, restored antioxidant status, improved pathological changes, reduced the release of cardiac injury markers, inhibited inflammation (TNF-alpha/IL-6/NF (kappa)B/IKK (beta) and apoptosis (increased Bcl-2, decreased Bax/Caspase-3 and TUNEL positivity) in the myocardium. This improvement in antioxidant, inflammation and anti-apoptosis markers could be due to downregulation of SAPK (p38/JNK) pathway and upregulation of survival kinase i.e. RISK pathway (ERK/eNOS) in the myocardium.

Conclusions:

IR induced oxidative stress leads to production of free radicals is attenuated by morin pretreatment for 28 days in rats which further reduced inflammation and apoptosis in the myocardium. This is the first experimental study which highlighted the role of SAPK/RISK pathways in morin induced cardio-protection in IR injury.
THE ROLE OF ADIPOKINES IN PATIENTS WITH CORONARY ARTERY DISEASE
Authors: Papadopoulos Dimitrios , Sanidas Elias , Tsakalis Konstantinos , Velliou Maria , Zerva Kanella , Ntaliou Liana , Iliopoulos Dimitrios , Mantzourani Marina , Nikiteas Nikolaos , Barbetseas John
Published: April 2021

Objective:

Several adipose tissue bioactive factors (adipokines) have been linked to atherosclerosis, namely adiponectin, apelin and omentin-1 prevent atherosclerosis whereas resistin, visfatin and chemerin predispose to the development of coronary atherosclerotic plaques. The aim of this study was to calculate adipokines plasma levels in patients with and without angiographically established coronary artery disease (CAD) investigating any potential corellation between them and CAD.

Design and method:

Overall, 80 patients (40 with significant CAD and 40 without significant CAD) were studied. Adiponectin, apelin, omentin-1, resistin, visfatin and chemerin plasma levels were measured by the Elisa method.

Results:

Adiponectin, apelin and omentin-1 plasma levels were significantly lower in patients with CAD whereas visfatin, resistin and chemerin levels were significantly higher compared to those without CAD (Figure). No significant differences in demographic characteristics were observed between the two groups (Table).

Conclusions:

In patients with angiographically established CAD cardioprotective adipokines were lower while non-cardioprotective adipokines were higher indicating a direct relationship of these factors with the progression of atherosclerosis.
IN-HOSPITAL BLOOD PRESSURE VARIABILITY AS A PREDICTOR OF CARDIOVASCULAR EVENTS AND RENAL DYSFUNCTION IN THE SETTING OF ACUTE MYOCARDIAL INFARCTION
Authors: Mantzouranis M. , Tsioufis K. , Konstantinou K. , Kolokathis K. , Koumelli A. , Kalos T. , Kouremeti M. , Yfantis A. , Magkas N. , Fragoulis C. , Kasiakogias A. , Leontsinis I. , Tolis E. , Tousoulis D.
Published: April 2021

Objective:

Recent data have associated blood pressure variability (BPV) with cardiovascular morbidity and renal dysfunction but not in the setting of acute coronary syndrome (ACS). The aim of this study is to determine the impact short-term BPV on in-hospital cardiovascular outcomes and renal function in patients suffering a myocardial infarction (MI).

Design and method:

A total population of 250 MI patients (79.6% male; mean age 62.5 years;68.4% hypertensives)underwent 24-h ambulatory BP measurement during their hospitalization. The parameters of BPV analyzed were: a) 24-h standard deviation (SD), b) coefficient of variation (CV) and c) average real variability (ARV) of systolic and diastolic BP. The study population was divided intoa STEMI (n = 127) and a non-STEMI (n = 123) group. Cardiovascular outcomes included: new onset of ACS, pulmonary edema, hypertensive emergency, life threatening arrhythmias,whereas worsening of renal function (WRF) was defined as a reduction of GFR > or = 25% according to the RIFLE criteria. No deaths or strokes occurred.

Results:

In the total population a significant association was demonstrated between SBP CV andthe incidence of cardiovascular outcomes (OR = 1.136; 95% CI: 0.452–1.819; P = 0.001). After separate analysis for each MI group, SBP CV remained a predictor in the STEMI group (OR = 1.825; 95% CI: 0.814–2.835; P = 0.001). Regarding WRF CV SBP demonstrated a prognostic role (OR = 1.946; 95% CI:0.923–2.969; P < 0.001)in the entire population. Results for STEMI group were similar (OR = 3.769; 95% CI:2.056–5.481; P < 0.001). However, non-STEMI group failed to demonstrate any significant associations. We therefore, conducted multivariate regression models for STEMI group, in which the CV SBP retained predictive value of cardiovascular outcomes (OR = 1.502; 95% CI:0.470–2.534; P = 0.005) and WRF (OR = 4.139; 95% CI:2.423–5.962; P < 0.001)independently of age, gender, history of hypertension, diabetes mellitus (DM), smoking and low-density lipoprotein (LDL-C).

Conclusions:

In the setting of STEMI, assessment of BPV using CV could have a prognostic role of in-hospital cardio-renal outcomes suggesting a clinical need for further individualization of BP regulation in the integrative ACS management.
PREVALENCE AND NATURE OF EXTRA-CORONARY ARTERIAL ABNORMALITIES IN PATIENTS WITH SPONTANEOUS CORONARY ARTERY DISSECTION VS. CONTROLS
Authors: Pappaccogli Marco , Lopez-Sublet Marilucy , Al-Hussaini Abtehale , Radhouani Ibtissem , Adlam David , Persu Alexandre
Published: April 2021

Objective:

Spontaneous Coronary Artery Dissection (SCAD) has been associated with a high prevalence of Fibromuscular Dysplasia (FMD) and other extra-coronary arterial abnormalities. However, the prevalence, severity and clinical relevance of these abnormalities is still unclear. The objectives of the current study were: (i) to assess extra-coronary arterial abnormalities by MRA in patients with SCAD compared to controls; (ii) to compare the performance of MRA vs. CTA.

Design and method:

All images were jointly analysed by a vascular medicine specialist and a radiologist blinded for subject status and characteristics. In addition to qualitative analysis of images, arterial tortuosity was assessed by number of angles > 45% and tortuosity index in the main vascular beds.

Results:

MRA from brain to pelvis was available for 166 patients with SCAD (97% women, age at diagnosis: 44.4 ± 7.8 years) and 42 healthy controls matched for age and gender. The prevalence of FMD in patients with SCAD was 30.7% vs. 9.5% in controls (p = 0.005). In the SCAD group, the most frequently affected vascular beds were renal (13.9%), cerebrovascular (12.0%) and iliac (10.8%) arteries. Only 22% of SCAD patients had FMD lesions in 2 or more arterial beds. Nine SCAD patients (5.4%) had aneurysms vs. one (2.4%) in the control group (p = 0.5). No case of arterial dissection was identified. The prevalence and degree of arterial tortuosity was similar in cases and controls, irrespective of measurement method or arterial bed. Finally, in 35 patients explored both by CTA and MRA, the performance of MRA for detection of extra-coronary arterial abnormalities was similar to that of CTA.

Conclusions:

Based on the current blinded analysis of a large series of fully explored patients with SCAD compared to controls: (i) extra-coronary FMD is three times more frequent in patients with SCAD than in apparently healthy controls; (ii) FMD associated with SCAD is less often multivessel and associated with less severe arterial manifestations than “classical” FMD; (iii) patients with SCAD are not prone to extra-coronary arterial tortuosity; (iv) the performance of MRA is similar to that of CTA for detection of extra-coronary abnormalities in patients with SCAD.
ATHEROSCLEROTIC CORONARY ARTERY DISEASE IN PATIENTS WITH CARDIOMETABOLIC SYNDROME: FROM THREE FUKUOKA UNIVERSITY REGISTRY IN JAPAN
Authors: Miura Shin-Ichiro , Ike Amane , Shiga Yuhei , Suematsu Yasunori , Iwata Atsushi
Published: April 2021

Objective:

Major coronary risk factors were included in aging, gender, family history, hypertension, diabetes, high cholesterol and smoking. Metabolic syndrome includes abdominal obesity, high blood pressure, high triglyceride (TG) and/or low high-density lipoprotein cholesterol (HDL-C) and diabetes. We determined the critical risk factors for the onset and progression of coronary artery disease (CAD).

Design and method:

We have been going on three Fukuoka University Registry in Japan to define the risk factors for primary and secondary prevention of atherosclerotic CAD: Coronary Computed Tomography Angiography (FU-CCTA) Registry, Coronary Intravascular Ultrasound (FU-IVUS) Registry and Quantitative Coronary Angiography (FU-QCA) Registry. We analyzed the data from three Registry.

Results:

First, HDL-C levels were most closely associated with the presence of CAD from the FU-CCTA registry, and we need to perform CCTA for suspected CAD patients with lower HDL-C levels under statin treatment. In addition, in the five groups classified according to the number of metabolic factors, the number of significantly coronary stenosed vessels was significantly increased as the number of metabolic factors increased. Second, we found that among CAD patients treated with statins, TG levels were associated with lipid-rich coronary plaques in females, but not in males according to the FU-IVUS Registry. TG levels may be more important indicators of residual risk after statin treatment in females than in males. Lastly, HDL-C < 40 mg/dl and low-density lipoprotein cholesterol (LDL-C) equal to or more than 100 mg/dl were even more strongly related to major adverse cardiac events in female patients, whereas the combination of LDL-C and HDL-C was not related to MACEs in male patients on the FU-QCA Registry.

Conclusions:

Although an increased metabolic factors induces more severe CAD and lower HDL-C and higher LDL-C induce the onset and progression of CAD, there may be gender differences in the significance of lipid profiles.
HIGH-NORMAL BLOOD PRESSURE IS PARTICULARLY ASSOCIATED WITH INCREASED RISK FOR ACUTE CORONARY SYNDROMES IN WOMEN: THE HORDALAND HEALTH STUDY
Authors: Kringeland Ester Anne , Tell Grethe S. , Midtbø Helga , Haugsgjerd Teresa R. , Igland Jannicke , Gerdts Eva
Published: April 2021

Objective:

Hypertension is a major risk factor for acute coronary syndromes (ACS). Less is known about whether high-normal blood pressure (BP) carries a different risk for ACS in women and men. We tested associations of high-normal BP with incident ACS in women and men participating in the community-based Hordaland Health Study (HUSK).

Design and method:

We followed 8262 participants aged 42 years (52% women) in HUSK from 1992/93 through 2009 by coupling them to the Cardiovascular Disease in Norway (CVDNOR) project and Cause of Death Registry. BP was measured at baseline in triples at after at least 2 minutes rest in seated position with calibrated sphygmomanometers in 1992/93. The average of the two last measurements was taken as the clinic BP measure. The cohort was divided according to BP class: normal BP (BP < 130/85 mmHg), high-normal BP (BP130–139/85–89) and hypertension (BP > 140/90 or use of antihypertensive drugs). ACS was defined as hospitalization or death with an acute myocardial infarction or unstable angina pectoris diagnosis (ICD-9 codes 410, 411 and ICD-10 codes I20.0, I21 and I22) in the period 1994–2009. The association between BP category and ACS was tested in sex-specific Cox regression analyses adjusted for diabetes, smoking and total cholesterol. Normal BP was used as the reference group.

Results:

At baseline, 17% women and 27% men had high-normal BP and 16% women and 32% men had hypertension (both p < 0.001 between sexes). During follow-up, 1.4% of women and 6.1% of men experienced an ACS (p < 0.001). In multivariable analyses in women, both hypertension and high-normal BP were associated with incident ACS (hazard ratio (HR) 2.79, 95% confidence interval (CI) 1.36–5.72 and HR 2.22, 95 % CI 1.05–4.71, respectively). In men, hypertension but not high-normal BP was associated with incident ACS (HR 1.63, 95 % CI 1.16–2.30 and HR 1.20, 95 % CI 0.81–1.77 respectively).

Conclusions:

In the Hordaland Health Study, high-normal BP was a stronger risk factor for ACS in middle-aged women than men. Our findings suggest that sex-specific diagnosis of high-normal BP and hypertension may be warranted.
INFECTIOUS-INFLAMMATORY MEDICAL HISTORY AND COURSE OF CORONARY HEART DISEASE IN MIDDLE AGE PERSONS
Authors: Evsevyeva Maria , Italyantseva Elena , Eremin Michail , Koshel Vladimir
Published: April 2021

Objective:

Inflammation is recognized risk factor, but it refers to immuno-inflammatory diseases such as rheumatoid arthritis, psoriasis, etc. Focal infection from these positions is poorly studied. The aim is to study the features of coronary heart disease (CHD) in persons of working age in relation to infectious and inflammatory diseases (IID) suffered in the past.

Design and method:

124 patients with CHD type of tension angina of functional class II-III (58 men and 66 women) aged 45 to 60 years were examined. Data on previously transferred diseases in the framework of focal chronic infection such as pyelonephritis, gallstone disease, tonsillitis, sinusitis, adnexitis, etc. were carefully studied. Exclusion criteria: presence of allergic and immune-inflammatory diseases, as well as diabetes mellitus. Patients were divided into two groups: 1st group - 35 CHD patients without IID; 2nd group - 89 patients with CHD and IID in history. These comparison groups were comparable in the profile of risk factors. Statistical analysis of the material was carried out using the program SPSS Statistics 17.0 version.

Results:

It turned out that almost three-quarters of able-bodied CHD patients have a history of IID. At the same time, oropharyngeal diseases are more common than others. Infectious-inflammatory anamnesis was registered more often than some classical risk factors. Patients with a history of IID were more likely to suffer myocardial infarction (p = 0.008), acute cerebrovascular accident, various cardiac arrhythmias and had more pronounced manifestations of heart failure.

Conclusions:

The presence of a history of IID contributes to more severe course of the main coronary pathology, which once again confirms the idea of the advisability of considering infection as a factor of cardiovascular risk.
A RARE CASE OF INFECTIVE ENDOCARDITIS FOLLOWING CORONARY ANGIOPLASTY WITH AN UNUSUAL PRESENTATION OF ENDOPHTHALMITIS
Authors: D'souza Monisha , M Roshan
Published: April 2021

Objective:

There is a rise in the global incidence of infective endocarditis due to gram-negative bacilli like Pseudomonas aeruginosa and involving structures of the left side of the heart such as valve apparatus and papillary muscles. It is due to the increasing usage of implantable cardiac devices and prosthetic valves. Occurrence of infective endocarditis following minor cardiac procedures like coronary angiography or angioplasty is extremely rare. Infective endocarditis has varied clinical presentations making its diagnosis difficult. Hence a high degree of clinical suspicion by the treating physician is essential for rapid diagnosis and treatment.

Design and method:

We present a case of a 54 year old man, a non-intravenous drug user with long standing history of diabetes mellitus, who underwent a per-cutaneous coronary angioplasty for a double vessel block of the coronary vasculature. Six months later he presented to the emergency room with a febrile illness. His initial blood report was positive for dengue fever. His clinical symptoms rapidly worsened over one day with development of endogenous endophthalmitis of left eye, erythema nodosum, new-onset Janeway lesions and transient glomerulonephritis. Blood and vitreous fluid cultures showed growth of Pseudomonas aeruginosa.

Results:

Transthoracic echocardiogram showed presence of an oscillating vegetation attached to the papillary muscle of the left ventricle, associated with moderate mitral regurgitation and new onset mitral valve prolapse. He was aggressively treated with a combination therapy of intravenous and intravitreal antibiotics. His clinical features and blood hemogram showed gradual improvement over the next four weeks, responding to medical treatment. Echocardiogram was repeated which showed no resolution in findings. As his visual acuity showed no improvement, an enucleation surgery of his left eye was planned. One day prior to the surgery, patient became unresponsive with no recordable pulse rate and blood pressure. He had developed a sudden cardiac arrest and died.

Conclusions:

Complications and systemic embolization are more commonly associated with the left heart infective endocarditis. Despite various advances and administration of adequate treatment, infective endocarditis is associated with a guarded prognosis. It has significantly high degree of morbidity and mortality.
ANGIOTENSIN-CONVERTING ENZYME INHIBITORS & ANGIOTENSIN RECEPTOR BLOCKERS ON RISK OF MORTALITY: A META-ANALYSIS OF RANDOMIZED-CONTROLLED TRIALS INVOLVING 317,984 PATIENTS
Authors: Alosaimi Manal , Roos Nur Aishah Che , Alnakhli Anwar Mansour , Cleland John G.F. , Padmanabhan Sandosh
Published: April 2021

Objective:

To evaluate the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) on all-cause & cardiovascular (CV) mortality in patients with or at high-risk of CV diseases

Design and method:

We performed a meta-analysis with data from randomized-controlled trials. Bibliographic databases were searched until 31 July 2019 for ACEIs & ARBs trials versus placebo or active therapy & supported with head-to-head trials in people with or at high-risk of CV diseases. Only trials with at least 100 participants and at least one year of follow-up were included. Studies were excluded if they were redacted or combined ACEIs with ARBs. Outcomes were all-cause mortality & CV mortality. Dichotomous outcomes data were analysed using risk ratio (RR) measure and its 95% CI with random-effects model. A random-effects meta-regression analysis was performed to explore role systolic blood pressure (SBP) reduction achieved.

Results:

97 trials with 317,984 patient-years of follow-up were included. Patients were randomly assigned to ACEIs in 42 trials, ARBs in 45 trials compared with control (placebo or active) & 10 trials compared ACEIs and ARBs head-to-head. Compared with control, those assigned to ACEIs had a 5% lower all-cause (RR, 0.95; 95% 0.91–0.98; p = 0.003) & 9% lower CV (RR, 0.91; 95% CI 0.86–0.97; p = 0.002) mortality. Whereas, no all-cause (RR, 0.99; 0.96–1.02; p = 0.55) & CV (RR, 0.99; 95% CI 0.94–1.05; p = 0.73) mortality could be demonstrated with ARBs therapy. However, head-to-head trials exhibited no difference between ARBs & ACEIs on either all-cause (RR, 1.03; 95% CI 0.98–1.08; p = 0.20) or CV (RR, 1.04; 95% CI 0.98–1.10; p = 0.16) mortality. The meta-regression analysis suggested that the effect of ACEIs on all-cause mortality and CV death was due to reduction in systolic blood pressure (SBP); p-value is 0.01 & 0.02; respectively. This did not appear to be the case for ARBs.

Conclusions:

ACEIs appear effective in reducing mortality; the evidence for ARBs appears less secure. The effect of ACEIs are associated with and may be due to a reduction in SBP.
ERDOSTEINE SALVAGES CARDIAC NECROSIS: NOVEL EFFECT THROUGH MODULATION OF MAPK AND NRF-2/HO-1 PATHWAY
Authors: Mutneja Ekta , Verma Vipin , Malik Salma , Arya D.S.
Published: April 2021

Objective:

To assess the pharmacological and molecular effects of erdosteine in ISO induced myocardial necrosis in rats

Design and method:

To optimize the effect of erdosteine against experimental model of myocardial necrosis, male albino Wistar rats were divided into eight groups (n = 6) i.e. normal, ISO-control (ISO-C), erdosteine treatment with ISO. Rats in treatment groups were administered erdosteine orally for 28 days, whereas in normal and ISO-C group, 1% CMC was administered orally at 2 ml/kg/day for 28 days. Two consecutive doses of ISO 85 mg/kg, s.c. were given to ISO-C and erdosteine treatment groups on 27th and 28th day at 24 h interval. On 29th day, hemodynamic parameters were recorded and animals were sacrificed to excise their heart for measurement of various parameters.

Results:

In ISO-C rats, significantly increased levels of inflammatory markers, pro-oxidants and structural damage was observed as compared to normal group. Furthermore, immunohistochemistry revealed an increased expression of apoptotic proteins and decreased expression of anti-apoptotic protein which was further confirmed through TUNEL assay. Pretreatment with erdosteine at 80 mg/kg and 160 mg/kg reversed the deleterious effects of isoproterenol and normalized myocardial architecture. Erdosteine showed anti-inflammatory and anti-apoptotic activities through inhibition of MAPK pathway. Furthermore, erdosteine partially activated transcription factor Nrf-2 and HO-1 expressions showing the anti-oxidant potential of erdosteine.

Conclusions:

Thus, this study revealed the new use of an old drug and concluded the protective effect of erdosteine in ISO-induced myocardial necrosis through combined effect of MAPK and Nrf-2/HO-1 pathway.
SOCIODEMOGRAPHIC, CLINICAL AND MORBIDITY FACTORS ASSOCIATED WITH COVID 19 MORTALITY IN HOSPITALIZED PATIENTS: A RETROSPECTIVE OBSERVATIONAL STUDY
Authors: Verma Anjana , Chaudhary Suresh
Published: April 2021

Objective:

To identify and evaluate the associations between baseline characteristics (sociodemographic variables, clinical features, morbidity factors) at the time of hospital admission and mortality in patients with COVID-19 at a tertiary hospital in north west India.

Design and method:

This retrospective observational study included 750 patients hospitalized for COVID-19 (from 1 st July to 30th September, 2020) at a tertiary care hospital in Rajasthan (north west state in India) who were discharged or who died. Information about gender, age, clinical features, comorbidities, and laboratory results for each patient were obtained from the electronic medical records. Associations between mortality and baseline characteristics on hospital admission were estimated as hazard ratios (HR) calculated with Cox regression models

Results:

Out of the total hospitalised patients, 64.6% were males and 35.4% were females. The overall mortality was 5.6%. Hypertension (9.7%) was the most common co morbidity, followed by Diabetes mellitus (6.8%). Mortality was higher among males, referred patients and the patients who presented with history of shortness of breath and fever. The variables most clearly associated with a greater hazard of death were age (2.5% HR increase per 1 year increase in age; 95%CI 1.2–5) and hypertension (HR 1.5, 95%CI 1.03–3.98).

Conclusions:

The patients who were not the local residents and referred from outside the district showed great vulnerability. The main baseline variables that were independently associated with mortality in patients hospitalized for COVID-19 were older age and hypertension.
COMORBIDITIES FACTORS AND HYPERTENSION IN RELATION TO COVID-19
Authors: Koh Jong Hoon , Shim Enjin , Kang Minjeong , Hwang Inkyeong
Published: April 2021

Objective:

Hypertension is commonly accompanied by many comorbidities that are major determinant factors for the severity of COVID-19. To investigate Comorbidities factors and hypertension in relation to COVID-19

Design and method:

A retrospective analysis that independent factors in hospitalized patients with COVID 19.

Results:

A study consisting of 164 COVID 19 patients with hypertension and comorbidities factors (HTCOB) was higher severity and complications in the 49 cases than in the 115 cases with only hypertension cases. Chest computed tomographic scans showed bilateral patchy shadows or ground glass opacity in the lungs of 14 COB patients. The median time from first symptom to dyspnea was 5 days, to hospital admission was 21 days in the HTCOB. Multivariable-adjusted analysis revealed that male sex, age over 60 years old, obesity and hypertension were independent factors for COVID 19 severity. Adjustment for age, high lactate dehydrogenase (LDH), and D dimer, hypertension with obesity was independently associated with the severity of COVID 19 on admission

Conclusions:

There patients with both obesity and hypertension are at particularly high risk for severe disease in COVID-19 and thus require careful observation and intensive treatment.
ROLE OF HYPERTENSION ON THE SEVERITY AND PROGRESSION OF COVID-19: A RETROSPECTIVE COHORT STUDY IN INDIA
Authors: K Ambily , Nair Tapas Sadasivan
Published: April 2021

Objective:

To compare the clinical characteristics and progression of COVID-19 in normotensive and hypertensive patients, and assess the potential role of hypertension in aggravation of COVID-19

Design and method:

This was a retrospective cohort study focusing on the clinical data of all the 1487 patients diagnosed with COVID-19 and admitted at the Maulana Azad Medical College, New Delhi from March to September 2020. Demographic data, medical history, clinical symptoms and signs, laboratory findings, chest computed tomography (CT), treatment details, and clinical outcomes were extracted from medical records.

Results:

1487 COVID-19 inpatients were included in this study, of whom 1252 were discharged and 235 were deceased in hospital. 61% of 235 deceased patients had hypertension, as opposed to 38% of the patients who were discharged (RR = 2.18, P < 0.05). The relative risk was highest for patients above 70 years, in males, in smokers, and in those with family history of hypertension. Higher risk was noticed in patients with uncontrolled hypertension as compared to those whose BP were under control. A similar relationship for hypertension was detected with admission to ICU (RR = 3.27, P < 0.01).

Conclusions:

Hypertension is not just a chronic underlying comorbidity, but also a risk factor affecting the severity of COVID-19 and adverse outcomes. Therefore, hypertension management in COVID-19 patients is an important aspect in the diagnostic and therapeutic strategies.
IMPACT OF COVID 19 PANDEMIC ON BLOOD PRESSURE OF HEALTHCARE PROFESSIONALS DURING LOCKDOWN - AN INDIAN STUDY
Authors: Gupta Amit , Maheshwari Anuj , Verma Narsingh , Jagadeesha Aravinda , Dariya S.S. , Sharma Amit , Saxena Divya , Srivastava Anubha , Patni Bijay , Das Deepak , Kaur Amrit , Aggarwal Amitesh , Gulati Padmashri , Srivastava Saurabh , Agnihotri Arti
Published: April 2021

Objective:

Covid-19 pandemic has challenged the healthcare system globally. Hypertension is one of the risk factors associated with increased mortality and morbidity with Covid-19 infection. Few studies have looked into the impact of the Covid-19 pandemic on the mental health of healthcare professionals (HCPs). However not much is known about its impact on physical health and blood pressure of HCPs. Objective is to to Study the distribution of blood pressure and impact of Covid 19 on blood pressure of HCPs.

Design and method:

Prospective cross-sectional survey

Methods:

The study was conducted among Indian HCPs. A self administered survey asked about the socio demographic data, known risk factors, past history of hypertension, working conditions in lockdown (work from home or working at a healthcare establishment with potential to exposure to Covid-19), work hours and blood pressure measurement for three consecutive days during lockdown.

Results:

Six Hundred and eighty seven HCPs (52.8% doctors, 25.1% nurses & paramedics, 22.1 allied HCPs), 63.78% males and 36.22% females, mean age 34.8% (SD = 11.5 years) participated in the study. 14.4% (98) had known hypertension while 28.8% (198) were found to be hypertensive for the first time (50% Doctors, 26.26% Nurses/Paramedics and 23.74% Allied Healthcare Professionals). 79.3% (n = 198) of these had normal blood pressure when checked in the past 12 months. 76.26% (n = 198) of these were directly at risk of exposure to Covid-19. The pandemic has seriously impacted the mental and psychological health of HCPs. Our study highlights that Covid 19 pandemic significantly impacts the blood pressure of HCPs with an alarming rise in risk for their health.

Conclusions:

Health care professionals developed hypertension in significantly higher numbers during COVID-19 pandemic. While working on the frontline with COVID-19, they are already on higher risk of getting infection. COVID-19 has been found to have serious complications with hypertension. Apart from this hypertension itself is known to lead adverse cardiovascular outcomes. Unfortunately, the majority of them are not aware of their elevated blood pressure. HCPs should remain more careful for their own blood pressure while working in pressure of COVID 19.
CARDIOVASCULAR COMPLICATIONS FROM COVID-19 MAY BE PREDICTED BY THE INCREASED LEVEL OF C-REACTIVE PROTEIN: A META-ANALYSIS
Authors: Greca Elona , Shah Muhammad , Pandav Krunal , Dedja Dario , Hoxhaj Ilda
Published: April 2021

Objective:

Current evidence suggests that the most common cardiovascular complications in the COVID-19 patients include acute myocardial injury, congestive heart failure (CHF), coronary artery disease (CAD), cardiac arrhythmias and thromboembolic events. Considering that the mechanism for myocardial injury is reported to result mainly from the direct viral involvement of cardiomyocytes and the effects of systemic inflammation, our scope is to evaluate the relation of the increased level of C-Reactive Protein (CRP) and the cardiovascular complications due to COVID-19.

Design and method:

We conducted a systematic literature search on various databases such as PubMed, Web of Science and Scopus to identify the relevant articles. We included studies published until September 2020. The receiver operating characteristic (ROC) curve was utilized to analyze the prognostic ability of CRP in the cardio-vascular complications from COVID-19. Subgroup and sensitivity analyses were performed. Heterogeneity was assessed using Cochran's Q test and I2 test. The presence of publication bias was evaluated by visual inspection of the symmetry in funnel plots

Results:

Nineteen studies met the inclusion criteria with more than 10,630 participants. Subgroup analysis of the clinical classification included acute myocardial injury, CHF, CAD and thromboembolic events. The ROC curve shows that AUC (CHF)=85% (95% CI of 0.598 to 1); AUC (CAD)=81% (95% CI of 05.44 to 1); AUC (Thromboembolic events)=100% (95% CI of 1 to 1). The Kaplan-Meier curve and the log-rank test were applied to further assess the potential risk factors associated with the progression of cardiovascular complications from COVID-19. The Youden index was implemented to set cutoff values. Data analysis was conducted using SPSS 23.0 software.

Conclusions:

This meta-analysis implies that CRP could be a valuable marker to anticipate the cardiovascular complications from COVID-19. Further evidence based research is mandated for the evaluation of the prognostic role of CRP in these patients.
IMPACT OF REDUCTION IN AIRCRAFT NOISE EXPOSURE ON BLOOD PRESSURE AND ARTERIAL STIFFNESS DURING COVID-19 PANDEMIC: CROSS-SECTIONAL AND LONGITUDINAL STUDY
Authors: Wojciechowska Wiktoria , Januszewicz Andrzej , Drozdz Tomasz , Rojek Marta , Baczalska Justyna , Terlecki Michal , Kurasz Karol , Olszanecka Agnieszka , Smolski Mikolaj , Prejbisz Aleksander , Dobrowolski Piotr , Hryniewiecki Tomasz , Kreutz Reinhold , Rajzer Marek
Published: April 2021

Objective:

The COVID-19 lockdown caused unprecedented decline in environmental noise pollution. We aimed to evaluate the impact of aircraft noise exposure decrease during lockdown on blood pressure (BP) and selected hypertension-mediated organ damages.

Design and method:

As previously reported (J Hypertens. 2019; 37) in 2015 (1st observation) we examined group of inhabitants exposed to high (>60 dB) aircraft noise living near Cracow Airport (n = 101), and compared them to unexposed group (<55 dB) (n = 100). In June 2020, 4 months after COVID-19 pandemic restrictions introduction, we reassessed (2nd observation) 74 and 75 participants from previously exposed and unexposed groups, respectively, using the same study protocol. We collected medical history, office and ambulatory BP, echocardiographic and arterial stiffness data.

Results:

In exposed to aircraft noise group the prevalence of arterial hypertension increased from 1st to 2nd observation (P < 0.05). During lockdown in the noise exposed group office and 24 hour diastolic BP (DBP, P < 0.022) decreased significantly, which was accompanied by a significant drop in annoyance (P = 0.006). In this group in 2nd observation DBP was significantly lower than estimated DBP (i.e. calculated as a sum of DBP at 1st observation and parameter estimates of cross-sectional association of DBP and age multiplied by 5.5 year – time period between observations) (P = 0.047). The obtained decline in DBP from 1st to 2nd observation was grater in noise exposed than unexposed participants, even after adjustment for covariates. The carotid-femoral pulse wave velocity (PWV), initially higher in noise exposed group, decreased from 1st to 2nd observation in both groups, however this was more pronounced in the exposed than unexposed group (P = 0.003). In 1st observation PWV in noise exposed participants did not show any relationship with age (Parameter Estimate (PE)=0.01 m/s/year; P = 0.71), while in 2nd observation, during aircraft noise decline caused by COVID-19 lockdown, the expected positive relation of PWV with age was reinstituted (PE = 0.15 m/s/year; P < 0.001).

Conclusions:

As our previous study indicated, aircraft noise exposure may increase BP and accelerate arterial stiffening. The decrease in BP and PWV due to noise intensity diminution, observed during COVID-19 lockdown, in fact provides evidence for this observation.
SKIN CAPILLARY ALTERATIONS IN PATIENTS WITH ACUTE SARS-COV-2 INFECTION
Authors: De Ciuceis Carolina , Rosei Claudia Agabiti , Brami Valeria , Rossini Claudia , Gaggero Andrea , Fama’ Francesca , Muiesan Maria Lorenza , Rizzoni Damiano
Published: April 2021

Objective:

Acute SarsCoV2 infection is associated with endothelial dysfunction and endothelitis which might explain systemic microvascular impairment. The presence of endothelial damage can promote vasoconstriction with consequent organ ischemia, inflammation, tissue edema and a procoagulant state resulting in an increase in the incidence of cardio- and cerebrovascular events. Microvascular thrombosis has been demonstrated in post-mortem autopsy of COVID19 patients; however no data are available about skin capillary alterations in these patients.

Design and method:

We evaluated skin microvascular alterations in 14 patients admitted to our hospital with SarsCov2 infection. Basal capillary density was performed by capillaroscopy bedside in the nailfold and in the dorsum of the 4th finger.

Results:

Fourteen patients (9 males, 5 females) were evaluated: average age was 66 ± 1 years, BMI 26 ± 3. Nine patients were hypertensive (64%), 4 diabetic (29%), 3 were dyslipidemic (21%), 3 with cerebrovascular or cardiovascular disease history (21%). Seven patients were treated with ev steroid (50%), 3 with tocilizumab (21%) and 7 were treated with non-invasive ventilation (50%).

During the hospitalisation all patients presented interstitial pneumonia SarsCov2 associated whereas vascular complication (ischaemic stroke or pulmonary embolism) were observed in 3 patients (21%) with SarsCov2 infection. Nine patients showed skin capillary alterations (5 thrombosis, 5 haemorrhage/microbleeding, 4 neoangiogenesis). Interestingly, capillary alterations were present only in patients treated with non-invasive ventilation and/or with cardio- or cerebrovascular complications. These alterations were not detected after 2 month from the discharge.

Conclusions:

This is the first in vivo evidence of skin capillary thrombosis, microhaemorragia and angiogenesis in patients with acute SARS-CoV2 infection which support the presence of endothelial dysfunction and inflammation. Capillary alterations might reflect systemic vascular effects of viral infection.
ROLE OF HYPERTENSION, CARDIOVASCULAR DISEASE AND CARDIOVASCULAR RISK FACTORS ON OUTCOME IN HOSPITALIZED COVID-19 PATIENTS
Authors: Chiarini Giulia , Boari Gianluca E.M. , Bonetti Silvia , Orlandini Federico Braglia , Malerba Paolo , Bianco Gianluca , Faustini Cristina , Rizzoni Damiano
Published: April 2021

Objective:

Emerging data show that hypertension as well as other cardiovascular risk factors may have a major role on outcome in terms of death on patients with COVID-19. We analysed a population of 258 consecutive patients admitted to General Medicine ward of the Hospital of Montichiari (Brixia, Italy) from 29 February to 30 April 2020.

Design and method:

A group of 258 consecutive patients (173 males and 85 females, aged 71 ± 14) was enrolled. In 168 patients, high-flow oxygen was required (Venturi mask), 20 patients needed orotracheal intubation and 11 were given continuous positive pressure oxygen therapy (CPAP). Patients were treated with the best approach according to available evidence during pandemic period: anti-malaria agents, anti-viral drugs, antibiotics (azithromycin and others), tocilizumab and low molecular weight heparin (LMWH). As of June 10th, 65 deaths had been observed. Survival curves were calculated according to Kaplan-Meier method. Comparison between groups was performed with Breslow and Mantel-Cox test.

Results:

As shown in the table, a significant raise in mortality was observed in patients older than 65 years (p < 0.001), of male sex (p < 0.001), hypertensives (p < 0.001) as well as in patients with heart disease (picture 1; p < 0.001), COPD (picture 2; p = 0.004), diabetes (p < 0.001) and neoplasms (p = 0.03) compared with patients with no comorbidities or different diseases, both at discharge and at standard follow-up. The number of comorbidities impacted on survival as well.

Conclusions:

Hypertension, heart disease and cardiovascular risk factors play a significant role as a negative prognostic factor in patients affected by SARS-CoV-2 pneumonia. This confirms previous observations (Pol Arch Intern Med 2020;130(4):304–309) and outlines the importance of prevention of contagion in population with cardiovascular risk factors or established cardiovascular disease.