Angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and HMG-CoA reductase inhibitors ("statins") have been hypothesized to affect COVID-19 severity. However, up ...to now, no studies investigating this association have been conducted in the most vulnerable and affected population groups (ie, older adults residing in nursing homes). The objective of this study was to explore the association of ACEi/ARB and/or statins with clinical manifestations in COVID-19-infected older adults residing in nursing homes.
We undertook a retrospective multicenter cohort study to analyze the association between ACEi/ARB and/or statin use with clinical outcome of COVID-19. The outcomes were (1) serious COVID-19 defined as long-stay hospital admission or death within 14 days of disease onset, and (2) asymptomatic (ie, no disease symptoms in the whole study period while still being diagnosed by polymerase chain reaction).
A total of 154 COVID-19-positive subjects were identified, residing in 1 of 2 Belgian nursing homes that experienced similar COVID-19 outbreaks.
Logistic regression models were applied with age, sex, functional status, diabetes, and hypertension as covariates.
We found a statistically significant association between statin intake and the absence of symptoms during COVID-19 (odds ratio OR 2.91; confidence interval CI 1.27-6.71), which remained statistically significant after adjusting for covariates (OR 2.65; CI 1.13-6.68). Although the effects of statin intake on serious clinical outcome were in the same beneficial direction, these were not statistically significant (OR 0.75; CI 0.24-1.87). There was also no statistically significant association between ACEi/ARB and asymptomatic status (OR 2.72; CI 0.59-25.1) or serious clinical outcome (OR 0.48; CI 0.10-1.97).
Our data indicate that statin intake in older, frail adults could be associated with a considerable beneficial effect on COVID-19 clinical symptoms. The role of statins and renin-angiotensin system drugs needs to be further explored in larger observational studies as well as randomized clinical trials.
The COVID-19 pandemic has disrupted life throughout the world. Newly developed vaccines promise relief to people who live in high-income countries, although vaccines and expensive new treatments are ...unlikely to arrive in time to help people who live in low-and middle-income countries. The pathogenesis of COVID-19 is characterized by endothelial dysfunction. Several widely available drugs like statins, ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have immunometabolic activities that (among other things) maintain or restore endothelial cell function. For this reason, we undertook an observational study in four Belgian hospitals to determine whether in-hospital treatment with these drugs could improve survival in 959 COVID-19 patients. We found that treatment with statins and ACEIs/ARBs reduced 28-day mortality in hospitalized COVID-19 patients. Moreover, combination treatment with these drugs resulted in a 3-fold reduction in the odds of hospital mortality (OR = 0.33; 95% CI 0.17-0.69). These findings were in general agreement with other published studies. Additional observational studies and clinical trials are needed to convincingly show that in-hospital treatment with statins, ACEIs/ARBs, and especially their combination saves lives.
Adjunctive Use of Statins for COVID-19 Sathekge, Mike; Byttebier, Geert; De Spiegeleer, Bart ...
Journal of clinical medicine,
04/2021, Letnik:
10, Številka:
7
Journal Article
Recenzirano
Odprti dostop
The interaction between obesity, cardiometabolic disorders and COVID-19 represents a syndemic that requires both social intervention and a multipharmacological approach ....
Statins are progressively accepted as being associated with reduced mortality. However, few real-world statin studies have been conducted on statin use in older people and especially the most frail, ...that is, the nursing home residents.
The aim of this study was to evaluate the impact of statin intake in nursing home residents on all-cause mortality.
This is a cross-sectional study of 1,094 older people residing in 6 nursing homes in Flanders (Belgium) between March 1, 2020 and May 30, 2020. We considered all residents who were taking statins for at least 5 days as statin users. All-cause mortality during the 3 months of data collection was the primary outcome. Propensity score overlap-weighted logistic regression models were applied with age, sex, functional status, diabetes, and cardiac failure/ischemia as potential confounders.
185 out of 1,094 residents were on statin therapy (17%). The statin intake was associated with decreased all-cause mortality: 4% absolute risk reduction; adjusted odds ratio 0.50; CI 0.31-0.81, p = 0.005.
The statin intake was associated with decreased all-cause mortality in older people residing in nursing homes. More in-depth studies investigating the potential geroprotector effect of statins in this population are needed.
Background: Adverse events of special interest (AESIs) were pre-specified to be monitored for the COVID-19 vaccines. Some AESIs are not only associated with the vaccines, but with COVID-19. Our aim ...was to characterise the incidence rates of AESIs following SARS-CoV-2 infection in patients and compare these to historical rates in the general population. Methods: A multi-national cohort study with data from primary care, electronic health records, and insurance claims mapped to a common data model. This study's evidence was collected between Jan 1, 2017 and the conclusion of each database (which ranged from Jul 2020 to May 2022). The 16 pre-specified prevalent AESIs were: acute myocardial infarction, anaphylaxis, appendicitis, Bell's palsy, deep vein thrombosis, disseminated intravascular coagulation, encephalomyelitis, Guillain- Barré syndrome, haemorrhagic stroke, non-haemorrhagic stroke, immune thrombocytopenia, myocarditis/pericarditis, narcolepsy, pulmonary embolism, transverse myelitis, and thrombosis with thrombocytopenia. Age-sex standardised incidence rate ratios (SIR) were estimated to compare post-COVID-19 to pre-pandemic rates in each of the databases. Findings: Substantial heterogeneity by age was seen for AESI rates, with some clearly increasing with age but others following the opposite trend. Similarly, differences were also observed across databases for same health outcome and age-sex strata. All studied AESIs appeared consistently more common in the post-COVID-19 compared to the historical cohorts, with related meta-analytic SIRs ranging from 1.32 (1.05 to 1.66) for narcolepsy to 11.70 (10.10 to 13.70) for pulmonary embolism. Interpretation: Our findings suggest all AESIs are more common after COVID-19 than in the general population. Thromboembolic events were particularly common, and over 10-fold more so. More research is needed to contextualise post-COVID-19 complications in the longer term. Funding: None.
Amitraz, 1,5 di-(2,4-dimethylphenyl)-3-methyl-1,3,5-tria za-penta-1,4-diene, a formamidine pesticide, is used worldwide. It causes side-effects in animals that resemble those caused by pure ...α2-adrenergic agonist drugs such as clonidine. Data on poisonings in humans are scanty. We report on a case of human poisoning with amitraz with typical signs of α2-adrenoreceptor stimulation.
The benefit of reperfusion therapies for ST-elevation acute myocardial infarction (STEMI) is limited by post-infarction left-ventricular (LV) dysfunction. Our aim was to investigate the effect of ...autologous bone marrow-derived stem cell (BMSC) transfer in the infarct-related artery on LV function and structure.
We did a randomised, double-blind, placebo-controlled study in 67 patients from whom we harvested bone marrow 1 day after successful percutaneous coronary intervention for STEMI. We assigned patients optimum medical treatment and infusion of placebo (n=34) or BMSC (n=33). Our primary endpoint was the increase in LV ejection fraction and our secondary endpoints were change in infarct size and regional LV function at 4 months' follow-up, all assessed by MRI. We assessed changes in myocardial perfusion and oxidative metabolism with serial 1-
11Cacetate PET. Analyses were per protocol. This study is registered with
clinicaltrials.gov, number NCT00264316.
Mean global LV ejection fraction 4 days after percutaneous coronary intervention was 46·9% (SD 8·2) in controls and 48·5% (7·2) in BMSC patients, and increased after 4 months to 49·1% (10·7) and 51·8% (8·8; OR for treatment effect 1·036, 95% CI 0·961–1·118, p=0·36). Compared with placebo infusion, BMSC transfer was associated with a significant reduction in myocardial infarct size (BMSC treatment effect 28%, p=0·036) and a better recovery of regional systolic function. Myocardial perfusion and metabolism increased similarly in both groups. We noted no complications associated with BMSC transfer and all but one patient in the BMSC group completed the 4 months' follow-up.
Intracoronary transfer of autologous bone marrow cells within 24 h of optimum reperfusion therapy does not augment recovery of global LV function after myocardial infarction, but could favourably affect infarct remodelling.
After cardiac surgery, a certain degree of myocardial injury is common. The arbitrarily proposed biomarker cut-off point in the Third Universal Definition for diagnosing coronary artery bypass ...grafting (CABG)-related perioperative myocardial infarction (PMI) is controversial and unvalidated for non-CABG surgery. Minimally invasive cardiac surgery is often thought to be associated with less myocardial damage compared to conventional surgical approaches. We conducted a real-life prospective study with serial sampling of high-sensitivity cardiac troponin T (hs-cTnT) in patients undergoing conventional and minimally invasive cardiac surgery. Four different types of cardiac surgery were performed in 400 patients (February 2014-January 2015): CABG, aortic valve replacement, minimally invasive mitral/tricuspid valve surgery through the HeartPort (HP) technique and combined CABG/valve surgery. Each group was further subdivided for comparison between the different surgical techniques. Blood samples were collected consecutively at intensive care unit (ICU) admission and 3, 6, 9, 12, 18, 24 and 48 h thereafter. The hs-cTnT values by peak timepoint differed significantly depending on the surgical approach. The overall peak timepoint for hs-cTnT occurred 6 h after ICU admission. The combined surgery and multiple-valve HP groups had the highest values (medians of 1067.5 (744.9- 1455) ng/L and 1166 (743.7-2470) ng/L, respectively). The peak hs-cTnT values for patients developing PMI showed high variability. Differentiation between cardiac surgery-related necrosis and PMI remains challenging. This study emphasizes the importance of a clinically reliable biomarker cut-off value in addition to electrocardiography and echocardiography to optimize PMI diagnosis.
Repetitive Negative Thinking (RNT) is a well-established predictor in adolescents of emotional problems, such as depression. Surprisingly little research, however, has looked at the relative ...importance of RNT vs. more interpersonally relevant variables in the context of depression, such as loneliness and lack of social connectedness.
The present study, therefore, set out to examine whether RNT is a significant predictor when taking into account the contribution of loneliness and social connectedness.
A sample of 135 typically developing adolescents (
= 135; 79.3% girls;
= 17.5; range 16-21) completed measures of depressive symptoms, RNT, loneliness and social connectedness at two time points with a 3-month interval.
Results showed that above and beyond baseline depressive symptoms, RNT was the only other significant predictor of prospective depressive symptoms.
According to these results, RNT seems a relatively more important factor to consider in the context of adolescent depression than factors in the interpersonal or social context. Consequently, targeting RNT might be expected to yield more significant gains in reducing or preventing depressive symptoms in adolescents compared to focusing on feelings of loneliness or social connectedness - a hypothesis that remains to be tested.
Abstract
The massive deployment of clean energy technologies plays a vital role in the strategy to attain carbon neutrality by 2050 and allow subsequent negative CO
2
emissions in order to achieve ...our climate goals. An emerging challenge, known as ‘From Emissions to Resources,’ highlights the significant increase in demand for critical raw materials (CRMs) in clean energy technologies. Despite the presence of ample geological reserves, ensuring sustainable access to these materials is crucial for the successful transition to clean energy, taking into account the environmental and social impacts. The commentary centers on four renewable energy technologies namely solar photovoltaics, wind turbines, Li-ion batteries, and water electrolysers. Four pathways for mitigation are quantitatively examined to assess their potential in reducing the vulnerability of the CRM supply chain for these four clean energy technologies: (i) Enhancing material efficiency, (ii) employing substitutivity strategies, (iii) exploring recycling prospects, and (iv) promoting relocalisation initiatives. It is important to note that no single mitigation lever can completely eliminate the risk of CRM supply, rather the accelerated adoption of all four levers is necessary to minimize the CRM supply risk to its absolute minimum. Hence, the study underscores the significance of increased research, innovation, and regulatory initiatives, along with raising social awareness, in effectively addressing the challenges faced by the CRM supply chain and contributing to a sustainable energy transition.
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