Previous studies that evaluated cardiovascular risk factors considered age as a potential confounder. We aimed to investigate the impact of cardiovascular disease (CVD) and its risk factors on fatal ...outcomes according to age in patients with COVID-19.
A systematic literature review and meta-analysis was performed on data collected from PubMed and Embase databases up to 11 June 2020. All observational studies (case series or cohort studies) that assessed in-hospital patients were included, except those involving the paediatric population. Prevalence rates of comorbid diseases and clinical outcomes were stratified by mean patient age in each study (ranges: <50 years, 50-60 years and ≥60 years). The primary outcome measure was a composite fatal outcome of severe COVID-19 or death.
We included 51 studies with a total of 48 317 patients with confirmed COVID-19 infection. Overall, the relative risk of developing severe COVID-19 or death was significantly higher in patients with risk factors for CVD (hypertension: OR 2.50, 95% CI 2.15 to 2.90; diabetes: 2.25, 95% CI 1.89 to 2.69) and CVD (3.11, 95% 2.55 to 3.79). Younger patients had a lower prevalence of hypertension, diabetes and CVD compared with older patients; however, the relative risk of fatal outcomes was higher among the former.
The results of the meta-analysis suggest that CVD and its risk factors (hypertension and diabetes) were closely related to fatal outcomes in COVID-19 for patients across all ages. Although young patients had lower prevalence rates of cardiovascular comorbidities than elderly patients, relative risk of fatal outcome in young patients with hypertension, diabetes and CVD was higher than in elderly patients.
CRD42020198152.
•Nearly 7 % of youth and young adults report concurrent cannabis and e-cigarette use.•Older age, male gender, and bisexual identity are risk factors for concurrent cannabis and e-cigarette ...use.•Household smoking, higher sensation seeking, and lower parental education are also risk factors for concurrent cannabis and e-cigarette use.•Demographic variables can help to guide efforts to prevent and reduce concurrent cannabis and e-cigarette use.
Given that cannabis and e-cigarettes are among the most commonly used substances among young people, there is a need to identify risk factors for concurrent cannabis consumption and nicotine vaping among youth and young adults.
Data were obtained from the Truth Longitudinal Cohort, collected from September 2020 to March 2021, among a cohort aged 15–24 years (N = 6379). Chi-square tests were conducted to detect differences in sample characteristics by dual use status (never e-cigarette and never cannabis users, never cannabis and former/noncurrent e-cigarette users, never e-cigarette and former/noncurrent cannabis users, former/noncurrent e-cigarette and cannabis users, current e-cigarette only users, current cannabis only users, and concurrent cannabis and e-cigarette dual users). Multinomial logistic regression was used to determine key demographic variables predicting dual use status.
Household tobacco use (Relative Risk Ratio, RRR = 4.93), higher sensation seeking (RRR = 3.98), and mental health score (RRR = 2.58) were associated with higher risk of dual use. Being 15–17 years (RRR = 0.22), being female (RRR = 0.59) and having parents with an education level of some college or more (RRR = 0.64) were associated with lower risk of dual use.
Findings suggest the need to carefully monitor cannabis and vaping nicotine among young people. The identification of risk factors provides additional guidance for prevention and treatment efforts, suggesting the need to address use of both substances and target those most at risk.
Abstract
Aims
Hypertriglyceridaemia is associated with increased risk of cardiovascular events. This clinical trial evaluated olezarsen, an N-acetyl-galactosamine-conjugated antisense oligonucleotide ...targeted to hepatic APOC3 mRNA to inhibit apolipoprotein C-III (apoC-III) production, in lowering triglyceride levels in patients at high risk for or with established cardiovascular disease.
Methods and results
A randomized, double-blind, placebo-controlled, dose-ranging study was conducted in 114 patients with fasting serum triglycerides 200–500 mg/dL (2.26–5.65 mmol/L). Patients received olezarsen (10 or 50 mg every 4 weeks, 15 mg every 2 weeks, or 10 mg every week) or saline placebo subcutaneously for 6–12 months. The primary endpoint was the percent change in fasting triglyceride levels from baseline to Month 6 of exposure. Baseline median (interquartile range) fasting triglyceride levels were 262 (222–329) mg/dL 2.96 (2.51–3.71) mmol/L. Treatment with olezarsen resulted in mean percent triglyceride reductions of 23% with 10 mg every 4 weeks, 56% with 15 mg every 2 weeks, 60% with 10 mg every week, and 60% with 50 mg every 4 weeks, compared with increase by 6% for the pooled placebo group (P-values ranged from 0.0042 to <0.0001 compared with placebo). Significant decreases in apoC-III, very low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B were also observed. There were no platelet count, liver, or renal function changes in any of the olezarsen groups. The most common adverse event was mild erythema at the injection site.
Conclusion
Olezarsen significantly reduced apoC-III, triglycerides, and atherogenic lipoproteins in patients with moderate hypertriglyceridaemia and at high risk for or with established cardiovascular disease.
Trial registration number
NCT03385239.
Structured Graphical Abstract
Structured Graphical Abstract
Potential clinical indications for olezarsen. Triglyceride levels represent a continuum of risk with levels 1.7–5.6 mmol/L (150–500 mg/dL) representing primarily cardiovascular disease risk (cardiovascular disease prevention), levels between 5.6 and 10.0 mmol/L (500–885 mg/dL) representing both cardiovascular disease and pancreatitis risk and >10.0 mmol/L primarily pancreatitis risk in patients with familial chylomicronemia syndrome and multifactorial chylomicronemia syndrome (represented by milky plasma). Treatment with olezarsen with the planned Phase 3 doses of 50 and 80 mg subcutaneously monthly would be expected to substantially reduce triglyceride levels in the entire continuum of hypertriglyceridaemia.
There is a need to identify high-risk features that predict early-onset atherosclerotic cardiovascular disease (ASCVD). The authors provide insights to help clinicians identify and address high-risk ...conditions in the 20- to 39-year age range (young adults). These include tobacco use, elevated blood pressure/hypertension, family history of premature ASCVD, primary severe hypercholesterolemia such as familial hypercholesterolemia, diabetes with diabetes-specific risk-enhancing factors, or the presence of multiple other risk-enhancing factors, including in females, a history of pre-eclampsia or menopause under age 40. The authors update current thinking on lipid risk factors such as triglycerides, non-high-density lipoprotein cholesterol, apolipoprotein B, or lipoprotein (a) that are useful in understanding an individual's long-term ASCVD risk. The authors review emerging strategies, such as coronary artery calcium and polygenic risk scores in this age group, that have potential clinical utility, but whose best use remains uncertain. Finally, the authors discuss both the obstacles and opportunities for addressing prevention in early adulthood.
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