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Dashtban A, Mizani MA, Pasea L, Tomlinson C, Mu Y, Islam N, Rafferty S, Warren-Gash C, Denaxas S, Horstmanshof K, Kontopantelis E, Petersen S, Sudlow C, Khunti K, Banerjee A. Vaccinations, cardiovascular drugs, hospitalization, and mortality in COVID-19 and Long COVID. Int J Infect Dis 2024; 146:107155. [PMID: 38942167 DOI: 10.1016/j.ijid.2024.107155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/06/2024] [Accepted: 06/23/2024] [Indexed: 06/30/2024] Open
Abstract
OBJECTIVE To identify highest-risk subgroups for COVID-19 and Long COVID(LC), particularly in contexts of influenza and cardiovascular disease(CVD). METHODS Using national, linked electronic health records for England (NHS England Secure Data Environment via CVD-COVID-UK/COVID-IMPACT Consortium), we studied individuals (of all ages) with COVID-19 and LC (2020-2023). We compared all-cause hospitalization and mortality by prior CVD, high CV risk, vaccination status (COVID-19/influenza), and CVD drugs, investigating impact of vaccination and CVD prevention using population preventable fractions. RESULTS Hospitalization and mortality were 15.3% and 2.0% among 17,373,850 individuals with COVID-19 (LC rate 1.3%), and 16.8% and 1.4% among 301,115 with LC. Adjusted risk of mortality and hospitalization were reduced with COVID-19 vaccination ≥ 2 doses(COVID-19:HR 0.36 and 0.69; LC:0.44 and 0.90). With influenza vaccination, mortality was reduced, but not hospitalization (COVID-19:0.86 and 1.01, and LC:0.72 and 1.05). Mortality and hospitalization were reduced by CVD prevention in those with CVD, e.g., anticoagulants- COVID:19:0.69 and 0.92; LC:0.59 and 0.88; lipid lowering- COVID-19:0.69 and 0.86; LC:0.68 and 0.90. COVID-19 vaccination averted 245044 of 321383 and 7586 of 8738 preventable deaths after COVID-19 and LC, respectively. INTERPRETATION Prior CVD and high CV risk are associated with increased hospitalization and mortality in COVID-19 and LC. Targeted COVID-19 vaccination and CVD prevention are priority interventions. FUNDING NIHR. HDR UK.
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Affiliation(s)
- Ashkan Dashtban
- Institute of Health Informatics, University College London, London, UK
| | - Mehrdad A Mizani
- Institute of Health Informatics, University College London, London, UK; British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, UK
| | | | - Yi Mu
- Institute of Health Informatics, University College London, London, UK
| | - Nazrul Islam
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Charlotte Warren-Gash
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
| | - Kim Horstmanshof
- Institute of Health Informatics, University College London, London, UK
| | | | | | - Cathie Sudlow
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK; Health Data Research UK, University College London, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK; Barts Health NHS Trust, London, UK; University College London Hospitals NHS Trust, London, UK.
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Jaatinen K, Shah P, Mazhari R, Hayden Z, Wargowsky R, Jepson T, Toma I, Perkins J, McCaffrey TA. RNAseq of INOCA patients identifies innate, invariant, and acquired immune changes: potential autoimmune microvascular dysfunction. Front Cardiovasc Med 2024; 11:1385457. [PMID: 38978787 PMCID: PMC11228317 DOI: 10.3389/fcvm.2024.1385457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/31/2024] [Indexed: 07/10/2024] Open
Abstract
Background Ischemia with non-obstructive coronary arteries (INOCA) is a major clinical entity that involves potentially 20%-30% of patients with chest pain. INOCA is typically attributed either to coronary microvascular disease and/or vasospasm, but is likely distinct from classical coronary artery disease (CAD). Objectives To gain insights into the etiology of INOCA and CAD, RNA sequencing of whole blood from patients undergoing both stress testing and elective invasive coronary angiography (ICA) was conducted. Methods Stress testing and ICA of 177 patients identified 40 patients (23%) with INOCA compared to 39 controls (stress-, ICA-). ICA+ patients divided into 38 stress- and 60 stress+. RNAseq was performed by Illumina with ribosomal RNA depletion. Transcriptome changes were analyzed by DeSeq2 and curated by manual and automated methods. Results Differentially expressed genes for INOCA were associated with elevated levels of transcripts related to mucosal-associated invariant T (MAIT) cells, plasmacytoid dendritic cells (pcDC), and memory B cells, and were associated with autoimmune diseases such as rheumatoid arthritis. Decreased transcripts were associated with neutrophils, but neutrophil transcripts, per se, were not less abundant in INOCA. CAD transcripts were more related to T cell functions. Conclusions Elevated transcripts related to pcDC, MAIT, and memory B cells suggest an autoimmune component to INOCA. Reduced neutrophil transcripts are likely attributed to chronic activation leading to increased translation and degradation. Thus, INOCA could result from stimulation of B cell, pcDC, invariant T cell, and neutrophil activation that compromises cardiac microvascular function.
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Affiliation(s)
- Kevin Jaatinen
- Department of Medicine, Division of Genomic Medicine, The George Washington University, Washington, DC, United States
| | - Palak Shah
- INOVA Heart and Vascular Institute, Fairfax, VA, United States
| | - Ramesh Mazhari
- Department of Medicine, Division of Cardiology, The George Washington University, Washington, DC, United States
| | - Zane Hayden
- Department of Medicine, Division of Genomic Medicine, The George Washington University, Washington, DC, United States
| | - Richard Wargowsky
- Department of Medicine, Division of Genomic Medicine, The George Washington University, Washington, DC, United States
| | - Tisha Jepson
- Department of Medicine, Division of Genomic Medicine, The George Washington University, Washington, DC, United States
- The St. Laurent Institute, Woburn, MA, United States
- True Bearing Diagnostics, Washington, DC, United States
| | - Ian Toma
- Department of Medicine, Division of Genomic Medicine, The George Washington University, Washington, DC, United States
- Department of Clinical Research and Leadership, The George Washington University, Washington, DC, United States
| | - John Perkins
- Department of Medicine, Division of Genomic Medicine, The George Washington University, Washington, DC, United States
| | - Timothy A. McCaffrey
- Department of Medicine, Division of Genomic Medicine, The George Washington University, Washington, DC, United States
- True Bearing Diagnostics, Washington, DC, United States
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington, DC, United States
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Ezeamii VC, Ofochukwu VC, Iheagwara C, Asibu T, Ayo-Farai O, Gebeyehu YH, Kaglo EO, Odoeke MC, Adeyemi OM, Shittu HO, Okobi OE. COVID-19 Vaccination Rates and Predictors of Uptake Among Adults With Coronary Heart Disease: Insight From the 2022 National Health Interview Survey. Cureus 2024; 16:e52480. [PMID: 38371067 PMCID: PMC10873900 DOI: 10.7759/cureus.52480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION COVID-19 has become a burden to all nations across the globe, and vaccination currently remains the most effective means of fighting the SARS-COV-2 pandemic. From the time of approval and subsequent distribution of the various COVID-19 vaccines, nearly 72.3% (5.5 billion) of the globe's population have been vaccinated, leaving slightly more than a quarter of the globe's population at risk. With the approval and availability of booster vaccine dosages to individuals with chronic conditions, including coronary heart disease (CHD), it is vital to comprehend the factors underlying the uptake of COVID-19 vaccination in such subgroups. Further, the American Heart Association recommends vaccination against COVID-19 in populations with coronary heart disease (CHD). This is because they are more likely to experience severe outcomes due to COVID-19 infection. This study assesses the uptake of COVID-19 vaccines as well as predictors of its uptake. METHODS Using the 2022 survey data from the National Health Interview Survey (NHIS), 1,708 adults ≥ 40 years with CHD who responded yes/no to whether they had received the vaccine were identified. A Pearson's chi-square test was used to ascertain differences among those who had received the vaccine and those who had not. A logistic regression (multivariate regression) was used to evaluate predictors of COVID-19 vaccination. RESULTS About 1,491/1,708 (86.8%) adults ≥ 40 years reported being vaccinated against COVID-19. Among them, 1,065/1,491 (68.4%) had received more than two vaccination doses. The predictors of COVID-19 vaccination were older age (odds ratio (OR): 2.01 (95% confidence interval (CI): 1.40-2.89), p < 0.001), ratio of family income to poverty threshold of 1 and above (OR: 2.40 (95% CI: 1.58-3.64), p < 0.001), having a college degree (OR: 3.09 (95% CI: 1.85-5.14), p < 0.001), and being insured (OR: 3.26 (95% CI: 1.03-10.26), p = 0.044). CONCLUSION The findings of the study have indicated that 68.4% of adults 40 years and above with CHD have been vaccinated against COVID-19 and have received more than two doses of vaccines. More than half have followed recommendations and have received booster doses of the vaccine. Old age (above 40 years) and a higher socioeconomic class are associated with being more likely to follow COVID-19 vaccination guidelines. Despite the higher vaccination rate of 68.4% in the adults with heart diseases group, strategies for improving booster vaccine awareness alongside accessibility are needed to enhance additional dosage uptake, protect them against novel COVID-19 variants, and ensure the development of sustained immunity.
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Affiliation(s)
- Victor C Ezeamii
- Public Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, USA
| | - Victor C Ofochukwu
- Medicine, Ebonyi State University, Abakaliki, NGA
- Medicine and Surgery, Hospital Corporation of America (HCA) Hospital Pearland, Pearland, USA
| | | | - Tracy Asibu
- Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, USA
| | - Oluwatoyin Ayo-Farai
- Epidemiology and Public Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, USA
| | | | - Eunice O Kaglo
- General Practice, Southwestern University School of Medicine, Calgary, CAN
| | - Moses C Odoeke
- Internal Medicine, Al Ruwaydah General Hospital, Riyadh, SAU
| | - Olaoluwa M Adeyemi
- Internal Medicine, Afe Babalola University, Ado, NGA
- Internal Medicine/Nephrology, William Osler Health System - Etobicoke General Hospital, Toronto, CAN
- Internal Medicine, Richmond Gabriel University, Kingstown, VCT
| | | | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
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