Infection, atherothrombosis and thromboembolism beyond the COVID-19 disease: what similar in physiopathology and researches

Long-Term Major Adverse Cardiovascular Events in Patients with Moderate and Severe COVID-19: A Focus on Early Statin Use and Previous CVD

Background

Limited data exist regarding the status of long-term cardiovascular disease (CVD) outcomes of hospitalized COVID-19 patients. We aimed to examine the efficacy of early statin use after SARS-CoV-2 pneumonia and the impact of prior CVD on the incidence of cardiovascular events.

Methods

A prospective cohort study was performed on hospitalized COVID-19 patients. The primary endpoint was major adverse cardiovascular events (MACE) as a composite of cardiovascular mortality, stroke, heart failure, venous thromboembolism (VTE), revascularization, and nonfatal myocardial infarction (MI). The secondary endpoints comprised MACE components, all-cause mortality, readmission for COVID-19, and impaired functional classes.

Results

The mean age of the 858 participants was 55.52±13.97 years, and the median follow-up time was 13 months (11.5-15). Men comprised 63.9% of the patients. Overall, MACE occurred in 84 subjects (9.8%), and 98 patients (11.4%) received ventilation. A multivariate Cox regression model was employed to explore the association between statin use and outcomes, and the following hazard ratios were obtained: MACE (0.831 [0.529 to 0.981]; P=0.044), All-cause mortality (1.098 [0.935 to 1.294]; P=0.255), stroke (0.118 [0.029 to 0.48]; P=0.003), revascularization (0.103 [0.029 to 0.367]; P<0.0001), poor functional capacity (0.827 [0.673 to 1.018]; P=0.073), nonfatal MI (0.599 [0.257 to 1.394]; P=0.234), VTE (0.376 [0.119 to 1.190]; P=0.096), and decompensated heart failure (0.137 [0.040 to 0.472]; P=0.002). Prior CVD predicted MACE (2.953 [1.393 to 6.271]; P=0.005), all-cause death (1.170 [0.960 to 1.412]; P=0.102), and VTE (2.770 [0.957 to 8.955]; P=0.051).

Conclusion

Previous CVD is a robust predictor of long-term MACE and VTE. Early statin use might decrease the incidence rates of MACE, ischemic stroke, revascularization, and readmission for heart failure.

The Evolving Phenotypes of Cardiovascular Disease during COVID-19 Pandemic

COVID-19 pandemic has negatively impacted the management of patients with acute and chronic cardiovascular disease: acute coronary syndrome patients were often not timely reperfused, heart failure patients not adequately followed up and titrated, atrial arrhythmias not efficaciously treated and became chronic. New phenotypes of cardiovascular patients were more and more frequent during COVID-19 pandemic and are expected to be even more frequent in the next future in the new world shaped by the pandemic. We therefore aimed to briefly summarize the main changes in the phenotype of cardiovascular patients in the COVID-19 era, focusing on new clinical challenges and possible therapeutic options.

Pathophysiology of Cardiac Injury in COVID-19 Patients with Acute Ischaemic Stroke: What Do We Know So Far?-A Review of the Current Literature

With the onset of the COVID-19 pandemic, it became apparent that, in addition to pulmonary infection, extrapulmonary manifestations such as cardiac injury and acute cerebrovascular events are frequent in patients infected with SARS-CoV-2, worsening clinical outcome. We reviewed the current literature on the pathophysiology of cardiac injury and its association with acute ischaemic stroke. Several hypotheses on heart and brain axis pathology in the context of stroke related to COVID-19 were identified. Taken together, a combination of disease-related coagulopathy and systemic inflammation might cause endothelial damage and microvascular thrombosis, which in turn leads to structural myocardial damage. Cardiac complications of this damage such as tachyarrhythmia, myocardial infarction or cardiomyopathy, together with changes in hemodynamics and the coagulation system, may play a causal role in the increased stroke risk observed in COVID-19 patients. These hypotheses are supported by a growing body of evidence, but further research is necessary to fully understand the underlying pathophysiology and allow for the design of cardioprotective and neuroprotective strategies in this at risk population.

COVID-19 Trend Analysis in Mexican States and Cities

This paper presents a trend analysis of the COVID-19 pandemics in Mexico. The studies were run in a subnational basis because they are more useful that way, providing important information about the pandemic to local authorities. Unlike classic approaches in the literature, the trend analysis presented here is not based on the variations in the number of infections along time, but rather on the predicted value of the final number of infections, which is updated every day employing new data. Results for four states and four cities, selected among the most populated in Mexico, are presented. The model was able to suitably fit the local data for the selected regions under evaluation. Moreover, the trend analysis enabled one to assess the accuracy of the forecasts.

The Link between SARS-CoV-2 Infection, Inflammation and Hypercoagulability-Impact of Hemorheologic Alterations on Cardiovascular Mortality

The link between severe forms of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and cardiovascular diseases has been well documented by various studies that indicated a higher risk of cardiovascular complications in COVID-19 patients, in parallel with a higher risk of mortality in COVID-19 patients with underlying cardiovascular diseases. It seems that inflammation, which is a major pathophysiological substrate for both acute myocardial infarction and severe forms of COVID-19, may play a pivotal role in the interrelation between these two critical conditions, and hypercoagulability associated with SARS-CoV-2 infection could be responsible for acute cardiovascular complications. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) proved to be independent predictors for prognosis in acute coronary syndromes and systemic inflammatory diseases; therefore, they may be used as independent prognostic markers of disease severity in COVID-19 infection. The aim of this review is to present the most recent advances in understanding the complex link between SARS-CoV-2 infection, inflammation and alteration of blood coagulability and hemorheology, leading to major cardiovascular events.