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Płazak W, Drabik L. SARS-CoV-2 infection and SLE: endothelial dysfunction, atherosclerosis, and thrombosis. Clin Rheumatol 2023; 42:2691-2702. [PMID: 36622519 PMCID: PMC9827021 DOI: 10.1007/s10067-022-06497-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 01/10/2023]
Abstract
An increased risk of atherosclerotic and thrombotic complications characterizes connective tissue diseases. Endothelial dysfunction is the basis for the initiation and progression of atherosclerosis and thrombosis. We present systemic lupus erythematosus (SLE) as a model rheumatic disease with endothelial dysfunction and discuss its mechanisms, factors that influence the early onset and rapid progression of atherosclerosis, and the increased risk of thromboembolic events. We focus on established methods to improve endothelium function, including statins, antiplatelet, and antithrombotic therapy. Hypercoagulable and hypofibrinolitic states and a hyperinflammatory response characterize severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Several pathogenic mechanisms are typical for an acute phase of Covid-19 post-Covid syndrome and connective tissue diseases: endothelial dysfunction, elevated antiphospholipid antibody titer, activation of the complement system, and formation of extracellular neutrophil traps (NET). The current review discusses the mechanisms underlying SLE and the COVID-19 in the context of endothelial function, atherosclerosis, and thrombosis (Graphical abstract). Key Points • The pathophysiology of systemic lupus erythematosus (SLE) and Covid-19 shows some similarities, such as endothelial cell activation and dysfunction, the activation of complementary systems, the presence of antiphospholipid antibodies, and the formation of extracellular neutrophil traps. • Autoimmunity in both diseases creates the basis for hyperinflammatory, hypercoagulable, and hypofibrinolitic states and their thromboembolic complications. • This paper presents our perspective on the mechanisms behind the cardiovascular manifestations of SLE and COVID-19, with a particular emphasis on endothelial dysfunction. Covid-19 and systemic lupus erythematosus-potential similarities in pathophysiology. Figures of the panel illustrate the clinical manifestations of endothelial dysfunction, atherosclerosis, and thromboembolism, including coronary artery disease ([A] coronary angiography with left anterior descending artery stenosis and [B] scintigraphy with reduced perfusion in the myocardial apical segments), stroke ([C] carotid angiography, left carotid artery occlusion) and pulmonary embolism ([D]computed tomography with thrombus in the right pulmonary artery).
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Affiliation(s)
- Wojciech Płazak
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland.
| | - Leszek Drabik
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
- Department of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
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Marcucci M, Duceppe E, Le Manach Y, Kearon C, Eikelboom JW, Pohl K, Vincent J, Darvish-Kazem S, Srinathan SK, Neary JDD, Parlow JL, Kurz A, Gross PL, Mrkobrada M, Balasubramanian K, Sessler DI, Devereaux PJ. Tranexamic acid and rosuvastatin in patients at risk of cardiovascular events after noncardiac surgery: a pilot of the POISE-3 randomized controlled trial. Pilot Feasibility Stud 2020; 6:104. [PMID: 32699643 PMCID: PMC7372857 DOI: 10.1186/s40814-020-00643-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Surgical bleeding is associated with postoperative cardiovascular complications. The efficacy and safety of tranexamic acid (TXA) in noncardiac surgery are still uncertain. Statins may prevent perioperative cardiovascular complications. We conducted a pilot to assess the feasibility of a perioperative trial of TXA and rosuvastatin. Methods Using a factorial design, we randomized patients at cardiovascular risk undergoing noncardiac surgery to intravenous TXA (1 g at the start and end of surgery) or placebo, and oral rosuvastatin (40 mg before and 20 mg daily for 30 days after surgery) or placebo. Feasibility outcomes included recruitment rates, follow-up, and compliance to interventions. Clinical outcomes were secondarily explored. Results After 3 months, we changed the design to a partial factorial due to the difficult recruitment of statin-naive patients. Over 6 months, 100 patients were randomized in the TXA trial (49 TXA, 51 placebo), 34 in the rosuvastatin trial (18 rosuvastatin, 16 placebo). Ninety-two percent (95% CI 80–98) of TXA and 86% (95% CI 74–94) of TXA-placebo patients received the 2 study doses. Thirty-three percent (95% CI 13–59) of rosuvastatin patients and 37% (95% CI 15–65) of rosuvastatin-placebo patients discontinued the study drug. A major cardiovascular complication occurred at 30 days in 1 TXA and 6 TXA-placebo patients, and 1 rosuvastatin and no rosuvastatin-placebo patients. Conclusions Our pilot study supports the feasibility of a perioperative TXA trial in noncardiac surgery. Feasibility of a perioperative rosuvastatin trial is uncertain because of a high prevalence of statin use in the target population and concerns about compliance. Trial registration ClinicalTrials.govNCT02546648.
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Affiliation(s)
- Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada.,Department of Medicine, McMaster University, Hamilton, ON Canada.,Population Health Research Institute, Hamilton, ON Canada
| | - Emmanuelle Duceppe
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada.,Population Health Research Institute, Hamilton, ON Canada.,Department of Medicine, University of Montreal, Montreal, QC Canada
| | - Yannick Le Manach
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada.,Population Health Research Institute, Hamilton, ON Canada.,Department of Anesthesia, McMaster University, Hamilton, ON Canada
| | - Clive Kearon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada.,Department of Medicine, McMaster University, Hamilton, ON Canada
| | - John W Eikelboom
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Kayla Pohl
- Population Health Research Institute, Hamilton, ON Canada
| | | | - Saeed Darvish-Kazem
- Department of Medicine, McMaster University, Hamilton, ON Canada.,William Osler Health System, Brampton, ON Canada
| | | | - John D D Neary
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Joel L Parlow
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital and Queen's University, Kingston, ON Canada
| | - Andrea Kurz
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH USA
| | - Peter L Gross
- Department of Medicine, University of Montreal, Montreal, QC Canada
| | - Marko Mrkobrada
- Department of Medicine, University of Western Ontario, London, ON Canada
| | | | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH USA
| | - P J Devereaux
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada.,Department of Medicine, McMaster University, Hamilton, ON Canada.,Population Health Research Institute, Hamilton, ON Canada
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Gavazzoni M, Gorga E, Derosa G, Maffioli P, Metra M, Raddino R. High-dose atorvastatin versus moderate dose on early vascular protection after ST-elevation myocardial infarction. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:3425-3434. [PMID: 29270001 PMCID: PMC5720039 DOI: 10.2147/dddt.s135173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background and aim Clinical benefits of early high-dose statin therapy after acute coronary syndromes are widely known; however, there is poor evidence on the specific setting of ST-elevation myocardial infarction (STEMI) and dose-dependent effects of this therapy on endothelial function and inflammatory biomarkers in the most vulnerable phase after acute coronary syndromes: the postdischarge period. In our study, we compared the short-term effects of high (80 mg) vs moderate doses of atorvastatin (20 mg) in patients with STEMI undergoing primary percutaneous coronary intervention on endothelial function and vascular inflammation. The aim of our study was the evaluation of dose-dependent short-term effects. Subjects and methods We enrolled 52 patients within 48 hours of a STEMI to atorvastatin 80 mg (n=26) or 20 mg (n=26). Every patient underwent endothelial function evaluation by the reactive hyperemia–peripheral arterial tonometry (RH-PAT) index on the first day and 1 month after the STEMI. At the same time, we measured lipid profile and serum levels of high-sensitivity CRP, IL6, TNFα, and oxidized LDL. Results After 1 month of therapy, we observed differences in high-sensitivity CRP levels (0.04±0.02 mg/dL vs 0.36±0.3 mg/dL, P=0.001), IL6 (1.12±0.93 pg/mL vs 3.13±2.84 pg/mL, P=0.03), and improvement in RH-PAT index (1.96±0.16 vs 1.72±0.19, P=0.002) in the group treated with high-dose vs moderate-dose atorvastatin. There was no significant difference in levels of TNFα or oxidized LDL with atorvastatin 20 mg, while there was a reduction in these variables in the group treated with atorvastatin 80 mg. We observed a correlation between high-sensitivity polymerase chain reaction and RH-PAT index on the 30th day after STEMI (r=0.5, P=0.001). Conclusion Higher dose statin therapy in patients with STEMI undergoing primary percutaneous coronary intervention showed early greater vascular protective effects that moderate dose.
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Affiliation(s)
- Mara Gavazzoni
- Cardiology Department, University of Brescia, Spedali Civili of Brescia, Brescia
| | - Elio Gorga
- Cardiology Department, University of Brescia, Spedali Civili of Brescia, Brescia
| | - Giuseppe Derosa
- Centre of Diabetes and Metabolic Diseases, Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico San Matteo.,Centre for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research, University of Pavia.,Centre for Prevention, Surveillance, Diagnosis, and Treatment of Rare Diseases, Fondazione IRCCS Policlinico San Matteo.,Laboratory of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Pamela Maffioli
- Centre of Diabetes and Metabolic Diseases, Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico San Matteo.,Centre for Prevention, Surveillance, Diagnosis, and Treatment of Rare Diseases, Fondazione IRCCS Policlinico San Matteo
| | - Marco Metra
- Cardiology Department, University of Brescia, Spedali Civili of Brescia, Brescia
| | - Riccardo Raddino
- Cardiology Department, University of Brescia, Spedali Civili of Brescia, Brescia
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Chyrchel M, Dziewierz A, Dudek D. A response to "The importance of vasodilator therapy before or during angiography, is ICD necessary or not?" by Tamer Kırat and Nuri Köse. Int J Cardiol 2015; 190:208-9. [PMID: 25920027 DOI: 10.1016/j.ijcard.2015.04.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Michał Chyrchel
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
| | - Artur Dziewierz
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Dariusz Dudek
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Vale N, Nordmann AJ, Schwartz GG, de Lemos J, Colivicchi F, den Hartog F, Ostadal P, Macin SM, Liem AH, Mills EJ, Bhatnagar N, Bucher HC, Briel M. Statins for acute coronary syndrome. Cochrane Database Syst Rev 2014; 2014:CD006870. [PMID: 25178118 PMCID: PMC11126893 DOI: 10.1002/14651858.cd006870.pub3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The early period following the onset of acute coronary syndrome (ACS) represents a critical stage of coronary heart disease, with a high risk of recurrent events and deaths. The short-term effects of early treatment with statins on patient-relevant outcomes in patients suffering from ACS are unclear. This is an update of a review previously published in 2011. OBJECTIVES To assess the effects, both harms and benefits, of early administered statins in patients with ACS, in terms of mortality and cardiovascular events. SEARCH METHODS We updated the searches of CENTRAL (2013, Issue 3), MEDLINE (Ovid) (1946 to April Week 1 2013), EMBASE (Ovid) (1947 to 2013 Week 14), and CINAHL (EBSCO) (1938 to 2013) on 12 April 2013. We applied no language restrictions. We supplemented the search by contacting experts in the field, by reviewing the reference lists of reviews and editorials on the topic, and by searching trial registries. SELECTION CRITERIA Randomized controlled trials (RCTs) comparing statins with placebo or usual care, with initiation of statin therapy within 14 days following the onset of ACS, follow-up of at least 30 days, and reporting at least one clinical outcome. DATA COLLECTION AND ANALYSIS Two authors independently assessed risk of bias and extracted data. We calculated risk ratios (RRs) for all outcomes in the treatment and control groups and pooled data using random-effects models. MAIN RESULTS Eighteen studies (14,303 patients) compared early statin treatment versus placebo or no treatment in patients with ACS. The new search did not identify any new studies for inclusion. There were some concerns about risk of bias and imprecision of summary estimates. Based on moderate quality evidence, early statin therapy did not decrease the combined primary outcome of death, non-fatal myocardial infarction, and stroke at one month (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.80 to 1.08) or four months (RR 0.93, 95% CI 0.81 to 1.06) of follow-up when compared to placebo or no treatment. There were no statistically significant risk reductions from statins for total death, total myocardial infarction, total stroke, cardiovascular death, revascularization procedures, and acute heart failure at one month or at four months, although there were favorable trends related to statin use for each of these endpoints. Moderate quality evidence suggests that the incidence of unstable angina was significantly reduced at four months following ACS (RR 0.76, 95% CI 0.59 to 0.96). There were nine individuals with myopathy (elevated creatinine kinase levels more than 10 times the upper limit of normal) in statin-treated patients (0.13%) versus one (0.015%) in the control groups. Serious muscle toxicity was mostly limited to patients treated with simvastatin 80 mg. AUTHORS' CONCLUSIONS Based on moderate quality evidence, due to concerns about risk of bias and imprecision, initiation of statin therapy within 14 days following ACS does not reduce death, myocardial infarction, or stroke up to four months, but reduces the occurrence of unstable angina at four months following ACS. Serious side effects were rare.
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Affiliation(s)
- Noah Vale
- St Mary's Hospital, McGill UniversityFamily Medicine377 Rue Jean BrilliantMontrealQCCanadaH3T 1M5
| | - Alain J Nordmann
- University Hospital BaselInstitute for Clinical Epidemiology and BiostatisticsHebelstrasse 10BaselSwitzerland4031
| | - Gregory G Schwartz
- VA Medical Center and University of Colorado1055 Clermont StDenverColoradoUSA
| | - James de Lemos
- University of Texas Southwestern Medical SchoolCardiology/Internal Medicine5909 Harry Hines BlvdDallasTexasUSA
| | - Furio Colivicchi
- S. Filippo Neri HospitalCardiovascular Department330 Viale Gorgia da LeontiniRomeItaly00124
| | - Frank den Hartog
- Gelderse Vallei HospitalCardiology Departmentpostbus 9025EdeNetherlands6710 HN
| | - Petr Ostadal
- Na Homolce HospitalDepartment of CardiologyPragueCzech Republic
| | - Stella M Macin
- Instituto de CardiologiaCoronary Intensive Care UnitJuana F CabrelCorrientesArgentina
| | - Anho H Liem
- Franciscus Gasthuis RotterdamDepartment of CardiologyRotterdamNetherlands
| | - Edward J Mills
- University of OttawaFaculty of Health Sciences451 Smyth RoadOttawaONCanadaK1H 8M5
| | - Neera Bhatnagar
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHamiltonONCanadaL8N 3Z5
| | - Heiner C Bucher
- University Hospital Basel (USB)Basel Institute for Clinical Epidemiology and BiostatisticsBaselSwitzerland
| | - Matthias Briel
- University Hospital Basel (USB)Basel Institute for Clinical Epidemiology and BiostatisticsBaselSwitzerland
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