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Rivera A, Al-Heeti O, Feinstein MJ, Williams J, Taiwo B, Achenbach C, Petito L. Association of early statin initiation during COVID-19 admission with inpatient mortality at an academic health system in Illinois, March 2020 to September 2022: a target trial emulation using observational data. BMJ Open 2024; 14:e085547. [PMID: 39353689 PMCID: PMC11448146 DOI: 10.1136/bmjopen-2024-085547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/26/2024] [Indexed: 10/04/2024] Open
Abstract
OBJECTIVE We assessed the association of early statin initiation with inpatient mortality among hospitalised COVID-19 patients. DESIGN, SETTING AND PARTICIPANTS This observational study emulated a hypothetical target trial using electronic health records data from Northwestern Medicine Health System, Illinois, 2020-2022. We included patients who were ≥40 years, admitted ≥48 hours for COVID-19 from March 2020 to August 2022 and had no evidence of statin use before admission. INTERVENTIONS Individuals who initiated any statins within 48 hours of admission were compared with individuals who did not initiate statins during this period. PRIMARY OUTCOME MEASURES Inpatient mortality at hospital days 7, 14, 21 and 28 were determined using hospital records. Risk differences between exposure groups were calculated using augmented inverse propensity weighting (AIPW) with SuperLearner. RESULTS A total of 8893 individuals (24.5% early statin initiators) were included. Early initiators tended to be older, male and have higher comorbidity burdens. Unadjusted day 28 mortality was higher in early initiators (6.0% vs 3.6%). Adjusted analysis showed slightly higher inpatient mortality risk at days 7 (RD: 0.5%, 95% CI: 0.2 to 0.8) and 21 (RD: 0.6%, 95% CI: 0.04 to 1.1), but not days 14 (RD: 0.4%, 95% CI: -0.03 to 0.9) and 28 (RD: 0.4%, 95% CI: -0.2 to 1.1). Sensitivity analyses using alternative modelling approaches showed no difference between groups. CONCLUSIONS Early statin initiation was not associated with lower mortality contrasting with findings of previous observational studies. Trial emulation helped in identifying and addressing sources of bias incompletely addressed by previous work. Statin use may be indicated for other conditions but not COVID-19.
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Affiliation(s)
- Adovich Rivera
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Omar Al-Heeti
- Department of Medicine, Division of Infectious Diseases, Southern Illinois University System, Carbondale, Illinois, USA
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J Feinstein
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Janna Williams
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Babafemi Taiwo
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chad Achenbach
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lucia Petito
- Department of Preventive Medicine, Division of Biostatistics and Informatics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Alshaalan KS, Alkahtani RF, Althobaiti RF, Aldhahi RA, Rebh FZ, Algezlan SS, Alanazi SM, Alrumaih SS, Alturki BA, Alahmadi AS, Alanazi RA, Al Ali AH, Alshabanah OM. Statin use and clinical outcomes in hospitalized COVID-19 patients: A retrospective analysis in Riyadh, Saudi Arabia. Saudi Med J 2024; 45:171-178. [PMID: 38309726 PMCID: PMC11115412 DOI: 10.15537/smj.2024.45.2.20230589] [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: 11/21/2023] [Accepted: 01/02/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES To investigate the relationship between statin use and coronavirus disease-19 (COVID-19) severity. METHODS This was a retrospective study of adult patients with confirmed COVID-19 who were hospitalized at Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia. The study was carried out from July - September 2020. Antecedent statin use was evaluated using medication information available in the electronic medical records. RESULTS In this retrospective study, we collected data from 689 patients hospitalized with COVID-19. Among the patients, 56.2% of them were non-Saudi and 67.3% were males. The mean age of the patients was 53.7 years. The most common comorbidities among patients with COVID-19 at admission were hypertension (65.2%) and diabetes mellitus (65%). Among these patients, 155 (22.5%) patients received statins during hospitalization and 79.7% of them received corticosteroids. Receiving statins significantly increased the risk of intensive care unit's admission by 1.64 times, intubation by 1.76 times, developing complications by 2.48 times, and mortality by 3.16 times. CONCLUSION Statins are associated with a higher risk of mortality and morbidity among patients hospitalized for COVID-19.
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Affiliation(s)
- Khalid S. Alshaalan
- From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Rahaf F. Alkahtani
- From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Renad F. Althobaiti
- From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Rana A. Aldhahi
- From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Fatimah Z. Rebh
- From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Sarah S. Algezlan
- From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Salma M. Alanazi
- From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Shawg S. Alrumaih
- From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Basma A. Alturki
- From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Abdullah S. Alahmadi
- From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Raneem A. Alanazi
- From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Alaa H. Al Ali
- From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Othman M. Alshabanah
- From the Department of Dermatology (Alshaalan); from the Department of Family Medicine (Alahmadi); from the Department of Internal Medicine and Adult Infectious Diseases (Rebh); from the Department of of Intensive Care Unit (Alshabanah), Prince Mohammad Bin Abdul-Aziz Hospital, from the College of Medicine (Alkahtani, Althobaiti, Aldhahi, Algezlan, M. Alanazi, Alrumaih, Alturki, A. Alanazi), Al Imam Muhammad Ibn Saud Islamic University, and from the Department of Internal Medicine and Infectious Diseases (Al Ali), King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
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Treating COVID-19: Targeting the Host Response, Not the Virus. Life (Basel) 2023; 13:life13030712. [PMID: 36983871 PMCID: PMC10054780 DOI: 10.3390/life13030712] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/19/2023] [Accepted: 01/31/2023] [Indexed: 03/09/2023] Open
Abstract
In low- and middle-income countries (LMICs), inexpensive generic drugs like statins, ACE inhibitors, and ARBs, especially if used in combination, might be the only practical way to save the lives of patients with severe COVID-19. These drugs will already be available in all countries on the first pandemic day. Because they target the host response to infection instead of the virus, they could be used to save lives during any pandemic. Observational studies show that inpatient statin treatment reduces 28–30-day mortality but randomized controlled trials have failed to show this benefit. Combination treatment has been tested for antivirals and dexamethasone but, with the exception of one observational study in Belgium, not for inexpensive generic drugs. Future pandemic research must include testing combination generic drug treatments that could be used in LMICs.
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Sadeghdoust M, Aligolighasemabadi F, Dehesh T, Taefehshokr N, Sadeghdoust A, Kotfis K, Hashemiattar A, Ravandi A, Aligolighasemabadi N, Vakili O, Grabarek B, Staszkiewicz R, Łos MJ, Mokarram P, Ghavami S. The Effects of Statins on Respiratory Symptoms and Pulmonary Fibrosis in COVID-19 Patients with Diabetes Mellitus: A Longitudinal Multicenter Study. Arch Immunol Ther Exp (Warsz) 2023; 71:8. [PMID: 36853269 PMCID: PMC9972324 DOI: 10.1007/s00005-023-00672-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/14/2022] [Indexed: 03/01/2023]
Abstract
The aim of this prospective cohort study was to explore the effect of statins on long-term respiratory symptoms and pulmonary fibrosis in coronavirus disease 2019 (COVID-19) patients with diabetes mellitus (DM). Patients were recruited from three tertiary hospitals, categorized into Statin or Non-statin groups, and assessed on days 0, 28, and 90 after symptoms onset to record the duration of symptoms. Pulmonary fibrosis was scored at baseline and follow-up time points by high-resolution computed tomography scans. Each group comprised 176 patients after propensity score matching. Data analysis revealed that the odds of having cough and dyspnea were significantly higher in the Non-statin group compared to the Statin group during the follow-up period. Overall, there was no significant difference in the change in pulmonary fibrosis score between groups. However, Non-statin patients with > 5 years of DM were more likely to exhibit a significantly higher fibrosis score during the follow-up period as compared to their peers in the Statin group. Our results suggest that the use of statins is associated with a lower risk of developing chronic cough and dyspnea in diabetic patients with COVID-19, and may reduce pulmonary fibrosis associated with COVID-19 in patients with long-term (> 5 years) DM.
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Affiliation(s)
- Mohammadamin Sadeghdoust
- grid.411768.d0000 0004 1756 1744Department of Internal Medicine, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad, Iran
| | - Farnaz Aligolighasemabadi
- grid.411768.d0000 0004 1756 1744Department of Internal Medicine, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad, Iran
| | - Tania Dehesh
- grid.412105.30000 0001 2092 9755Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nima Taefehshokr
- grid.39381.300000 0004 1936 8884Department of Microbiology and Immunology, Center for Human Immunology, The University of Western Ontario, London, ON Canada
| | - Adel Sadeghdoust
- grid.412237.10000 0004 0385 452XDepartment of Internal Medicine, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Katarzyna Kotfis
- grid.107950.a0000 0001 1411 4349Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Amirhossein Hashemiattar
- grid.411768.d0000 0004 1756 1744Department of Radiology, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad, Iran
| | - Amir Ravandi
- grid.21613.370000 0004 1936 9609Institute of Cardiovascular Sciences, Sr. Boniface Research Centre, University of Manitoba, Winnipeg, Canada
| | - Neda Aligolighasemabadi
- grid.411874.f0000 0004 0571 1549Department of Internal Medicine, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Omid Vakili
- grid.411036.10000 0001 1498 685XDepartment of Clinical Biochemistry, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Beniamin Grabarek
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine in Zabrze, Academy of Silesia in Katowice, Zabrze, Poland ,Department of Gynaecology and Obstetrics, Faculty of Medicine in Zabrze, Academy of Silesia in Katowice, Zabrze, Poland ,Laboratory of Molecular Biology and Virology, GynCentrum, Katowice, Poland
| | - Rafał Staszkiewicz
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine in Zabrze, Academy of Silesia in Katowice, Zabrze, Poland ,Department of Neurosurgery, 5Th Military Clinical Hospital with the SP ZOZ Polyclinic in Krakow, Krakow, Poland
| | - Marek J. Łos
- grid.6979.10000 0001 2335 3149Biotechnology Center, Silesian University of Technology, Gliwice, Poland ,grid.412571.40000 0000 8819 4698Autophagy Research Center, Department of Biochemistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooneh Mokarram
- Autophagy Research Center, Department of Biochemistry, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Saeid Ghavami
- Autophagy Research Center, Department of Biochemistry, Shiraz University of Medical Sciences, Shiraz, Iran. .,Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada. .,Faculty of Medicine in Zabrze, University of Technology in Katowice, Academia of Silesia, Zabrze, Poland. .,Research Institute of Oncology and Hematology, Cancer Care, Manitoba University of Manitoba, Winnipeg, Canada. .,Biology of Breathing Theme, Children Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada.
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Trivedi VS, Magnusen AF, Rani R, Marsili L, Slavotinek AM, Prows DR, Hopkin RJ, McKay MA, Pandey MK. Targeting the Complement-Sphingolipid System in COVID-19 and Gaucher Diseases: Evidence for a New Treatment Strategy. Int J Mol Sci 2022; 23:14340. [PMID: 36430817 PMCID: PMC9695449 DOI: 10.3390/ijms232214340] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/22/2022] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)-induced disease (COVID-19) and Gaucher disease (GD) exhibit upregulation of complement 5a (C5a) and its C5aR1 receptor, and excess synthesis of glycosphingolipids that lead to increased infiltration and activation of innate and adaptive immune cells, resulting in massive generation of pro-inflammatory cytokines, chemokines and growth factors. This C5a-C5aR1-glycosphingolipid pathway- induced pro-inflammatory environment causes the tissue damage in COVID-19 and GD. Strikingly, pharmaceutically targeting the C5a-C5aR1 axis or the glycosphingolipid synthesis pathway led to a reduction in glycosphingolipid synthesis and innate and adaptive immune inflammation, and protection from the tissue destruction in both COVID-19 and GD. These results reveal a common involvement of the complement and glycosphingolipid systems driving immune inflammation and tissue damage in COVID-19 and GD, respectively. It is therefore expected that combined targeting of the complement and sphingolipid pathways could ameliorate the tissue destruction, organ failure, and death in patients at high-risk of developing severe cases of COVID-19.
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Affiliation(s)
- Vyoma Snehal Trivedi
- Cincinnati Children’s Hospital Medical Center, Division of Human Genetics, 3333 Burnet Avenue, Building R1, MLC 7016, Cincinnati, OH 45229, USA
| | - Albert Frank Magnusen
- Cincinnati Children’s Hospital Medical Center, Division of Human Genetics, 3333 Burnet Avenue, Building R1, MLC 7016, Cincinnati, OH 45229, USA
| | - Reena Rani
- Cincinnati Children’s Hospital Medical Center, Division of Human Genetics, 3333 Burnet Avenue, Building R1, MLC 7016, Cincinnati, OH 45229, USA
| | - Luca Marsili
- Department of Neurology, James J. and Joan A. Gardner Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, 3113 Bellevue Ave, Cincinnati, OH 45219, USA
| | - Anne Michele Slavotinek
- Cincinnati Children’s Hospital Medical Center, Division of Human Genetics, 3333 Burnet Avenue, Building R1, MLC 7016, Cincinnati, OH 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Daniel Ray Prows
- Cincinnati Children’s Hospital Medical Center, Division of Human Genetics, 3333 Burnet Avenue, Building R1, MLC 7016, Cincinnati, OH 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Robert James Hopkin
- Cincinnati Children’s Hospital Medical Center, Division of Human Genetics, 3333 Burnet Avenue, Building R1, MLC 7016, Cincinnati, OH 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Mary Ashley McKay
- Cincinnati Children’s Hospital Medical Center, Division of Human Genetics, 3333 Burnet Avenue, Building R1, MLC 7016, Cincinnati, OH 45229, USA
| | - Manoj Kumar Pandey
- Cincinnati Children’s Hospital Medical Center, Division of Human Genetics, 3333 Burnet Avenue, Building R1, MLC 7016, Cincinnati, OH 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267, USA
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The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19). Cardiovasc Diabetol 2022; 21:216. [PMID: 36261811 DOI: 10.1186/s12933-022-01657-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is not clear whether pre-existing macrovascular complications (ischemic heart disease, stroke or peripheral artery disease) are associated with health outcomes in people with diabetes mellitus hospitalized for COVID-19. METHODS We conducted cohort studies of adults with pre-existing diabetes hospitalized for COVID-19 infection in the UK, France, and Spain during the early phase of the pandemic (between March 2020-October 2020). Logistic regression models adjusted for demographic factors and other comorbidities were used to determine associations between previous macrovascular disease and relevant clinical outcomes: mortality, intensive care unit (ICU) admission and use of invasive mechanical ventilation (IMV) during the hospitalization. Output from individual logistic regression models for each cohort was combined in a meta-analysis. RESULTS Complete data were available for 4,106 (60.4%) individuals. Of these, 1,652 (40.2%) had any prior macrovascular disease of whom 28.5% of patients died. Mortality was higher for people with compared to those without previous macrovascular disease (37.7% vs 22.4%). The combined crude odds ratio (OR) for previous macrovascular disease and mortality for all four cohorts was 2.12 (95% CI 1.83-2.45 with an I2 of 60%, reduced after adjustments for age, sex, type of diabetes, hypertension, microvascular disease, ethnicity, and BMI to adjusted OR 1.53 [95% CI 1.29-1.81]) for the three cohorts. Further analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors of adverse outcomes. However, proportions of people admitted to ICU (adjOR 0.48 [95% CI 0.31-0.75], I2 60%) and the use of IMV during hospitalization (adjOR 0.52 [95% CI 0.40-0.68], I2 37%) were significantly lower for people with previous macrovascular disease. CONCLUSIONS This large multinational study of people with diabetes mellitus hospitalized for COVID-19 demonstrates that previous macrovascular disease is associated with higher mortality and lower proportions admitted to ICU and treated with IMV during hospitalization suggesting selective admission criteria. Our findings highlight the importance correctly assess the prognosis and intensive monitoring in this high-risk group of patients and emphasize the need to design specific public health programs aimed to prevent SARS-CoV-2 infection in this subgroup.
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Zhao X, Huang P, Yuan J. Influence of glimepiride plus sitagliptin on treatment outcome, blood glucose, and oxidative stress in diabetic patients. Am J Transl Res 2022; 14:7459-7466. [PMID: 36398218 PMCID: PMC9641479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE This research sets out to investigate the influence of glimepiride (GLIM) plus sitagliptin (SITA) on the treatment outcome, blood glucose (BG), and oxidative stress (OS) in diabetic patients. METHODS In this retrospective study, 189 patient cases of type 2 diabetes mellitus (T2DM) admitted from July 2017 to July 2021 to the Affiliated Hospital of Nantong University were selected, of whom 99 cases treated with GLIM + SITA were assigned to the research group (RG) and 90 cases receiving GLIM monotherapy were set as the control group (CG). The two cohorts of patients were compared in terms of treatment outcomes, BG, islet function, OS, inflammatory responses (IRs), and safety. The BG indexes detected mainly included fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG) and glycosylated hemoglobin (HbA1c). Islet function was mainly measured by Homeostasis Model Assessment of β-cell Function (HOMA-β) and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). The OS parameters measured primarily included malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX). Tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-18 were the inflammatory factors measured. RESULTS A statistically higher excellent or good rate of treatment was determined in the RG compared to the CG. After treatment, FBG, 2hPG, HbA1c, HOMA-IR, MDA, TNF-α, IL-6, and IL-18 were lower in the RG while HOMA-β, SOD, and GSH-PX were higher, compared to the levels before treatment and the CG. A non-significantly different incidence of adverse reactions between groups was determined. CONCLUSIONS Our findings demonstrated high efficacy of GLIM + SITA in the treatment of T2DM patients, which can effectively improve the BG and OS of patients and reduce inflammation without increasing the incidence of adverse reactions. This should have high clinical application value.
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Affiliation(s)
- Xiaoqin Zhao
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Nantong University Nantong 226001, Jiangsu, PR China
| | - Ping Huang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Nantong University Nantong 226001, Jiangsu, PR China
| | - Jie Yuan
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Nantong University Nantong 226001, Jiangsu, PR China
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Lipid Raft Integrity and Cellular Cholesterol Homeostasis Are Critical for SARS-CoV-2 Entry into Cells. Nutrients 2022; 14:nu14163417. [PMID: 36014919 PMCID: PMC9415163 DOI: 10.3390/nu14163417] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 12/20/2022] Open
Abstract
Lipid rafts in cell plasma membranes play a critical role in the life cycle of many viruses. However, the involvement of membrane cholesterol-rich lipid rafts in the entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into target cells is not well known. In this study, we investigated whether the presence of cholesterol-rich microdomains is required for the entry of SARS-CoV-2 into host cells. Our results show that depletion of cholesterol in the rafts by methyl-beta-cyclodextrin (MβCD) treatment impaired the expression of the cell surface receptor angiotensin-converting enzyme 2 (ACE2), resulting in a significant increase in SARS-CoV-2 entry into cells. The effects exerted by MβCD could be substantially reversed by exogenous cholesterol replenishment. In contrast, disturbance of intracellular cholesterol homeostasis by statins or siRNA knockdown of key genes involved in the cholesterol biosynthesis and transport pathways reduced SARS-CoV-2 entry into cells. Our study also reveals that SREBP2-mediated cholesterol biosynthesis is involved in the process of SARS-CoV-2 entry in target cells. These results suggest that the host membrane cholesterol-enriched lipid rafts and cellular cholesterol homeostasis are essential for SARS-CoV-2 entry into cells. Pharmacological manipulation of intracellular cholesterol might provide new therapeutic strategies to alleviate SARS-CoV-2 entry into cells.
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Bouillon K, Baricault B, Semenzato L, Botton J, Bertrand M, Drouin J, Dray‐Spira R, Weill A, Zureik M. Association of Statins for Primary Prevention of Cardiovascular Diseases With Hospitalization for COVID-19: A Nationwide Matched Population-Based Cohort Study. J Am Heart Assoc 2022; 11:e023357. [PMID: 35699173 PMCID: PMC9238639 DOI: 10.1161/jaha.121.023357] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 05/03/2022] [Indexed: 12/22/2022]
Abstract
Background There is little evidence on the relationship between statin use and the risk of hospitalization attributable to COVID-19. Methods and Results The French National Healthcare Data System database was used to conduct a matched-cohort study. For each adult aged ≥40 years receiving statins for the primary prevention of cardiovascular diseases, one nonuser was randomly selected and matched for year of birth, sex, residence area, and comorbidities. The association between statin use and hospitalization for COVID-19 was examined using conditional Cox proportional hazards models, adjusted for baseline characteristics, comorbidities, and long-term medications. Its association with in-hospital death from COVID-19 was also explored. All participants were followed up from February 15, 2020, to June 15, 2020. The matching procedure generated 2 058 249 adults in the statin group and 2 058 249 in the control group, composed of 46.6% of men with a mean age of 68.7 years. Statin users had a 16% lower risk of hospitalization for COVID-19 than nonusers (adjusted hazard ratio [HR], 0.84; 95% CI, 0.81-0.88). All types of statins were significantly associated with a lower risk of hospitalization, with the adjusted HR ranging from 0.75 for fluvastatin to 0.89 for atorvastatin. Low- and moderate-intensity statins also showed a lower risk compared with nonusers (HR, 0.78 [95% CI, 0.71-0.86] and HR, 0.84 [95% CI, 0.80-0.89], respectively), whereas high-intensity statins did not (HR, 1.01; 95% CI, 0.86-1.18). We found similar results with in-hospital death from COVID-19. Conclusions Our findings support that the use of statins for primary prevention is associated with lower risks of hospitalization for COVID-19 and of in-hospital death from COVID-19.
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Affiliation(s)
- Kim Bouillon
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
| | - Bérangère Baricault
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
| | - Laura Semenzato
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
| | - Jérémie Botton
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
- Faculty of PharmacyParis‐Saclay UniversityChâtenay‐MalabryFrance
| | - Marion Bertrand
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
| | - Jérôme Drouin
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
| | - Rosemary Dray‐Spira
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
| | - Alain Weill
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
| | - Mahmoud Zureik
- EPI‐PHARE Scientific Interest Group in Epidemiology of Health ProductsSaint‐DenisFrance
- Paris‐Saclay UniversityUVSQCESP‐Inserm, Anti‐infective evasion and pharmacoepidemiologyMontigny le BretonneuxFrance
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10
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Harris S, Ruan Y, Wild SH, Wargny M, Hadjadj S, Delasalle B, Saignes M, Ryder RE, Field BCT, Narendran P, Zaccardi F, Wilmot EG, Vlacho B, Llauradó G, Mauricio D, Nagi D, Patel D, Várnai KA, Davies J, Gourdy P, Cariou B, Rea R, Khunti K. Association of statin and/or renin-angiotensin-aldosterone system modulating therapy with mortality in adults with diabetes admitted to hospital with COVID-19: A retrospective multicentre European study. Diabetes Metab Syndr 2022; 16:102484. [PMID: 35472685 PMCID: PMC8996468 DOI: 10.1016/j.dsx.2022.102484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS To assess the impact of pre-admission renin-angiotensin-aldosterone system inhibitor (RAASi) and statin use on mortality following COVID-19 hospitalization in adults with pre-existing diabetes. METHODS Retrospective cohort study of adults with diabetes admitted to ninety-nine participating hospitals in the United Kingdom, France and Spain during the first wave of the COVID-19 pandemic. Logistic regression models adjusted for demographic factors and comorbidity were used to describe associations with mortality in hospital or within 28 days of admission and individual or combined RAASi and statin therapy prescription followed by a country level meta-analysis. RESULTS Complete data were available for 3474 (42.6%) individuals. Prescribing patterns varied by country: 25-50% neither RAASi nor statin therapy, 14-36% both RAASi and statin therapy, 9-24% RAASi therapy alone, 12-36% statin alone. Overall, 20-37% of patients died within 28 days. Meta-analysis found no evidence of an association between mortality and prescription of RAASi therapy (OR 1.09, CI 0.78-1.52 (I2 22.2%)), statin (OR 0.97, CI 0.59-1.61 (I2 72.9%)) or both (OR 1.14, CI 0.67-1.92 (I2 78.3%)) compared to those prescribed neither drug class. CONCLUSIONS This large multicentre, multinational study found no evidence of an association between mortality from COVID-19 infection in people with diabetes and use of either RAASi, statin or combination therapy. This provides reassurance that clinicians should not change their RAASi and statin therapy prescribing practice in people with diabetes during the COVID-19 pandemic.
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Affiliation(s)
| | - Yue Ruan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, UK; Oxford NIHR Biomedical Research Centre, UK
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Matthieu Wargny
- L'institut du thorax, Université de Nantes, CHU Nantes, CNRS, Inserm, Nantes, France; CHU de Nantes, CIC Inserm 1413, Clinique des Données, Nantes, France
| | - Samy Hadjadj
- L'institut du thorax, Université de Nantes, CHU Nantes, CNRS, Inserm, Nantes, France
| | - Béatrice Delasalle
- CHU Nantes, Direction de la recherche clinique et de l'innovation, Nantes, France
| | - Maëva Saignes
- CHU Nantes, Direction de la recherche clinique et de l'innovation, Nantes, France
| | - Robert Ej Ryder
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Benjamin C T Field
- Department of Clinical & Experimental Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK; Department of Diabetes & Endocrinology, Surrey & Sussex Healthcare NHS Trust, Redhill, Surrey, UK
| | - Parth Narendran
- Medical and Dental Sciences, University of Birmingham, Birmingham, UK; University Hospital Birmingham, NHS Foundation Trust, UK
| | - Francesco Zaccardi
- University Hospitals of Leicester NHS Trust, Diabetes Research Centre, Leicester General Hospital, UK
| | - Emma G Wilmot
- Diabetes Department, University Hospitals of Derby and Burton NHS FT, Derby, UK; University of Nottingham, Nottingham, UK
| | - Bogdan Vlacho
- DAP_CAT group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Gemma Llauradó
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Didac Mauricio
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Dept. of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Dinesh Nagi
- Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, UK
| | | | - Kinga A Várnai
- Oxford NIHR Biomedical Research Centre, UK; Oxford University Hospitals NHS Foundation Trust, UK
| | - Jim Davies
- Oxford NIHR Biomedical Research Centre, UK; Department of Computer Science, University of Oxford, Oxford, UK
| | - Pierre Gourdy
- CHU de Toulouse & UMR1048/I2MC, Université de Toulouse, Toulouse, France
| | - Bertrand Cariou
- L'institut du thorax, Université de Nantes, CHU Nantes, CNRS, Inserm, Nantes, France
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, UK; Oxford NIHR Biomedical Research Centre, UK
| | - Kamlesh Khunti
- University Hospitals of Leicester NHS Trust, Diabetes Research Centre, Leicester General Hospital, UK
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Andrews L, Goldin L, Shen Y, Korwek K, Kleja K, Poland RE, Guy J, Sands KE, Perlin JB. Discontinuation of atorvastatin use in hospital is associated with increased risk of mortality in COVID-19 patients. J Hosp Med 2022; 17:169-175. [PMID: 35504528 PMCID: PMC9088329 DOI: 10.1002/jhm.12789] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/03/2022] [Accepted: 01/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Statins are a commonly used class of drugs, and reports have suggested that their use may affect COVID-19 disease severity and mortality risk. OBJECTIVE The purpose of this analysis was to determine the effect of discontinuation of previous atorvastatin therapy in patients hospitalized for COVID-19 on the risk of mortality and ventilation. METHODS Data from 146,413 hospitalized COVID-19 patients were classified according to statin therapy. Home + in hospital atorvastatin use (continuation of therapy); home + no in hospital atorvastatin use (discontinuation of therapy); no home + no in hospital atorvastatin use (no statins). Logistic regression was performed to assess the association between atorvastatin administration and either mortality or use of mechanical ventilation during the encounter. RESULTS Continuous use of atorvastatin (home and in hospital) was associated with a 35% reduction in the odds of mortality compared to patients who received atorvastatin at home but not in hospital (odds ratio [OR]: 0.65, 95% confidence interval [CI]: 0.59-0.72, p < .001). Similarly, the odds of ventilation were lower with continuous atorvastatin therapy (OR: 0.70, 95% CI: 0.64-0.77, p < .001). CONCLUSIONS Discontinuation of previous atorvastatin therapy is associated with worse outcomes for COVID-19 patients. Providers should consider maintaining existing statin therapy for patients with known or suspected previous use.
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Affiliation(s)
- Laura Andrews
- Clinical Operations GroupHCA HealthcareNashvilleTennesseeUSA
| | - Laurel Goldin
- Clinical Operations GroupHCA HealthcareNashvilleTennesseeUSA
| | - Yan Shen
- Clinical Operations GroupHCA HealthcareNashvilleTennesseeUSA
| | - Kimberly Korwek
- Clinical Operations GroupHCA HealthcareNashvilleTennesseeUSA
| | - Kacie Kleja
- Clinical Operations GroupHCA HealthcareNashvilleTennesseeUSA
| | | | - Jeffrey Guy
- Clinical Operations GroupHCA HealthcareNashvilleTennesseeUSA
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12
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Kim JY, Choi J, Kim SG, Kim NH. Relative contributions of statin intensity, achieved low-density lipoprotein cholesterol level, and statin therapy duration to cardiovascular risk reduction in patients with type 2 diabetes: population based cohort study. Cardiovasc Diabetol 2022; 21:28. [PMID: 35193571 PMCID: PMC8861991 DOI: 10.1186/s12933-022-01466-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/08/2022] [Indexed: 12/11/2022] Open
Abstract
Background Current guidelines recommend life-long use of statin for patients with type 2 diabetes (T2D), however, a number of patients discontinue statin therapy in clinical practice. We aimed to estimate the optimal statin therapy including statin therapy duration, statin intensity, and low-density lipoprotein cholesterol (LDL-C) level among patients with T2D in a real-world setting. Methods From Korean National Health Insurance Service Cohort (2007–2015), 8937 patients with T2D (≥ 40 years of age) who received statin therapy for at least 90 days were included. Risk of major adverse cardiovascular event (MACE) including ischemic heart disease, ischemic stroke, and cardiovascular death was estimated according to statin intensity, achieved serum LDL-C level, and statin therapy duration, respectively. The relative contributions of these factors to MACE risk were quantified by calculating the proportion of log-likelihood explained by each factor. Results The hazard ratio (HR) of MACE was lower in patients receiving moderate- or high-intensity statins than in those receiving low-intensity statins (HR, 0.72; p = 0.027). Among patients who received moderate- or high-intensity statins, lower achieved LDL-C level was associated with lower cardiovascular risk. Notably, the longer the patients received statins, the lower was the risk of MACE; the HR of MACE was significantly reduced after at least 18 months (adjusted HR, 0.70; p = 0.009) as a reference to 3–6 months of therapy. The proportion of explainable log-likelihood for MACE was greatest for statin duration (2.55), followed by achieved LDL-C level (2.18), and statin intensity (0.95). Conclusions Statin therapy duration is as important as or more crucial than statin intensity or achieved LDL-C level for the reduction of cardiovascular risk in T2D patients. The concept of “longer is better” regarding statin therapy should be considered in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01466-z.
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Affiliation(s)
- Ji Yoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Jimi Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
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13
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Real world data on cardiometabolic diseases in U.S. adults during the SARS-CoV-2 pandemic: a decentralized registry study. Cardiovasc Diabetol 2022; 21:24. [PMID: 35164745 PMCID: PMC8845313 DOI: 10.1186/s12933-022-01462-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/04/2022] [Indexed: 12/15/2022] Open
Abstract
Background Pre-existing cardiometabolic comorbidities place SARS-CoV-2 positive patients at a greater risk for poorer clinical course and mortality than those without it. We aimed to analyze real-world registry data focused primarily on participants with cardiometabolic diseases (CMD), which were remotely obtained via a digital platform. Methods Participants were divided into two groups: CMD or no cardiometabolic disease (non-CMD). They were evaluated based on their medical history, current medications/supplements, COVID-19 status, demographics, and baseline characteristics. The frequency of medications/supplements for CMD were compared using relative risks and 95% confidence intervals. The WHO (Five) Well-Being Index (WHO-5) were collected monthly for 6 months to assess psychological well-being which included cheerfulness, calmness, vigor, rest, and engagement with daily activities of interest. Results The 791 enrollees represented 49 U.S. states. The CMD group had significantly higher (p < 0.0001) BMI (mean + 3.04 kg/m2) and age (mean + 9.15 years) compared to non-CMD group. In the CMD group, participants who tested positive for COVID-19 had lower (p < 0.0001) well-being scores than those without COVID-19. For the 274 participants on CMD medications/supplements, there was no statistical difference in risk of COVID-19 contracture based on medication/supplement type; however, all six participants who were not being treated for CMD were COVID-19 positive (RR ~ 104). For 89 participants who were on treatment for diabetes or insulin resistance, there was a 90% reduced risk of COVID-19 incidence (p = 0.0187). Conclusion The well-being score of the CMD group was dependent on whether they tested positive for COVID-19. Type of CMD treatment did not impact COVID-19 status, but absence of treatment significantly increased COVID-19 incidence. With respect to SARS-CoV-2, our analysis supports continued use of the statins, ACE-I, ARBs, and diabetes medications in CMD patients. Trial registration: ClinicalTrials.gov Identifier: NCT04348942.
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14
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Rauchman SH, Mendelson SG, Rauchman C, Kasselman LJ, Pinkhasov A, Reiss AB. Ongoing Use of SSRIs Does Not Alter Outcome in Hospitalized COVID-19 Patients: A Retrospective Analysis. J Clin Med 2021; 11:70. [PMID: 35011811 PMCID: PMC8745642 DOI: 10.3390/jcm11010070] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/29/2022] Open
Abstract
SARS-CoV-2 continues to have devastating consequences worldwide. Though vaccinations have helped reduce spread, new strains still pose a threat. Therefore, it is imperative to identify treatments that prevent severe COVID-19 infection. Recently, acute use of SSRI antidepressants in COVID+ patients was shown to reduce symptom severity. The aim of this retrospective observational study was to determine whether COVID+ patients already on SSRIs upon hospital admission had reduced mortality compared to COVID+ patients not on chronic SSRI treatment. Electronic medical records of 9044 patients with laboratory-confirmed COVID-19 from six hospitals were queried for demographic and clinical information. Using R, a logistic regression model was run with mortality as the outcome and SSRI status as the exposure. In this sample, no patients admitted on SSRIs had them discontinued. There was no significant difference in the odds of dying between COVID+ patients on chronic SSRIs vs. those not taking SSRIs, after controlling for age category, gender, and race. This study shows the utility of large clinical databases in determining what commonly prescribed drugs might be useful in treating COVID-19. During pandemics due to novel infectious agents, it is critical to evaluate safety and efficacy of drugs that might be repurposed for treatment.
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Affiliation(s)
| | | | | | - Lora J. Kasselman
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (L.J.K.); (A.P.); (A.B.R.)
| | - Aaron Pinkhasov
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (L.J.K.); (A.P.); (A.B.R.)
| | - Allison B. Reiss
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (L.J.K.); (A.P.); (A.B.R.)
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Levin MG. Circulating Lipids and COVID-19: Insights From Mendelian Randomization. Arterioscler Thromb Vasc Biol 2021; 41:2811-2813. [PMID: 34587759 PMCID: PMC8545247 DOI: 10.1161/atvbaha.121.316940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Michael G. Levin
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
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