Management of Dyslipidemia in Type 2 Diabetes: Recent Advances in Nonstatin Treatment

Impact of statin use on COVID-19 outcomes in hospitalized patients in Saudi Arabia: a retrospective cohort study

There is an increasing requirement for new therapeutic approaches to address lung inflammation caused by COVID-19. Recent evidence suggests that statins may reduce mortality in patients with respiratory infections. This study aimed to investigate the impact of statin use on COVID-19 outcomes among hospitalized patients at Ohud Hospital and King Salman Medical City (KSMC) in Madinah, Saudi Arabia. A retrospective cohort study was conducted, including 547 patients with confirmed COVID-19 diagnoses admitted between March 2020 and December 2022. Patients were classified into statin and non-statin users based on statin administration during hospitalization. Logistic regression analyses-including univariate, multivariate, and predictive stepwise models-were employed to assess associations between statin use and clinical factors. Among the 547 patients, 200 (36.5%) were prescribed statins upon admission. Statin users were predominantly men and older. The presence of low-density lipoprotein (LDL) levels ≥ 100 mg/dL, cardiovascular disease (CVD), and advanced age were identified as strong predictors of statin use, with odds ratios (ORs) of 11.1, 3.8, and 3.1, respectively. Furthermore, the odds of receiving statins were significantly higher in male patients, individuals with hypertension, those with HbA1c levels ≥ 8%, and patients with positive cultures and sensitivity results. Statin use was associated with an 18%% reduction in the risk of mortality, with an adjusted OR of 0.80 (95% CI, 0.30-2.32), and a 7% reduction in the risk of hospital stay > 10 days, although these findings did not reach statistical significance. Among patients with COVID-19, LDL ≥ 100 mg/dl, CVD, and patients older than 60 years were identified as strong predictors for statin prescription.

MSCTA imaging analysis of autologous arteriovenous fistula dysfunction in maintenance hemodialysis patients

OBJECTIVE

To observe the multi-slice spiral CT angiography (MSCTA) imaging features of arteriovenous fistula dysfunction in patients undergoing maintenance hemodialysis and analyze the significance of the imaging examination.

METHODS

Altogether 90 patients with end-stage renal disease treated by maintenance hemodialysis in General Hospital of China Resources & Wisco from June 2020 to February 2023 were divided into a normal function group (n=68) and a dysfunction group (n=22) according to the function of autogenous arteriovenous fistula. The clinical data of the two groups were recorded. The MSCTA was performed in each patient, and the manifestations of arteriovenous fistula dysfunction were analyzed. Additionally, the vascular access stenosis, vascular access lumen stenosis, arteriovenous diameter, blood flow, and hemodynamic indices were tested, and the value of MSCTA in predicting arteriovenous fistula function was analyzed by Logistic regression.

RESULTS

The degree of vascular access stenosis and vascular access lumen stenosis in the normal group were less than those in the dysfunctional group (P<0.05). The arteriovenous diameter, blood flow, blood flow velocity at anastomotic vein end, dialysis adequacy (spKt/V), and von Willebrand factor (vWF) function in the normal group were larger than those in the dysfunction group, and the radial artery shear force was lower than in the dysfunction group, with statistical significance (P<0.05). Among the arteriovenous fistula dysfunction, there were 3 patients with anastomotic + outflow vein stenosis, 4 patients with outflow vein stenosis, 9 patients with inflow artery + anastomosis + outflow vein stenosis, and 6 patients with superior vena cava stenosis. Logistic regression analysis showed that slow blood flow velocity at the venous end of anastomosis and high shear force of radial artery were influencing factors of arteriovenous fistula dysfunction, and the area under ROC curve of blood flow velocity at the venous end of anastomosis plus shear force of radial artery was 0.93, with a sensitivity of 0.87 and a specificity of 0.85.

CONCLUSION

MSCTA can be used to evaluate the dysfunction of autologous arteriovenous fistula in patients undergoing maintenance hemodialysis, and provide important reference information for the formulation of the next best clinical treatment plan.

SUBCLINICAL HYPOTHYROIDISM AS A CONTRIBUTOR TO MACROVASCULAR COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

This study aimed to evaluate changes of the lipid panel data in patients with comorbid type 2 diabetes mellitus (T2DM) and subclinical hypothyroidism (SCH) and to identify the probable prognostic values of the lipid profile for macrovascular complication (MVC) development. The study included 370 patients presented with only T2DM and 30 patients suffering from both T2DM and SCH. Receiver operating characteristic (ROC) analysis was used to identify prognostically significant values of the lipid profile with the optimal ratio of sensitivity and specificity for MVC development. All lipid profile values in the patients with T2DM combined with SCH were significantly higher compared to those with only T2DM. At the same time, SCH + T2DM increased the risk of exceeding target levels of triglycerides by 2.9 times and HDL-C by 4.1 times. Analysis of lipid profile values according to macrovascular involvement showed that total cholesterol, LDL-C and non-HDL-C in patients with T2DM and SCH were significantly higher compared to those with only T2DM. The levels of triglycerides >1.65 mmol/L, non-HDL-C >3.74 mmol/L and remnant cholesterol >0.74 mmol/L determined by the ROC analysis can be used for stratification of patients with T2DM combined with SCH into the category of increased risk of MVC development.