Incidence of type 2 diabetes before and during the COVID-19 pandemic in Naples, Italy: a longitudinal cohort study

Low LDL-cholesterol drives the risk of bleeding in patients treated with aspirin: A 15-year study in a real-world large population

We aimed to investigate the link between LDL cholesterol (LDL-C) levels and hemorrhage risk over an extended period, both in subjects taking aspirin and in individuals not receiving any antiplatelet agent. We calculated the predicted adjusted relative hazard of bleeding by LDL-C concentration for the whole cohort and the aspirin-treated subgroup. The study included 39,784 individuals with a mean follow-up of 14.9 years, totaling over 500,000 patient-years. Across the cohort, 3380 bleeding events were reported, with a higher incidence in patients with LDL-C < 70 mg/dL compared to those with LDL-C ≥ 70 mg/dL (9.9 % vs 8.4 %). In aspirin-treated patients, multivariable analysis revealed that hemorrhagic events were significantly associated with aging, male sex, body mass index, hypertension, and LDL-C < 70 mg/dL. These patients had a significantly lower event-free survival probability if their LDL-C was < 70 mg/dL compared to ≥ 70 mg/dL. Low LDL-C values were a significant risk factor (HR >1) while higher LDL-C values were protective (HR <1). A stepwise increase of 10 mg/dL in LDL-C from < 30 to ≥ 200 mg/dL was associated with a decreasing trend for bleeding events in both the entire cohort and the aspirin-treated subgroup. This is the first report specifically addressing the relationship between LDL-C levels and bleeding risk in a population receiving low-intensity antithrombotic therapy. Our data demonstrate that in patients taking aspirin, LDL-C levels below 70 mg/dL significantly increase the risk of bleeding, with major implications for long-term cardiovascular risk management.

Risk of New-Onset Diabetes Before and During the COVID-19 Pandemic: A Real-World Cohort Study

BACKGROUND

Studies of new-onset diabetes as a post-acute sequela of SARS-CoV-2 infection are difficult to generalize to all socio-demographic subgroups.

OBJECTIVE

To study the risk of new-onset diabetes after SARS-CoV-2 infection in a socio-demographically diverse sample.

DESIGN

Retrospective cohort study of electronic health record (EHR) data available from the OneFlorida + clinical research network within the National Patient-Centered Clinical Research Network (PCORnet).

SUBJECTS

Persons aged 18 or older were included as part of an Exposed cohort (positive SARS-CoV-2 test or COVID-19 diagnosis between 1 March 2020 and 29 January 2022; n = 43,906), a contemporary unexposed cohort (negative SARS-CoV-2 test; n = 162,683), or an age-sex matched historical control cohort (index visits between 2 Mar 2018 and 30 Jan 2020; n = 40,957).

MAIN MEASURES

The primary outcome was new-onset type 2 diabetes ≥ 30 days after index visit. Hazard ratios and cases per 1000 person-years of new-onset diabetes were studied using target trial approaches for observational data. Associations were reported by sex, race/ethnicity, age, and hospitalization status subgroups.

KEY RESULTS

The sample was 62% female, 21.4% non-Hispanic Black, and 21.4% Hispanic; mean age was 51.8 (SD, 18.9) years. Relative to historical controls (cases, 28.2 [26.0-30.5]), the unexposed (HR, 1.28 [95% CI, 1.18-1.39]; excess cases, [5.1-10.3]), and exposed cohorts (HR, 1.64 [95% CI, 1.50-1.80]; excess cases, 17.3 [13.7-20.8]) had higher risk of new-onset T2DM. Relative to the unexposed cohort, the exposed cohort had a higher risk (HR, 1.28 [1.19-1.37]); excess cases, 9.5 [6.4-12.7]). Findings were similar across subgroups.

CONCLUSION

The pandemic period was associated with increased T2DM cases across all socio-demographic subgroups; the greatest risk was observed among individuals exposed to SARS-CoV-2.

Trends in medication use during the COVID-19 pandemic in Quebec, Canada

The COVID-19 pandemic has disrupted health and services worldwide. We aimed to describe the changes in medication use during the COVID-19 pandemic in Quebec, Canada. Using a large healthcare database, we created weekly cohorts of all individuals ≥ 1 year old covered by the public drug plan from January 2016 to March 2022. We calculated the weekly number of prevalent and new users of different medications, including both chronic and short-term medications. We integrated the 2016-2019 weekly numbers in Quasi-Poisson regressions, with each gender and age group fitted separately. From these models, we estimated the weekly proportions of prevalent and new users expected for 2020-2021 and their 99% prediction interval [99% PI]. Results were analyzed using the ratio of the overall weekly proportion of users (observed/expected) across four periods, selected according to the different waves of the pandemic: Period 1: 1st wave (February 2020-August 2020), Period 2: 2nd wave (August 2020-March 2021), Period 3: 3rd and 4th waves (March 2021-December 2021), and Period 4: 5th and 6th waves (December 2021-March 2022). Each cohort included over 3,000,000 individuals (53% female). The proportion of new users of most medications dropped in Period 1, with exceptions like antipsychotics (ratio of adjusted overall weekly proportion observed/expected [99% PI] 1.02 [1.00-1.04]). From Period 2 onwards, the initiation of antidiabetics, lipid-lowering medications and attention deficit hyperactivity disorder (ADHD) medications, among others, exceeded expected trends, but remained below expectations notably for systemic antibiotics (Period 4: 0.71 [0.69-0.72]), nasal/oral corticosteroids (Period 4: 0.69 [0.67-0.70]/Period 4: 0.69 [0.67-0.70]) and medications for obstructive lung diseases (Period 4: 0.69 [0.68-0.71]). While the prevalent use of most chronic medications remained relatively close to expectations, observed immediate and long-term variations in medication use should be considered in studies including pandemic years and anticipated in public health planning in case of future pandemics.

Evidence of Declining Mortality Trends for Hypertrophic Cardiomyopathy in the United States and the Impact of the COVID-19 Pandemic

BACKGROUND

Dedicated hypertrophic cardiomyopathy (HCM) center cohorts have reported reductions in HCM-related deaths, likely due to the introduction of contemporary treatments. Similar declining HCM mortality rates are reported in the general US population over 2 decades (1999-2019), but the impact of the COVID-19 pandemic on HCM has not been assessed.

METHODS AND RESULTS

Age-adjusted mortality rates based on death certificates from 1999 to 2022 were extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research. HCM-related mortality trends were compared with non-HCM cardiovascular deaths and all-cause deaths. Excess HCM-related deaths were estimated during the 2020 to 2022 COVID-19 pandemic. From 1999 to 2019, HCM-related age-adjusted mortality rates declined progressively, reaching a cumulative 53% (95% CI, 50%-56%) reduction in 2019, exceeding declines in non-HCM cardiovascular disease (25%) and all-cause deaths (18%). Declines were evident among all age groups but were most substantial among patients aged 15 to 24 years (62%; 95% CI, 47%-73%) and 25 to 44 years (62% [95% CI, 56%-68%]) but less so in patients aged ≥65 years. During the COVID-19 pandemic, HCM-related deaths increased by 31% (95% CI, 23%-40%), exceeding increases in non-HCM cardiovascular and all-cause deaths. During the pandemic, 5462 HCM-related deaths were observed compared with 4770 expected deaths on the basis of the preceding period, resulting in a 692 estimated excess HCM-related deaths (95% CI, 554-830).

CONCLUSIONS

Based on an analysis of death certificates, the marked decline in HCM-related deaths of >50% achieved in the US general population during the 2 decades from 1999 to 2019 was substantially reversed (by 29%) during the subsequent 3-year COVID-19 pandemic.

Impact of the COVID-19 Pandemic and Control Measures on Screening and Diagnoses of Type 2 Diabetes in British Columbia

INTRODUCTION

In British Columbia (BC), Canada, COVID-19 and associated control measures impacted routine care for patients with diabetes. Some of these measures may have impacted timely screening and diagnosis of type 2 diabetes. We assessed the impact of control measures on screening and diagnosis of type 2 diabetes in BC.

METHODS

We used data from the BC COVID-19 Cohort, which includes COVID-19 and healthcare administrative data on all residents of BC. We assessed and compared screening (≥40 yrs) and diagnosis (≥18 yrs) of diabetes among the adult population during the pandemic period (1 April 2020-31 December 2022), with 1 January 2016-31 March 2020 used as a historical reference period. We used interrupted time series with generalized additive models to evaluate the impact of policy measures on screening and diagnoses trends.

RESULTS

We observed an initial decline in the mean number of screenings and diagnoses. In the third post-policy phase (January 2022-December 2022), there was a 4.8% (-5.1, 15.4) increase in screenings while after an initial reduction in diabetes diagnoses, we observed a significant increase of 31.6% (17.8, 46.6) in the third post-policy phase. Further stratification by age and sex showed the entire increase in diagnoses trends was driven by younger females with a 56.4% (25.1, 92.9) and 58.7% (38.2, 81.3) increment in diagnoses in the 18-29 and 40-49 age groups, respectively.

CONCLUSIONS

The initial reduced number of screenings and diagnoses followed by the significant upward trend in diabetes diagnoses in the later post-policy phase have important clinical and public health implications. Further research is needed to understand the post-pandemic increase in diabetes among females.

Dynamics of diabetes prevalence, incidence and mortality in France: A nationwide study, 2013-2021

AIM

To estimate the time trends of treated diabetes incidence, prevalence and mortality in France from 2013 to 2019 and to compare with the Covid-19 pandemic period (2020-2021).

METHODS

Using the French National Health Data System, people with treated diabetes ≥ 45 years-old were identified based on their medications. Annual time trends over 2013-2019 were estimated using Poisson log-linear model controlled for age, year and region for prevalence (aPTT), incidence (aITT) and mortality (aMTT). Numbers of incident cases and deaths in 2020-2021 were estimated from these trends, and compared with those observed.

RESULTS

Over 2013-2019, incidence and mortality declined significantly in men, aITT=-0.61 % (-0.95;-0.26); aMTT=-0.52 % (-0.81;-0.22), leading to a stable prevalence, aPTT=0.18 % (-0.03;0.40). In women, the fall in incidence was more marked, aITT=-1.45 % (-1.95;-0.95), mortality was stable, aMTT=-0.19 % (-0.54;0.15), leading to a significant decrease in prevalence, aPTT=-0.31 % (-0.60;-0.02). Compared with people not treated for diabetes, the relative risk of mortality increased significantly in men over the 2013-2019 period, from 1.38 (1.37;1.39) to 1.42 (1.41;1.43), while the risk remained stable in women, from 1.45 (1.44;1.46) to 1.46 (1.45;1.47). In 2020, there were 7,458 and 4,404 additional deaths and 3,550 and 4,919 new cases in respectively men and women. In 2021, there were 11,576 and 6,371 additional deaths and 30,057 and 26,169 new cases in respectively men and women.

CONCLUSION

This study reports a favorable dynamic of diabetes over 2013-2019 followed by a sharp increase in incidence and mortality in 2020 and 2021. Continued monitoring is necessary to identify long-term trend and potential indirect effect of the pandemic.

Prevalence of cardiovascular symptoms in post-acute COVID-19 syndrome: a meta-analysis

BACKGROUND

Since its emergence in 2019, COVID-19 has continued to pose significant threats to both the physical and mental health of the global population, as well as to healthcare systems worldwide (Raman et al., Eur Heart J 43:1157-1172, 2022). Emerging evidence indicates that COVID-19 may lead to post-acute COVID-19 syndrome (PACS) with cardiovascular implications, potentially driven by factors such as ACE2 interaction with viruses, systemic inflammation, and endothelial dysfunction. However, there remains a limited amount of research on the cardiovascular manifestations of PACS, which may delay the development of optimal treatment strategies for affected patients. Therefore, it is crucial to investigate the prevalence of cardiovascular sequelae in COVID-19 patients and to determine whether COVID-19 infection acts as an independent risk factor for these outcomes.

METHODS

This meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024524290). A systematic search of PubMed, Embase, and the Cochrane Library was conducted up to March 17, 2024. The primary outcomes included hypertension, palpitations, and chest pain, with pooled effect estimate reported as proportions and odds ratios (ORs) with 95% confidence intervals (CIs). Sensitivity and subgroup analysis were performed to assess the robustness of the results and to identify sources of heterogeneity.

RESULTS

A total of 37 studies, encompassing 2,965,467 patients, were included in the analysis. Pooled results from case-control studies revealed that, compared to the control group, the ORs of chest pain in the COVID-19 group was 4.0 (95% CI: 1.6, 10.0). The ORs for palpitation and hypertension were 3.4 (95% CI: 1.1, 10.2) and 1.7 (95% CI: 1.6, 1.8), respectively. The proportions of PACS patients experiencing chest pain, palpitation, and hypertension as sequelae were 22% (95% CI: 14%, 33%), 18% (95% CI: 13%, 24%), and 19% (95% CI: 12%, 31%), respectively.

CONCLUSIONS

Our findings indicate that 15% of COVID-19 patients experience cardiovascular sequelae. Furthermore, COVID-19 infection significantly increases the likelihood of developing these sequelae compared to uninfected individuals. Future research should prioritize investigating the underlying pathological mechanisms and developing targeted preventive and management strategies.

TRIAL REGISTRATION

CRD42024524290.

A Critical Review on the Long-Term COVID-19 Impacts on Patients With Diabetes

BACKGROUND

The world is currently grappling with the potentially life-threatening coronavirus disease 2019 (COVID-19), marking it as the most severe health crisis in the modern era. COVID-19 has led to a pandemic, with the World Health Organization (WHO) predicting that individuals with diabetes are at a higher risk of contracting the virus compared to the general population. This review aims to provide a practical summary of the long-term impacts of COVID-19 on patients with diabetes. Specifically, it focuses on the effects of SARS-CoV-2 on different types of diabetic patients, the associated mortality rate, the underlying mechanisms, related complications, and the role of vitamin D and zinc in therapeutic and preventive approaches.

METHODS

Relevant literature was identified through searches on PubMed, Web of Science, and Science Direct in English, up to April 2023.

RESULTS

COVID-19 can lead to distressing symptoms and pose a significant challenge for individuals living with diabetes. Older individuals and those with pre-existing conditions such as diabetes, coronary illness, and asthma are more susceptible to COVID-19 infection. Managing COVID-19 in individuals with diabetes presents challenges, as it not only complicates the fight against the infection but also potentially prolongs the recovery time. Moreover, the virus may thrive in individuals with high blood glucose levels. Various therapeutic approaches, including antidiabetic drugs, are available to help prevent COVID-19 in diabetic patients.

CONCLUSIONS

Diabetes increases the morbidity and mortality risk for patients with COVID-19. Efforts are globally underway to explore therapeutic interventions aimed at reducing the impact of diabetes on COVID-19.

Comparing myocardial perfusion scan findings in patients with and without Covid-19

BACKGROUND

Covid-19 is a pandemic viral disease that directly or indirectly affects multiple organ systems, including the cardiovascular system. SPECT GATED MPI is a non-invasive nuclear imaging modality used to assess myocardial perfusion and function. The aim of this study was to evaluate the effect of Covid-19 pandemic on myocardial perfusion imaging in ischemic heart disease.

METHODS

This was a cross-sectional (descriptive-analytical) study of 750 patients requiring myocardial perfusion imaging (MPI) who were referred to the nuclear medicine center of Kowsar Hospital, a teaching hospital in Sanandaj, the center of Kurdistan Province in north-western Iran. Data collection was performed during the Covid-19 pandemic, between 6 April 2020 and 21 March 2021. Data analysis was performed in SPSS using independent samples t-test and chi-squared.

RESULTS

A total of 750 patients, including 328 (43.7%) Covid-19 positive and 422 (56.3%) Covid-19 negative, were included in the analysis. Although Covid-19 infected obese patients had a significantly higher rate of abnormal MPI (P < 0.0001), no significant difference in abnormal MPI was observed between the two groups (p = 0.551).

CONCLUSION

The lack of a significant difference in the incidence of abnormal MPI between the two groups suggests that there may be Covid-19 patients with potentially abnormal MPI who have gone undetected. In addition, Covid-19 patients with pleural chest pain, myalgia or dyspnea may have been misdiagnosed as having chest pain secondary to heart disease.

The EPICOVID19-BS study: a web-based epidemiological survey in bariatric patients

PURPOSE

To assess the occurrence and severity of SARS-CoV-2 infection/COVID-19, frequency of symptoms, clinical manifestations and behaviours in a sample of patients undergoing bariatric surgery (BS).

METHODS

The EPICOVID19-BS is an observational cross-sectional study conducted in Italy during the second wave of the COVID-19 pandemic (September 2021-February 2022). Patients with severe/extreme obesity undergoing BS were asked to complete an online multiple-choice questionnaire and to provide additional clinical information and blood biochemistry. Positive COVID-19 cases were defined by the combination of positive nasopharyngeal swab test results and/or positive serological test results. Sociodemographic, clinical and behavioural characteristics were compared between positive and negative COVID-19 cases.

RESULTS

A total of 745 participants were enrolled (mean age 44.5 ± 10.5 years SD, 78% female). The proportion of positive COVID-19 cases was 20.4%. They were more likely to be health care workers, to have close contacts with confirmed cases, to use anti-inflammatory drugs, to have immune system disorders, to have previous CMV infection, to have lower cholesterol levels and to have less metabolic syndrome than negative cases. Infected participants significantly increased their use of national health resources for minor health problems. The majority of participants experienced flu-like symptoms and taste and smell disturbances. Only 9.6% were hospitalised and none required intubation.

CONCLUSIONS

Our results seem to support the evidence that patients undergoing BS have a low rate of severe SARS-CoV2. Further longitudinal studies in multiple obesity treatment centres are needed to more effectively monitor and control obesity in this specific population.

Global, regional, and national trends in type 2 diabetes mellitus burden among adolescents and young adults aged 10-24 years from 1990 to 2021: a trend analysis from the Global Burden of Disease Study 2021

BACKGROUND

Type 2 diabetes mellitus (T2DM) poses an escalating public health challenge among adolescents and young adults worldwide. Despite the rising incidence, comprehensive data on the burden and trends of T2DM in this demographic remain scarce. This study aims to evaluate the burden of T2DM among individuals aged 10-24 years globally, regionally, and nationally from 1990 to 2021.

METHODS

Utilizing data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we assessed incidence rates, disability-adjusted life-years (DALYs), and average annual percentage changes (AAPCs) for T2DM in the specified age group. Analyses accounted for variations by age, sex, and socio-demographic index (SDI). Joinpoint regression analysis identified years of significant trend shifts.

RESULTS

The global incidence of T2DM among adolescents and young adults rose from 56.02 per 100,000 (95% UI 43.03-72.32) in 1990 to 123.86 per 100,000 (95% UI 100.43-149.79) in 2021, reflecting an AAPC of 3.01 (95% CI 2.78-3.23). Notable increases were recorded in 1995, 2002, and 2009, with joinpoints indicating significant trend stabilization post-2010 for prevalence and DALYs. The largest relative incidence increase was observed in the 15-19 age group [AAPC 2.97 (95% CI 2.71-3.24)]. Although T2DM mortality was 2.4 times higher in the 15-19 age group compared to the 20-24 age group, the latter exhibited a significantly higher overall mortality rate. Regionally, Oceania recorded the highest incidence rates in 2021, while North Africa and the Middle East showed the greatest AAPCs. High-SDI countries experienced the most substantial increase in T2DM burden, with males comprising 54.8% of cases.

CONCLUSIONS

From 1990 to 2021, the global burden of T2DM among adolescents and young adults has markedly increased, underscoring the necessity for targeted, region-specific interventions to address this issue. The observed demographic disparities in mortality rates necessitate the implementation of age-specific strategies. Furthermore, the emergent trends in T2DM indicators warrant urgent attention to mitigate the rising burden in this vulnerable population.

Prevalence of Diabetes, Hypertension, and Associated of Cardiovascular Diseases: A Comparative Pre- and Post-COVID Study

Background: Diabetes and hypertension are major global health challenges aggravated by COVID-19's impact on healthcare and lifestyle factors. This study aims to compare the prevalence and associated socio-demographic factors of these conditions before and after the pandemic (2019 vs. 2022). Materials and Methods: We used data from Italy's "Aspects of Daily Life" survey; 74,294 adults were included. Results: Results show a rise in diabetes prevalence from 7.76% in 2019 to 8.49% in 2022 (p < 0.05), while hypertension did not show this. Logistic regression analysis for the years 2019 and 2022 revealed a statistically significant association between the year 2022 and increased odds of diabetes (OR = 1.08, p = 0.008). BMI's role as a risk factor intensified, with higher odds ratios (ORs) for both conditions in overweight and obese individuals in 2022. For example, obesity-related ORs for diabetes increased from 2.45 (95%CI 1.73-3.47) in 2019 to 3.02 (95%CI 2.09-4.35) in 2022, and for hypertension from 2.86 (95%CI 2.28-3.58) to 3.64 (95%CI 2.87-4.61). Lower education levels also showed a greater association with hypertension risk in 2022; subjects with only middle or high school diplomas had significantly higher ORs than individuals with higher education; there was a non-significant trend in 2019. However, diabetes risk associated with lower education remained stable and significant in both years. Conclusions: These findings suggest that the pandemic may have increased risk factors for diabetes and hypertension, particularly BMI and educational level, compared with the literature on the increased burden of chronic diseases during COVID-19.

Increased prevalence of cardiovascular-kidney-metabolic syndrome during COVID-19: A propensity score-matched study

A recent presidential advisory from the American Heart Association (AHA) has introduced the term cardiovascular-kidney-metabolic (CKM) syndrome to describe the complex interplay among health conditions linking heart, kidney, and metabolism. The aim of our study was to compare the prevalence of concurrent CKM syndrome components before and during the COVID-19 pandemic and identify associated risk factors. We conducted a study utilizing data from a real-world population obtained from a primary care database. The study cohort comprised a closed group followed over a 6-year period (2017-2022). A total of 81,051 individuals were included: 32,650 in the pre-pandemic period and 48,401 in the 2020-2022 triennium. After propensity-score matching for sex, age, and BMI, the study included 30,511 participants for each period. 3554 individuals were diagnosed with type 2 diabetes in the pre-pandemic period, compared to 7430 during the pandemic. Hypertension, dyslipidemia, and obesity displayed significant increases in prevalence during the pandemic, and prediabetes had a particularly sharp rise of 170%. Age-stratified analyses revealed a higher burden of CKM conditions with advancing age. Our findings indicate a substantial increase in the prevalence of CKM syndrome during the COVID-19 pandemic, with nearly half of the patients exhibiting one or more CKM syndrome components.

Mortality trends from all causes and diabetes mellitus according to sex between 1998 and 2021

Introduction

The variation of mortality rates according to sex, regarding mortality from all causes and from specific conditions related to diabtes mellitus (DM) is widely discussed.

Aim

The aim of this study was to analyze the mortality trends from all causes and DM according to sex in Bauru, São Paulo, Brazil, between 1998 and 2021.

Methodology

This was a retrospective, observational, epidemiological, population-based study. Data were collected from the Unified Health System, the Brazilian Institute of Geography and Statistics, and the Automatic Recovery System. A time series analysis was conducted using age-adjusted rates for segmented analysis with annual percentage change and average annual percentage change (AAPC) computed.

Results

All-cause mortality rose from 2.080 to 3.806 deaths, an 82.31% increase, with a stable trend (AAPC: −0.70%). DM-related deaths increased from 84 to 168, with a stable trend (AAPC: −0.90%). Sex-specific mortality figures show a higher average mortality rate in males for all causes (26.50% higher) and females for DM (25% higher). All-cause mortality had a stationary trend for both sexes. DM mortality showed a slight decline in females (AAPC: −1.30%) but remained stable in males.

Conclusions

Men maintained a higher mortality rate from all causes when compared to women. Women kept a higher DM-related mortality rate than men, although their DM-related mortality rate showed a decreasing trend throughout the period evaluated.

A six-year study in a real-world population reveals an increased incidence of dyslipidemia during COVID-19

BACKGROUNDRecent studies conducted in individuals who survived COVID-19 suggest that SARS-CoV-2 infection is associated with an increased risk of dyslipidemia. However, it remains unclear whether this augmented risk is confirmed in the general population and how this phenomenon is affecting the overall burden of cardiometabolic diseases.METHODSTo address these aspects, we conducted a 6-year longitudinal study to examine the broader effects of COVID-19 on dyslipidemia incidence in a real-world population (228,266 individuals) residing in Naples in southern Italy. The pre-COVID-19 and COVID-19 groups were balanced for demographic and clinical factors using propensity score matching.RESULTSOur analysis spans a period of 3 years during the COVID-19 pandemic (2020-2022), comparing dyslipidemia incidence with pre-pandemic data (2017-2019), with a follow-up of at least 1,095 days corresponding to 21,349,215 person-years. During the COVID-19 period, we detected an increased risk of developing any dyslipidemia when compared with the pre-COVID-19 triennium (OR = 1.29; 95% CI, 1.19-1.39). Importantly, these estimates were adjusted for comorbidities by a multivariate analysis.CONCLUSIONSTaken together, our data reveal a notable rise in dyslipidemia incidence during the COVID-19 pandemic, suggesting the utility of establishing specialized clinical monitoring protocols for patients who survive COVID-19 to mitigate the risk of developing dyslipidemia.

The relationship between COVID-19 and hyperglycemia: screening and monitoring hospitalized patients

BACKGROUND

Elevated blood glucose concentration, also known as hyperglycemia, has been identified as a significant factor influencing the prognosis of COVID-19, alongside the impact of the SARS-CoV-2 infection itself.

METHODS

This research is a cross-sectional investigation that examined the relationship between COVID-19 and hyperglycemia in patients admitted to Afzalipour Hospital in Kerman, Iran, from July to September 2021. A standardized data sheet was used to capture demographic data (age, gender) and laboratory information (blood sugar, arterial blood oxygen saturation, and C-reactive protein (CRP)) upon admission.

RESULTS

The present research evaluated a total of 300 individuals diagnosed with COVID-19, with an average age of 50.19 ± 15.55 years. Among these patients, the majority were male, accounting for 51.67% of the total. Hyperglycemia was seen in 21.67% of patients, but less than 20% had new-onset diabetes. Individuals exhibiting hyperglycemia were typical of advanced age (P < 0.001). Furthermore, there was a slight but statistically significant association between advanced age and elevated blood glucose concentration (R = 0.254, P < 0.001). Gender had no significant impact on the occurrence of hyperglycemia (P = 0.199). There was no significant association between CRP levels and blood glucose concentration (P = 0.524) or the incidence of hyperglycemia (P = 0.473). Although there was no significant disparity in blood oxygen saturation between individuals with or without hyperglycemia (P = 0.06), higher blood glucose concentration was correlated with lower blood oxygen saturation (R = -0.151, P < 0.001).

CONCLUSION

Considering the correlation between blood glucose concentration, advanced age, and disease severity, it is recommended to carefully screen and monitor all COVID-19 patients for hyperglycemia and new-onset diabetes. Effective management of these complications could enhance the control of patients' overall prognosis and subsequent complications.

Incidence of new-onset hypertension before, during, and after the COVID-19 pandemic: a 7-year longitudinal cohort study in a large population

BACKGROUND

While the augmented incidence of diabetes after COVID-19 has been widely confirmed, controversial results are available on the risk of developing hypertension during the COVID-19 pandemic.

METHODS

We designed a longitudinal cohort study to analyze a closed cohort followed up over a 7-year period, i.e., 3 years before and 3 years during the COVID-19 pandemic, and during 2023, when the pandemic was declared to be over. We analyzed medical records of more than 200,000 adults obtained from a cooperative of primary physicians from January 1, 2017, to December 31, 2023. The main outcome was the new diagnosis of hypertension.

RESULTS

We evaluated 202,163 individuals in the pre-pandemic years and 190,743 in the pandemic years, totaling 206,857 when including 2023 data. The incidence rate of new hypertension was 2.11 (95% C.I. 2.08-2.15) per 100 person-years in the years 2017-2019, increasing to 5.20 (95% C.I. 5.14-5.26) in the period 2020-2022 (RR = 2.46), and to 6.76 (95% C.I. 6.64-6.88) in 2023. The marked difference in trends between the first and the two successive observation periods was substantiated by the fitted regression lines of two Poisson models conducted on the monthly log-incidence of hypertension.

CONCLUSIONS

We detected a significant increase in new-onset hypertension during the COVID-19 pandemic, which at the end of the observation period affected ~ 20% of the studied cohort, a percentage higher than the diagnosis of COVID-19 infection within the same time frame. This observation suggests that increased attention to hypertension screening should not be limited to individuals who are aware of having contracted the infection but should be extended to the entire population.

Endothelial Extracellular Vesicles Enriched in microRNA-34a Predict New-Onset Diabetes in Coronavirus Disease 2019 (COVID-19) Patients: Novel Insights for Long COVID Metabolic Sequelae

Emerging evidence indicates that the relationship between coronavirus disease 2019 (COVID-19) and diabetes is 2-fold: 1) it is known that the presence of diabetes and other metabolic alterations poses a considerably high risk to develop a severe COVID-19; 2) patients who survived a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have an increased risk of developing new-onset diabetes. However, the mechanisms underlying this association are mostly unknown, and there are no reliable biomarkers to predict the development of new-onset diabetes. In the present study, we demonstrate that a specific microRNA (miR-34a) contained in circulating extracellular vesicles released by endothelial cells reliably predicts the risk of developing new-onset diabetes in COVID-19. This association was independent of age, sex, body mass index (BMI), hypertension, dyslipidemia, smoking status, and D-dimer. SIGNIFICANCE STATEMENT: We demonstrate for the first time that a specific microRNA (miR-34a) contained in circulating extracellular vesicles released by endothelial cells is able to reliably predict the risk of developing diabetes after having contracted coronavirus disease 2019 (COVID-19). This association was independent of age, sex, body mass index (BMI), hypertension, dyslipidemia, smoking status, and D-dimer. Our findings are also relevant when considering the emerging importance of post-acute sequelae of COVID-19, with systemic manifestations observed even months after viral negativization (long COVID).