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Barbetta LMDS, Correia ETDO, Gismondi RAOC, Mesquita ET. Influenza Vaccination to Prevention Therapy for Stable Coronary Artery Disease and Acute Coronary Syndrome: A Meta-Analysis of Randomized Trials. Am J Med 2023; 136:466-475. [PMID: 36809811 DOI: 10.1016/j.amjmed.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/28/2023] [Accepted: 02/02/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Influenza can cause a significant burden on patients with coronary artery disease. This meta-analysis assessed the effectiveness of influenza vaccination in patients with acute coronary syndrome and stable coronary artery disease. METHODS We searched the Cochrane Controlled Register of Trials (CENTRAL), Embase, MEDLINE, www. CLINICALTRIALS gov, and the World Health Organization International Clinical Trials Registry Platform from inception to September 2021. Estimates were summarized using the Mantel-Haenzel method and a random-effects model. To assess heterogeneity the I² statistic was used. RESULTS Five randomized trials, comprising 4187 patients, were included, 2 of which included patients with acute coronary syndrome and 3 that included patients with stable coronary artery disease and acute coronary syndrome. Influenza vaccination significantly reduced the risk for all-cause mortality (relative risk [RR] = 0.56; 95% confidence interval [CI], 0.38-0.84), cardiovascular mortality (RR = 0.54; 95% CI, 0.37-0.80), major acute cardiovascular events (RR = 0.66; 95% CI, 0.49-0.88), and acute coronary syndrome (RR = 0.63; 95% CI, 0.44-0.89). On subgroup analysis, influenza vaccination remained effective for these outcomes in acute coronary syndrome but did not meet statistical significance in coronary artery disease. Furthermore, influenza vaccination did not reduce the risk for revascularization (RR = 0.89; 95% CI, 0.54-1.45), stroke or transient ischemic attack (RR = 0.85; 95% CI, 0.31-2.32), or heart failure hospitalization (RR = 0.91; 95% CI, 0.21-4.00). CONCLUSIONS Influenza vaccine is a cheap and effective intervention to reduce the risk for all-cause mortality, cardiovascular mortality, major acute cardiovascular events, and acute coronary syndrome among coronary artery disease patients, especially in those with acute coronary syndrome.
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Affiliation(s)
- Letícia Mara Dos Santos Barbetta
- Fluminense Federal University, Niterói, Rio de Janeiro, Brazil; Cardiovascular Disease Doctoral Program, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
| | - Eduardo Thadeu de Oliveira Correia
- Fluminense Federal University, Niterói, Rio de Janeiro, Brazil; Cardiovascular Disease Doctoral Program, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Yedlapati SH, Mendu A, Tummala VR, Maganti SS, Nasir K, Khan SU. Vaccines and cardiovascular outcomes: lessons learned from influenza epidemics. Eur Heart J Suppl 2023; 25:A17-A24. [PMID: 36937374 PMCID: PMC10021491 DOI: 10.1093/eurheartjsupp/suac110] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the world and is largely preventable. An increasing amount of evidence suggests that annual influenza vaccination reduces CVD-related morbidity and mortality. Despite various clinical guidelines recommending annual influenza vaccination for the general population for influenza-like illness risk reduction, with a particular emphasis on people with CVD, vaccination rates fall consistently below the goal established by the World Health Organization. This review outlines the importance of influenza vaccination, mechanisms of cardiovascular events in influenza, summarizing the available literature on the effects of influenza vaccine in CVD and the benefits of influenza vaccine during the COVID-19 pandemic.
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Affiliation(s)
- Siva H Yedlapati
- Department of Medicine, Erie County Medical Center, 462 Grider Street, Buffalo, NY 14215, USA
| | - Anuradha Mendu
- Department of Medicine, Erie County Medical Center, 462 Grider Street, Buffalo, NY 14215, USA
| | - Venkat R Tummala
- Department of Biology, Virginia Commonwealth University, 1000 W Cary St, Richmond, VA 23284, USA
| | - Sowmith S Maganti
- Department of Biology, Virginia Commonwealth University, 1000 W Cary St, Richmond, VA 23284, USA
| | - Khurram Nasir
- Department of Cardiology, DeBakey Heart and Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - Safi U Khan
- Department of Cardiology, DeBakey Heart and Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
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Zhou H, Astore C, Skolnick J. PHEVIR: an artificial intelligence algorithm that predicts the molecular role of pathogens in complex human diseases. Sci Rep 2022; 12:20889. [PMID: 36463386 PMCID: PMC9719543 DOI: 10.1038/s41598-022-25412-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022] Open
Abstract
Infectious diseases are known to cause a wide variety of post-infection complications. However, it's been challenging to identify which diseases are most associated with a given pathogen infection. Using the recently developed LeMeDISCO approach that predicts comorbid diseases associated with a given set of putative mode of action (MOA) proteins and pathogen-human protein interactomes, we developed PHEVIR, an algorithm which predicts the corresponding human disease comorbidities of 312 viruses and 57 bacteria. These predictions provide an understanding of the molecular bases of complications and means of identifying appropriate drug targets to treat them. As an illustration of its power, PHEVIR is applied to identify putative driver pathogens and corresponding human MOA proteins for Type 2 diabetes, atherosclerosis, Alzheimer's disease, and inflammatory bowel disease. Additionally, we explore the origins of the oncogenicity/oncolyticity of certain pathogens and the relationship between heart disease and influenza. The full PHEVIR database is available at https://sites.gatech.edu/cssb/phevir/ .
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Affiliation(s)
- Hongyi Zhou
- grid.213917.f0000 0001 2097 4943Center for the Study of Systems Biology, School of Biological Sciences, Georgia Institute of Technology, 950 Atlantic Drive, N.W., Atlanta, GA 30332 USA
| | - Courtney Astore
- grid.213917.f0000 0001 2097 4943Center for the Study of Systems Biology, School of Biological Sciences, Georgia Institute of Technology, 950 Atlantic Drive, N.W., Atlanta, GA 30332 USA
| | - Jeffrey Skolnick
- grid.213917.f0000 0001 2097 4943Center for the Study of Systems Biology, School of Biological Sciences, Georgia Institute of Technology, 950 Atlantic Drive, N.W., Atlanta, GA 30332 USA
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Parekh T, Javed Z, Khan SU, Xue H, Nasir K. Disparities in Influenza Vaccination Coverage and Associated Factors Among Adults with Cardiovascular Disease, United States, 2011-2020. Prev Chronic Dis 2022; 19:E67. [PMID: 36302382 PMCID: PMC9616130 DOI: 10.5888/pcd19.220154] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Influenza vaccination can reduce the incidence of cardiovascular disease (CVD) in the US. However, differences in state-level trends in CVD and sociodemographic and health care characteristics of adults with CVD have not yet been studied. METHODS In this repeated cross-sectional study, we extracted 476,227 records of adults with a self-reported history of CVD from the Behavioral Risk Factor Surveillance System from January 2011 through December 2020. We calculated the prevalence and likelihood of annual influenza vaccination by sociodemographic characteristics, health care characteristics, and CVD risk factors. Additionally, we examined annual trends of influenza vaccination by geographic location. RESULTS The annual age-adjusted influenza vaccination rate among adults with CVD increased from 38.6% (2011) to 44.3% (2020), with an annual average percentage change of 1.1%. Adults who were aged 18 to 44 years, male, non-Hispanic Black/African American, or Hispanic, or had less than a high school diploma, annual household income less than $50,000, and no health insurance had a lower prevalence of vaccination. The odds of vaccination were lower among non-Hispanic Black/African American (adjusted odds ratio, 0.73; 95% CI, 0.70-0.77) and non-Hispanic American Indian/Alaska Native (adjusted odds ratio, 0.86; 95% CI, 0.75-0.98) compared with non-Hispanic White adults. Only 16 states achieved a vaccination rate of 50%; no state achieved the Healthy People 2020 goal of 70%. Nonmedical settings (supermarkets, drug stores) gained popularity (19.2% in 2011 to 28.5% in 2018) as a vaccination setting. CONCLUSION Influenza vaccination among adults with CVD improved marginally during the past decade but is far behind the targeted national goals. Addressing existing disparities requires attention to the role of social determinants of health in determining access to vaccination, particularly among young people, racial and ethnic minority populations, people who lack health insurance, and people with comorbidities.
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Affiliation(s)
- Tarang Parekh
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
- Center for Health Data Science and Analytics, Houston Methodist Hospital, 7550 Greenbriar Dr, Houston, TX 77030.
| | - Zulqarnain Javed
- Center for Health Data Science and Analytics, Houston Methodist Hospital, Houston, Texas
| | - Safi U Khan
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Hong Xue
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Khurram Nasir
- Center for Health Data Science and Analytics, Houston Methodist Hospital, Houston, Texas
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
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Pang Y, Liu X, Liu G, Lv M, Lu M, Wu J, Huang Y. Effectiveness of influenza vaccination on in-hospital death and recurrent hospitalization in older adults with cardiovascular diseases. Int J Infect Dis 2022; 122:162-168. [PMID: 35654282 DOI: 10.1016/j.ijid.2022.05.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/21/2022] [Accepted: 05/26/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES There is limited evidence on the effectiveness of influenza vaccination on hospitalization outcomes by cardiovascular disease (CVD) subtypes or comorbidities. METHODS This study involved 713,488 records of hospitalization of adults ≥60 years with CVD from the Beijing Urban Employee Basic Medical Insurance database. Logistic regression with generalized estimating equations was conducted to estimate the effectiveness of influenza vaccination on in-hospital death and recurrent hospitalization, adjusting for unmeasured confounders. RESULTS The coverage of influenza vaccination was only 13.3% among older adults hospitalized for CVD. Influenza vaccination was associated with 15% (odds ratios 0.85 [0.74, 0.99]) lower risk of in-hospital death among patients with CVD, with stronger associations in patients with stroke. Influenza vaccination was associated with 6% (0.94 [0.88, 0.99]) and 28% (0.72 [0.56, 0.93]) lower risks of recurrent hospitalization for ischemic heart disease (IHD) and respiratory disease in patients with IHD, but there were no clear associations in patients with stroke. For in-hospital death, the protective association of influenza vaccination was stronger in patients with fewer comorbidities and was similar to that of joint vaccinations of influenza and pneumococcal vaccinations. CONCLUSION The protective association of influenza vaccination on CVD hospitalization outcomes serves as the evidence base to increase the uptake of influenza vaccination among older adults in China.
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Affiliation(s)
- Yuanjie Pang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Xiaofan Liu
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Guangqi Liu
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Min Lv
- Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Ming Lu
- Department of Biomedical Informatics, School of Basic Medicine, Peking University, Beijing, 100191, China
| | - Jiang Wu
- Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Yangmu Huang
- Department of Global Health, School of Public Health, Peking University, Beijing, China.
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Wang Y, Abe JI, Chau KM, Wang Y, Vu HT, Reddy Velatooru L, Gulraiz F, Imanishi M, Samanthapudi VSK, Nguyen MTH, Ko KA, Lee LL, Thomas TN, Olmsted-Davis EA, Kotla S, Fujiwara K, Cooke JP, Zhao D, Evans SE, Le NT. MAGI1 inhibits interferon signaling to promote influenza A infection. Front Cardiovasc Med 2022; 9:791143. [PMID: 36082118 PMCID: PMC9445416 DOI: 10.3389/fcvm.2022.791143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 07/21/2022] [Indexed: 11/21/2022] Open
Abstract
We have shown that membrane-associated guanylate kinase with inverted domain structure-1 (MAGI1), a scaffold protein with six PSD95/DiscLarge/ZO-1 (PDZ) domains, is involved in the regulation of endothelial cell (EC) activation and atherogenesis in mice. In addition to causing acute respiratory disease, influenza A virus (IAV) infection plays an important role in atherogenesis and triggers acute coronary syndromes and fatal myocardial infarction. Therefore, the aim of this study is to investigate the function and regulation of MAGI1 in IAV-induced EC activation. Whereas, EC infection by IAV increases MAGI1 expression, MAGI1 depletion suppresses IAV infection, suggesting that the induction of MAGI1 may promote IAV infection. Treatment of ECs with oxidized low-density lipoprotein (OxLDL) increases MAGI1 expression and IAV infection, suggesting that MAGI1 is part of the mechanistic link between serum lipid levels and patient prognosis following IAV infection. Our microarray studies suggest that MAGI1-depleted ECs increase protein expression and signaling networks involve in interferon (IFN) production. Specifically, infection of MAGI1-null ECs with IAV upregulates expression of signal transducer and activator of transcription 1 (STAT1), interferon b1 (IFNb1), myxovirus resistance protein 1 (MX1) and 2'-5'-oligoadenylate synthetase 2 (OAS2), and activate STAT5. By contrast, MAGI1 overexpression inhibits Ifnb1 mRNA and MX1 expression, again supporting the pro-viral response mediated by MAGI1. MAGI1 depletion induces the expression of MX1 and virus suppression. The data suggests that IAV suppression by MAGI1 depletion may, in part, be due to MX1 induction. Lastly, interferon regulatory factor 3 (IRF3) translocates to the nucleus in the absence of IRF3 phosphorylation, and IRF3 SUMOylation is abolished in MAGI1-depleted ECs. The data suggests that MAGI1 inhibits IRF3 activation by maintaining IRF3 SUMOylation. In summary, IAV infection occurs in ECs in a MAGI1 expression-dependent manner by inhibiting anti-viral responses including STATs and IRF3 activation and subsequent MX1 induction, and MAGI1 plays a role in EC activation, and in upregulating a pro-viral response. Therefore, the inhibition of MAGI1 is a potential therapeutic target for IAV-induced cardiovascular disease.
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Affiliation(s)
- Yin Wang
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jun-ichi Abe
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,*Correspondence: Jun-ichi Abe
| | - Khanh M. Chau
- Department of Cardiovascular Sciences, Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Yongxing Wang
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hang Thi Vu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Loka Reddy Velatooru
- Department of Cardiovascular Sciences, Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Fahad Gulraiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Masaki Imanishi
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Minh T. H. Nguyen
- Department of Cardiovascular Sciences, Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Kyung Ae Ko
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ling-Ling Lee
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Tamlyn N. Thomas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth A. Olmsted-Davis
- Department of Cardiovascular Sciences, Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Sivareddy Kotla
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Keigi Fujiwara
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - John P. Cooke
- Department of Cardiovascular Sciences, Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Di Zhao
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Scott E. Evans
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,Scott E. Evans
| | - Nhat-Tu Le
- Department of Cardiovascular Sciences, Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, TX, United States,Nhat-Tu Le
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Influenza Vaccination for Cardiovascular Prevention: Further Insights from the IAMI Trial and an Updated Meta-analysis. Curr Cardiol Rep 2022; 24:1327-1335. [PMID: 35876953 PMCID: PMC9310360 DOI: 10.1007/s11886-022-01748-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/04/2022]
Abstract
Purpose of Review Influenza infection is a significant, well-established cause of cardiovascular disease (CVD) and CV mortality. Influenza vaccination has been shown to reduce major adverse cardiovascular events (MACE) and CV mortality. Therefore, major society guidelines have given a strong recommendation for its use in patients with established CVD or high risk for CVD. Nevertheless, influenza vaccination remains underutilized. Historically, influenza vaccination is administered to stable outpatients. Until recently, the safety and efficacy of influenza vaccination among patients with acute myocardial infarction (MI) had not been established. Recent Findings The recently published Influenza Vaccination after Myocardial Infarction (IAMI) trial showed that influenza vaccination within 72 h of hospitalization for MI led to a significant 28% reduction in MACE and a 41% reduction in CV mortality, without any excess in serious adverse events. Additionally, we newly performed an updated meta-analysis of randomized clinical trials (RCTs) including IAMI and the recent Influenza Vaccine to Prevent Adverse Vascular Events (IVVE) trial. In pooled analysis of 8 RCTs with a total of 14,420 patients, influenza vaccine, as compared with control/placebo, was associated with significantly lower risk of MACE at follow-up [RR 0.75 (95%CI 0.57–0.97), I2 56%]. Summary The recent IAMI trial showed that influenza vaccination in patients with recent MI is safe and efficacious at reducing CV morbidity and mortality. Our updated meta-analysis confirms a 25% reduction in MACE. The influenza vaccine should be strongly encouraged in all patients with CVD and incorporated as an essential facet of post-MI care and secondary CVD prevention.
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Hinterseer M, Zens M, Wimmer RJ, Delladio S, Lederle S, Kupatt C, Hartmann B. Acute myocardial infarction due to coronary stent thrombosis in a symptomatic COVID-19 patient. Clin Res Cardiol 2021; 110:302-306. [PMID: 32430631 PMCID: PMC7235975 DOI: 10.1007/s00392-020-01663-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Martin Hinterseer
- Department of Medicine, Heart Center Fuessen-Ausserfern, Fuessen Hospital, Kliniken Ostallgaeu-Kaufbeuren, Stadtbleiche 1, 87629, Fuessen, Germany.
| | - Martin Zens
- Department of Medicine, Heart Center Fuessen-Ausserfern, Fuessen Hospital, Kliniken Ostallgaeu-Kaufbeuren, Stadtbleiche 1, 87629, Fuessen, Germany
| | - Roland Jean Wimmer
- Department of Medicine, Heart Center Fuessen-Ausserfern, Fuessen Hospital, Kliniken Ostallgaeu-Kaufbeuren, Stadtbleiche 1, 87629, Fuessen, Germany
| | - Simon Delladio
- Department of Medicine, Heart Center Fuessen-Ausserfern, Fuessen Hospital, Kliniken Ostallgaeu-Kaufbeuren, Stadtbleiche 1, 87629, Fuessen, Germany
| | - Susanne Lederle
- Department of Medicine, Heart Center Fuessen-Ausserfern, Fuessen Hospital, Kliniken Ostallgaeu-Kaufbeuren, Stadtbleiche 1, 87629, Fuessen, Germany
| | - Christian Kupatt
- Internal Medicine I, University Clinic Rechts Der Isar, TUM Munich, Munich, Germany
- DZHK (German Cardiovascular Research Centre), Partner Site Munich Heart Alliance, Munich, Germany
| | - Bernd Hartmann
- Department of Anesthesia and Intensive Care, Fuessen Hospital, Kliniken Ostallgaeu-Kaufbeuren, Stadtbleiche 1, Fuessen, Germany
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Schiavone M, Gobbi C, Biondi-Zoccai G, D’Ascenzo F, Palazzuoli A, Gasperetti A, Mitacchione G, Viecca M, Galli M, Fedele F, Mancone M, Forleo GB. Acute Coronary Syndromes and Covid-19: Exploring the Uncertainties. J Clin Med 2020; 9:E1683. [PMID: 32498230 PMCID: PMC7356537 DOI: 10.3390/jcm9061683] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
Since an association between myocardial infarction (MI) and respiratory infections has been described for influenza viruses and other respiratory viral agents, understanding possible physiopathological links between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and acute coronary syndromes (ACS) is of the greatest importance. The initial data suggest an underestimation of ACS cases all over the world, but acute MI still represents a major cause of morbidity and mortality worldwide and should not be overshadowed during the coronavirus disease (Covid-19) pandemic. No common consensus regarding the most adequate healthcare management policy for ACS is currently available. Indeed, important differences have been reported between the measures employed to treat ACS in China during the first disease outbreak and what currently represents clinical practice across Europe and the USA. This review aims to discuss the pathophysiological links between MI, respiratory infections, and Covid-19; epidemiological data related to ACS at the time of the Covid-19 pandemic; and learnings that have emerged so far from several catheterization labs and coronary care units all over the world, in order to shed some light on the current strategies for optimal management of ACS patients with confirmed or suspected SARS-CoV-2 infection.
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Affiliation(s)
- Marco Schiavone
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
- University of Milan, 20122 Milan, Italy;
| | | | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy;
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Fabrizio D’Ascenzo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy;
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Medical Sciences, AOUS Le Scotte Hospital, University of Siena, 53100 Siena, Italy;
| | - Alessio Gasperetti
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
| | - Gianfranco Mitacchione
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
| | - Maurizio Viecca
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
| | - Massimo Galli
- Department of Infectious Diseases, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy;
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Francesco Fedele
- Department of Clinical Internal, Anesthesiological and Cardiovascular Science, Sapienza University of Rome, 00161 Rome, Italy;
| | - Massimo Mancone
- Department of Clinical Internal, Anesthesiological and Cardiovascular Science, Sapienza University of Rome, 00161 Rome, Italy;
| | - Giovanni Battista Forleo
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
- University of Milan, 20122 Milan, Italy;
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Secco GG, Zocchi C, Parisi R, Roveta A, Mirabella F, Vercellino M, Pistis G, Reale M, Maggio S, Audo A, Kozel D, Centini G, Maconi A, Di Mario C. Decrease and Delay in Hospitalization for Acute Coronary Syndromes During the 2020 SARS-CoV-2 Pandemic. Can J Cardiol 2020; 36:1152-1155. [PMID: 32447060 PMCID: PMC7242185 DOI: 10.1016/j.cjca.2020.05.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 01/11/2023] Open
Abstract
The diffusion of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) forced the Italian population to restrictive measures that modified patients’ responses to non-SARS-CoV-2 medical conditions. We evaluated all patients with acute coronary syndromes admitted in 3 high-volume hospitals during the first month of SARS-CoV-2 Italian-outbreak and compared them with patients with ACS admitted during the same period 1 year before. Hospitalization for ACS decreased from 162 patients in 2019 to 84 patients in 2020. In 2020, both door-to-balloon and symptoms-to-percutaneous coronary intervention were longer, and admission levels of high-sensitive cardiac troponin I were higher. They had a lower discharged residual left-ventricular function and an increased predicted late cardiovascular mortality based on their Global Registry of Acute Coronary Events (GRACE) scores.
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Affiliation(s)
- Gioel Gabrio Secco
- Department of Cardiology, Interventional Cardiology and Cardiac Surgery, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Department of Cardiology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
| | - Chiara Zocchi
- Structural Interventional Cardiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Rosario Parisi
- Department of Cardiology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Annalisa Roveta
- IRFI, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Francesca Mirabella
- Department of Cardiology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Matteo Vercellino
- Department of Cardiology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gianfranco Pistis
- Department of Cardiology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Maurizio Reale
- Department of Cardiology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Silvia Maggio
- Department of Cardiology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Andrea Audo
- Department of Cardiology, Interventional Cardiology and Cardiac Surgery, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Daniela Kozel
- IRFI, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Giacomo Centini
- IRFI, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Maconi
- IRFI, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41:407-477. [PMID: 31504439 DOI: 10.1093/eurheartj/ehz425] [Citation(s) in RCA: 3596] [Impact Index Per Article: 899.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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12
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Blackburn R, Zhao H, Pebody R, Hayward A, Warren-Gash C. Laboratory-Confirmed Respiratory Infections as Predictors of Hospital Admission for Myocardial Infarction and Stroke: Time-Series Analysis of English Data for 2004-2015. Clin Infect Dis 2019; 67:8-17. [PMID: 29324996 PMCID: PMC6005111 DOI: 10.1093/cid/cix1144] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/05/2018] [Indexed: 01/01/2023] Open
Abstract
Background Acute respiratory infections are associated with increased risk of myocardial infarction (MI) and stroke; however, the role of different organisms is poorly characterized. Methods Time-series analysis of English hospital admissions for MI and stroke (age-stratified: 45–64, 65–74, ≥75 years), laboratory-confirmed viral respiratory infections, and environmental data for 2004–2015. Weekly counts of admissions were modeled using multivariable Poisson regression with weekly counts of respiratory viruses (influenza, parainfluenza, rhinovirus, respiratory syncytial virus [RSV], adenovirus, or human metapneumovirus [HMPV]) investigated as predictors. We controlled for seasonality, long-term trends, and environmental factors. Results Weekly hospital admissions in adults aged ≥45 years averaged 1347 (interquartile range [IQR], 1217–1541) for MI and 1175 (IQR, 1023–1395) for stroke. Respiratory infections ranged from 11 cases per week (IQR, 5–53) for influenza to 55 (IQR, 7–127) for rhinovirus. In the adjusted models, all viruses except parainfluenza were significantly associated with MI and ischemic stroke admissions in those aged ≥75. Among 65- to 74-year-olds, adenovirus, rhinovirus, and RSV were associated with MI but not ischemic stroke admissions. Respiratory infections were not associated with MI or ischemic stroke in people aged 45–64 years, nor with hemorrhagic stroke in any age group. An estimated 0.4%–5.7% of MI and ischemic stroke admissions may be attributable to respiratory infection. Conclusions We identified small but strongly significant associations in the timing of respiratory infection (with HMPV, RSV, influenza, rhinovirus, and adenovirus) and MI or ischemic stroke hospitalizations in the elderly. Clinical Trials Registration NCT02984280.
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Affiliation(s)
- Ruth Blackburn
- Farr Institute of Health Informatics Research, University College London
| | - Honxin Zhao
- National Infection Service Colindale, Public Health England
| | - Richard Pebody
- National Infection Service Colindale, Public Health England
| | - Andrew Hayward
- Farr Institute of Health Informatics Research, University College London
| | - Charlotte Warren-Gash
- Farr Institute of Health Informatics Research, University College London.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
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13
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Feldman C, Normark S, Henriques-Normark B, Anderson R. Pathogenesis and prevention of risk of cardiovascular events in patients with pneumococcal community-acquired pneumonia. J Intern Med 2019; 285:635-652. [PMID: 30584680 DOI: 10.1111/joim.12875] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
It is now well recognized that cardiovascular events (CVE) occur quite commonly, both in the acute phase and in the long-term, in patients with community-acquired pneumonia (CAP). CVE have been noted in up to 30% of patients hospitalized with all-cause CAP. One systematic review and meta-analysis of hospitalized patients with all-cause CAP noted that the incidence rates for overall cardiac events were 17.7%, for incident heart failure were 14.1%, for acute coronary syndromes were 5.3% and for incident cardiac arrhythmias were 4.7%. In the case of pneumococcal CAP, almost 20% of patients studied had one or more of these cardiac events. Recent research has provided insights into the pathogenesis of the acute cardiac events occurring in pneumococcal infections. With respect to the former, key involvements of the major pneumococcal protein virulence factor, pneumolysin, are now well documented, whilst systemic platelet-driven neutrophil activation may also contribute. However, events involved in the pathogenesis of the long-term cardiovascular sequelae remain largely unexplored. Emerging evidence suggests that persistent antigenaemia may predispose to the development of a systemic pro-inflammatory/prothrombotic phenotype underpinning the risk of future cardiovascular events. The current manuscript briefly reviews the occurrence of cardiovascular events in patients with all-cause CAP, as well as in pneumococcal and influenza infections. It highlights the close interaction between influenza and pneumococcal pneumonia. It also includes a brief discussion of mechanisms of the acute cardiac events in CAP. However, the primary focus is on the prevalence, pathogenesis and prevention of the longer-term cardiac sequelae of severe pneumococcal disease, particularly in the context of persistent antigenaemia and associated inflammation.
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Affiliation(s)
- C Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Normark
- Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Stockholm, Sweden.,Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.,Lee Kong Chian School of Medicine (LKC), Singapore Centre on Environmental Life Sciences Engineering (SCELCE), Nanyang Technical University, Singapore, Singapore
| | - B Henriques-Normark
- Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Stockholm, Sweden.,Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.,Lee Kong Chian School of Medicine (LKC), Singapore Centre on Environmental Life Sciences Engineering (SCELCE), Nanyang Technical University, Singapore, Singapore
| | - R Anderson
- Department of Immunology and Institute of Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Piccaro de Oliveira P, Gonzales V, Lopes RD, Schmidt MM, Garofallo S, Santos RPD, Carrion L, Gottschall C, Quadros AS. Serious infections among unselected patients with ST-elevation myocardial infarction treated with contemporary primary percutaneous coronary intervention. Am Heart J 2016; 181:52-59. [PMID: 27823693 DOI: 10.1016/j.ahj.2016.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/17/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Contemporary studies assessing the frequency, characteristics, and outcomes of serious infections (SIs) in patients presenting a ST-elevation myocardial infarction are scarce. METHODS Prospective cohort of consecutive patients undergoing primary percutaneous coronary intervention (pPCI). Serious infection was defined as the presence of infection that prolonged hospitalization. Community-acquired infection (CAI) was defined by SI diagnosed in the first 72 hours of hospitalization, whereas hospital-acquired infections (HAI) were those diagnosed after 72 hours of hospital admission. RESULTS From December 2009 to November 2012, 1,486 patients were included in the analysis. Serious infection was present in 58 (3.9%) individuals; 30 (2%) patients had CAI and 28 (1.9%) patients had HAI. Respiratory tract infection was responsible for 82% of the SI. Patients with SI were older, had more comorbidities, and had worse angiographic results of the pPCI procedure when compared with those without SIs. After multivariable adjustment, SI was associated with an approximately 10-fold risk of 30-day death. Patients with CAI had more often a history of smoking, Killip III/IV on hospital admission, worse pPCI, and angiographic results than did patients with HAI. However, no differences were seen in 30-day major cardiovascular outcomes between patients with CAI and HAI. CONCLUSION In a contemporary cohort of unselected ST-elevation myocardial infarction patients representative of the daily practice, SI was uncommon but associated with worse pPCI results and high risk of mortality. The occurrences of CAI or HAI were similar, but CAI patients presented distinctly worse angiographic outcomes than did patients with HAI.
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Huang XZ, Liu XX, Song JT, Wang L, Liu XL, Qu HY, Wang SX, Zhang C, Zhang Y, Zhang M. Prolyl-4-hydroxylase- 1 improves the stability of advanced plaques but accelerates the atherosclerotic lesion formation of early plaques. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Clar C, Oseni Z, Flowers N, Keshtkar‐Jahromi M, Rees K. Influenza vaccines for preventing cardiovascular disease. Cochrane Database Syst Rev 2015; 2015:CD005050. [PMID: 25940444 PMCID: PMC8511741 DOI: 10.1002/14651858.cd005050.pub3] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND This is an update of the original review published in 2008. The risk of adverse cardiovascular outcomes is increased with influenza-like infection, and vaccination against influenza may improve cardiovascular outcomes. OBJECTIVES To assess the potential benefits of influenza vaccination for primary and secondary prevention of cardiovascular disease. SEARCH METHODS We searched the following electronic databases on 18 October 2013: The Cochrane Library (including Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Economic Evaluation Database (EED) and Health Technology Assessment database (HTA)), MEDLINE, EMBASE, Science Citation Index Expanded, Conference Proceedings Citation Index - Science and ongoing trials registers (www.controlled-trials.com/ and www.clinicaltrials.gov). We examined reference lists of relevant primary studies and systematic reviews. We performed a limited PubMed search on 20 February 2015, just before publication. SELECTION CRITERIA Randomised controlled trials (RCTs) of influenza vaccination compared with placebo or no treatment in participants with or without cardiovascular disease, assessing cardiovascular death or non-fatal cardiovascular events. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by The Cochrane Collaboration. We carried out meta-analyses only for cardiovascular death, as other outcomes were reported too infrequently. We expressed effect sizes as risk ratios (RRs), and we used random-effects models. MAIN RESULTS We included eight trials of influenza vaccination compared with placebo or no vaccination, with 12,029 participants receiving at least one vaccination or control treatment. We included six new studies (n = 11,251), in addition to the two included in the previous version of the review. Four of these trials (n = 10,347) focused on prevention of influenza in the general or elderly population and reported cardiovascular outcomes among their safety analyses; four trials (n = 1682) focused on prevention of cardiovascular events in patients with established coronary heart disease. These populations were analysed separately. Follow-up continued between 42 days and one year. Five RCTs showed deficits in at least three of the risk of bias criteria assessed. When reported (seven studies), vaccination provided adequate immunogenicity or protection against influenza. Cardiovascular mortality was reported by four secondary prevention trials and was significantly reduced by influenza vaccination overall (risk ratio (RR) 0.45, 95% confidence interval (CI) 0.26 to 0.76; P value 0.003) with no significant heterogeneity between studies, and by three trials reporting cardiovascular mortality as part of their safety analyses when the numbers of events were too small to permit conclusions. In studies of patients with coronary heart disease, composite outcomes of cardiovascular events tended to be decreased with influenza vaccination compared with placebo. Generally no significant difference was found between comparison groups regarding individual outcomes such as myocardial infarction. AUTHORS' CONCLUSIONS In patients with cardiovascular disease, influenza vaccination may reduce cardiovascular mortality and combined cardiovascular events. However, studies had some risk of bias, and results were not always consistent, so additional higher-quality evidence is necessary to confirm these findings. Not enough evidence was available to establish whether influenza vaccination has a role to play in the primary prevention of cardiovascular disease.
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Affiliation(s)
| | - Zainab Oseni
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryWarwickshireUK
| | - Nadine Flowers
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryWarwickshireUK
| | - Maryam Keshtkar‐Jahromi
- Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical CenterDivision of Infectious DiseasesMason F.Lord Building, Center Tower, Suite 3815200 Eastern AvenueBaltimoreMDUSA21224
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryWarwickshireUK
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Shah PK, Chyu KY, Dimayuga PC, Nilsson J. Vaccine for Atherosclerosis. J Am Coll Cardiol 2014; 64:2779-91. [DOI: 10.1016/j.jacc.2014.10.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 11/25/2022]
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