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Linschoten M, Uijl A, Schut A, Jakob CEM, Romão LR, Bell RM, McFarlane E, Stecher M, Zondag AGM, van Iperen EPA, Hermans-van Ast W, Lea NC, Schaap J, Jewbali LS, Smits PC, Patel RS, Aujayeb A, van der Harst P, Siebelink HJ, van Smeden M, Williams S, Pilgram L, van Gilst WH, Tieleman RG, Williams B, Asselbergs FW, Al-Ali AK, Al-Muhanna FA, Al-Rubaish AM, Al-Windy NYY, Alkhalil M, Almubarak YA, Alnafie AN, Alshahrani M, Alshehri AM, Anning C, Anthonio RL, Badings EA, Ball C, van Beek EA, ten Berg JM, von Bergwelt-Baildon M, Bianco M, Blagova OV, Bleijendaal H, Bor WL, Borgmann S, van Boxem AJM, van den Brink FS, Bucciarelli-Ducci C, van Bussel BCT, Byrom-Goulthorp R, Captur G, Caputo M, Charlotte N, vom Dahl J, Dark P, De Sutter J, Degenhardt C, Delsing CE, Dolff S, Dorman HGR, Drost JT, Eberwein L, Emans ME, Er AG, Ferreira JB, Forner MJ, Friedrichs A, Gabriel L, Groenemeijer BE, Groenendijk AL, Grüner B, Guggemos W, Haerkens-Arends HE, Hanses F, Hedayat B, Heigener D, van der Heijden DJ, Hellou E, Hellwig K, Henkens MTHM, Hermanides RS, Hermans WRM, van Hessen MWJ, Heymans SRB, Hilt AD, van der Horst ICC, Hower M, van Ierssel SH, Isberner N, Jensen B, Kearney MT, van Kesteren HAM, Kielstein JT, Kietselaer BLJH, Kochanek M, Kolk MZH, Koning AMH, Kopylov PY, Kuijper AFM, Kwakkel-van Erp JM, Lanznaster J, van der Linden MMJM, van der Lingen ACJ, Linssen GCM, Lomas D, Maarse M, Macías Ruiz R, Magdelijns FJH, Magro M, Markart P, Martens FMAC, Mazzilli SG, McCann GP, van der Meer P, Meijs MFL, Merle U, Messiaen P, Milovanovic M, Monraats PS, Montagna L, Moriarty A, Moss AJ, Mosterd A, Nadalin S, Nattermann J, Neufang M, Nierop PR, Offerhaus JA, van Ofwegen-Hanekamp CEE, Parker E, Persoon AM, Piepel C, Pinto YM, Poorhosseini H, Prasad S, Raafs AG, Raichle C, Rauschning D, Redón J, Reidinga AC, Ribeiro MIA, Riedel C, Rieg S, Ripley DP, Römmele C, Rothfuss K, Rüddel J, Rüthrich MM, Salah R, Saneei E, Saxena M, Schellings DAAM, Scholte NTB, Schubert J, Seelig J, Shafiee A, Shore AC, Spinner C, Stieglitz S, Strauss R, Sturkenboom NH, Tessitore E, Thomson RJ, Timmermans P, Tio RA, Tjong FVY, Tometten L, Trauth J, den Uil CA, Van Craenenbroeck EM, van Veen HPAA, Vehreschild MJGT, Veldhuis LI, Veneman T, Verschure DO, Voigt I, de Vries JK, van de Wal RMA, Walter L, van de Watering DJ, Westendorp ICD, Westendorp PHM, Westhoff T, Weytjens C, Wierda E, Wille K, de With K, Worm M, Woudstra P, Wu KW, Zaal R, Zaman AG, van der Zee PM, Zijlstra LE, Alling TE, Ahmed R, van Aken K, Bayraktar-Verver ECE, Bermúdez Jiménes FJ, Biolé CA, den Boer-Penning P, Bontje M, Bos M, Bosch L, Broekman M, Broeyer FJF, de Bruijn EAW, Bruinsma S, Cardoso NM, Cosyns B, van Dalen DH, Dekimpe E, Domange J, van Doorn JL, van Doorn P, Dormal F, Drost IMJ, Dunnink A, van Eck JWM, Elshinawy K, Gevers RMM, Gognieva DG, van der Graaf M, Grangeon S, Guclu A, Habib A, Haenen NA, Hamilton K, Handgraaf S, Heidbuchel H, Hendriks-van Woerden M, Hessels-Linnemeijer BM, Hosseini K, Huisman J, Jacobs TC, Jansen SE, Janssen A, Jourdan K, ten Kate GL, van Kempen MJ, Kievit CM, Kleikers P, Knufman N, van der Kooi SE, Koole BAS, Koole MAC, Kui KK, Kuipers-Elferink L, Lemoine I, Lensink E, van Marrewijk V, van Meerbeeck JP, Meijer EJ, Melein AJ, Mesitskaya DF, van Nes CPM, Paris FMA, Perrelli MG, Pieterse-Rots A, Pisters R, Pölkerman BC, van Poppel A, Reinders S, Reitsma MJ, Ruiter AH, Selder JL, van der Sluis A, Sousa AIC, Tajdini M, Tercedor Sánchez L, Van De Heyning CM, Vial H, Vlieghe E, Vonkeman HE, Vreugdenhil P, de Vries TAC, Willems AM, Wils AM, Zoet-Nugteren SK. Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries. Eur Heart J 2022; 43:1104-1120. [PMID: 34734634 DOI: 10.1093/eurheartj/ehab656] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/22/2021] [Accepted: 09/01/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. METHODS AND RESULTS We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients. CONCLUSION Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.
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Kaptein FHJ, Stals MAM, Grootenboers M, Braken SJE, Burggraaf JLI, van Bussel BCT, Cannegieter SC, Ten Cate H, Endeman H, Gommers DAMPJ, van Guldener C, de Jonge E, Juffermans NP, Kant KM, Kevenaar ME, Koster S, Kroft LJM, Kruip MJHA, Leentjens J, Marechal C, Soei YL, Tjepkema L, Visser C, Klok FA, Huisman MV. Incidence of thrombotic complications and overall survival in hospitalized patients with COVID-19 in the second and first wave. Thromb Res 2021; 199:143-148. [PMID: 33535120 PMCID: PMC7832218 DOI: 10.1016/j.thromres.2020.12.019] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION In the first wave, thrombotic complications were common in COVID-19 patients. It is unknown whether state-of-the-art treatment has resulted in less thrombotic complications in the second wave. METHODS We assessed the incidence of thrombotic complications and overall mortality in COVID-19 patients admitted to eight Dutch hospitals between September 1st and November 30th 2020. Follow-up ended at discharge, transfer to another hospital, when they died, or on November 30th 2020, whichever came first. Cumulative incidences were estimated, adjusted for competing risk of death. These were compared to those observed in 579 patients admitted in the first wave, between February 24th and April 26th 2020, by means of Cox regression techniques adjusted for age, sex and weight. RESULTS In total 947 patients with COVID-19 were included in this analysis, of whom 358 patients were admitted to the ICU; 144 patients died (15%). The adjusted cumulative incidence of all thrombotic complications after 10, 20 and 30 days was 12% (95% confidence interval (CI) 9.8-15%), 16% (13-19%) and 21% (17-25%), respectively. Patient characteristics between the first and second wave were comparable. The adjusted hazard ratio (HR) for overall mortality in the second wave versus the first wave was 0.53 (95%CI 0.41-0.70). The adjusted HR for any thrombotic complication in the second versus the first wave was 0.89 (95%CI 0.65-1.2). CONCLUSIONS Mortality was reduced by 47% in the second wave, but the thrombotic complication rate remained high, and comparable to the first wave. Careful attention to provision of adequate thromboprophylaxis is invariably warranted.
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Affiliation(s)
- F H J Kaptein
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - M A M Stals
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - M Grootenboers
- Department of Pulmonology, Amphia Hospital Breda, the Netherlands
| | - S J E Braken
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - J L I Burggraaf
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - B C T van Bussel
- Department of Intensive Care Medicine, Maastricht, UMC+, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - S C Cannegieter
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - H Ten Cate
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - H Endeman
- Department of Adult Intensive Care, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - D A M P J Gommers
- Department of Adult Intensive Care, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - C van Guldener
- Department of Internal Medicine, Amphia Hospital Breda, the Netherlands
| | - E de Jonge
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - N P Juffermans
- Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - K M Kant
- Department of Intensive Care Medicine, Amphia Hospital Breda, the Netherlands
| | - M E Kevenaar
- Department of Internal Medicine, Franciscus Gasthuis& Vlietland, Rotterdam, the Netherlands
| | - S Koster
- Department of Intensive Care Medicine, Zaans Medical Center, Zaandam, the Netherlands
| | - L J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - M J H A Kruip
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - J Leentjens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C Marechal
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Y L Soei
- Department of Internal Medicine, Franciscus Gasthuis& Vlietland, Rotterdam, the Netherlands
| | - L Tjepkema
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - C Visser
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - F A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - M V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
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van Bussel BCT, Henry RMA, Schalkwijk CG, Dekker JM, Nijpels G, Feskens EJM, Stehouwer CDA. Alcohol and red wine consumption, but not fruit, vegetables, fish or dairy products, are associated with less endothelial dysfunction and less low-grade inflammation: the Hoorn Study. Eur J Nutr 2017; 57:1409-1419. [PMID: 28349255 PMCID: PMC5959974 DOI: 10.1007/s00394-017-1420-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 02/27/2017] [Indexed: 01/22/2023]
Abstract
Purpose
Endothelial dysfunction and low-grade inflammation are key phenomena in the pathobiology of cardiovascular disease (CVD). Their dietary modification might explain the observed reduction in CVD that has been associated with a healthy diet rich in fruit, vegetables and fish, low in dairy products and with moderate alcohol and red wine consumption. We investigated the associations between the above food groups and endothelial dysfunction and low-grade inflammation in a population-based cohort of Dutch elderly individuals. Methods Diet was measured by food frequency questionnaire (n = 801; women = 399; age 68.5 ± 7.2 years). Endothelial dysfunction was determined (1) by combining von Willebrand factor, and soluble intercellular adhesion molecule 1 (sICAM-1), vascular cell adhesion molecule 1, endothelial selectin and thrombomodulin, using Z-scores, into a biomarker score and (2) by flow-mediated vasodilation (FMD), and low-grade inflammation by combining C-reactive protein, serum amyloid A, interleukin 6, interleukin 8, tumour necrosis factor α and sICAM-1 into a biomarker score, with smaller FMD and higher scores representing more dysfunction and inflammation, respectively. We used linear regression analyses to adjust associations for sex, age, energy, glucose metabolism, body mass index, smoking, prior CVD, educational level, physical activity and each of the other food groups. Results Moderate [β (95% CI) −0.13 (−0.33; 0.07)] and high [−0.22 (−0.45; −0.003)] alcohol consumption, and red wine [−0.16 (−0.30; −0.01)] consumption, but none of the other food groups, were associated with a lower endothelial dysfunction biomarker score and a greater FMD. The associations for FMD were, however, not statistically significant. Only red wine consumption was associated with a lower low-grade inflammation biomarker score [−0.18 (−0.33; −0.04)]. Conclusions Alcohol and red wine consumption may favourably influence processes involved in atherothrombosis. Electronic supplementary material The online version of this article (doi:10.1007/s00394-017-1420-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- B C T van Bussel
- Department of Medicine, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands.,School of Nutrition, and Translational Research in Metabolism (NUTRIM), MUMC+, Maastricht, The Netherlands.,Top Institute Food and Nutrition (TIFN), Wageningen, The Netherlands
| | - R M A Henry
- Department of Medicine, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands.,Top Institute Food and Nutrition (TIFN), Wageningen, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), MUMC+, Maastricht, The Netherlands
| | - C G Schalkwijk
- Department of Medicine, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands.,Top Institute Food and Nutrition (TIFN), Wageningen, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), MUMC+, Maastricht, The Netherlands
| | - J M Dekker
- The EMGO Institute for Health and Care Research (EMGO), Vrije Universiteit Medical Centre (VUMC), Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VUMC, Amsterdam, The Netherlands
| | - G Nijpels
- Department of Epidemiology and Biostatistics, VUMC, Amsterdam, The Netherlands.,Department of General Practice, VUMC, Amsterdam, The Netherlands
| | - E J M Feskens
- Top Institute Food and Nutrition (TIFN), Wageningen, The Netherlands.,Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - C D A Stehouwer
- Department of Medicine, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands. .,School of Nutrition, and Translational Research in Metabolism (NUTRIM), MUMC+, Maastricht, The Netherlands. .,Top Institute Food and Nutrition (TIFN), Wageningen, The Netherlands. .,Cardiovascular Research Institute Maastricht (CARIM), MUMC+, Maastricht, The Netherlands. .,Department of Medicine, Maastricht University Medical Centre, Prof. Debyelaan 25, Maastricht, HX, 6229, The Netherlands.
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