Visiting Instructor/Lecturer, Medicine - Cardiovascular Medicine
- Reducing Mortality and Cardiovascular Disease: Stepping Up Our Game. Journal of the American College of Cardiology 2023
- COVID-19 and smoking: Considerations after two years. European journal of internal medicine 2023
- Post-COVID or long-COVID? That is the question Reply POLISH ARCHIVES OF INTERNAL MEDICINE-POLSKIE ARCHIWUM MEDYCYNY WEWNETRZNEJ 2023; 133 (5)
Arrhythmogenic Cardiomyopathy and Athletes - A Dangerous Relationship.
Current problems in cardiology
Arrhythmogenic cardiomyopathy (ACM) is a disease characterized by a progressive replacement of myocardium by fibro-adipose material, predisposing to ventricular arrhythmias (VA) and sudden cardiac death (SCD). Its prevalence is estimated at 1:2000 to 1:5000, with a higher incidence in males, and clinical onset is usually between the 2nd and 4th decade of life. The prevalence of ACM in SCD victims is relatively high, making it one of the most common etiologies in young patients with SCD, especially if they are athletes. Cardiac events occur more frequently in individuals with ACM who participate in competitive sports and/or high-intensity training. In effect, exercise activity can worsen RV function in cases of hereditary ACM. Estimating the incidence of SCD caused by ACM in athletes remains challenging, being reported frequency ranging from 3-20%. Here, we review the potential implications of exercising on the clinical course of the classical genetic form of ACM, as well as the diagnostic tools, risk stratification, and the different therapeutic tools available for managing ACM.
View details for DOI 10.1016/j.cpcardiol.2023.101799
View details for PubMedID 37172878
COVID-19 and its long-term sequelae: what do we know in 2023?
POLISH ARCHIVES OF INTERNAL MEDICINE-POLSKIE ARCHIWUM MEDYCYNY WEWNETRZNEJ
Post‑viral syndrome is a well‑known medical condition characterized by different levels of physical, cognitive, and emotional impairment that may persist with fluctuating severity after recovering from an acute viral infection. Unsurprisingly, COVID‑19 may also be accompanied by medium- and long‑term clinical sequelae after recovering from a SARS‑CoV‑2 infection. Although many clinical definitions have been provided, "long‑COVID" can be defined as a condition occurring in patients with a history of SARS‑CoV‑2 infection, developing 3 months from the symptoms onset, persisting for at least 2 months, and not explained by alternative diagnoses. According to recent global analyses, the cumulative prevalence of long‑COVID seems to range between 9% and 63%, and is up to 6‑fold higher than that of similar postviral infection conditions. Long‑COVID primarily encompasses the presence of at least 1 symptom, such as fatigue, dyspnea, cognitive impairment / brain fog, postexertional malaise, memory issues, musculoskeletal pain / spasms, cough, sleep disturbances, tachycardia / palpitations, altered smell / taste perception, headache, chest pain, and depression. The most important demographic and clinical predictors to date are female sex, older age, cigarette smoking, pre‑existing medical conditions, lack of COVID‑19 vaccination, infection with pre‑Omicron SARS‑CoV‑2 variants, number of acute phase symptoms, viral load, severe / critical COVID‑19 illness, as well as invasive mechanical ventilation. Concerning the care for long‑COVID patients, the greatest challenge is the fact that this syndrome cannot be considered a single clinical entity, and thus it needs an integrated multidisciplinary management, specifically tailored to the type and severity of symptoms.
View details for DOI 10.20452/pamw.16402
View details for Web of Science ID 000916942100001
View details for PubMedID 36626183
Estimating Worldwide Impact of Low Physical Activity on Risk of Developing Ischemic Heart Disease-Related Disability: An Updated Search in the 2019 Global Health Data Exchange (GHDx).
Medicines (Basel, Switzerland)
2022; 9 (11)
We provide here updated analysis of the impact of physical inactivity on risk of developing ischemic heart disease (IHD)-related disability along with the latest 10-year progression. We collected data through an electronic search in the 2019 Global Health Data Exchange (GHDx) database using the keywords "low physical activity", complemented with the additional epidemiologic variables "disability-adjusted life years" (DALYs; number); "ischemic heart disease"; "socio-demographic index" (SDI); "age"; "sex" and "year", for calculating volume of DALYs lost due to physical activity (PA)-related disability after IHD (LPA-IHD impairment). Based on this search, the overall LPA-IHD impairment was estimated at 7.6 million DALYs in 2019 (3.9 and 3.7 million DALYs in males and females, respectively), thus representing nearly 50% of all PA-related disabilities. The highest impact of LPA-IHD impairment was observed in middle SDI countries, being the lowest in low SDI countries. The LPA-IHD DALYs increased by 17.5% in both sexes during the past 10 years (19.2% in males, and 15.8% in females, respectively), though this trend was dissimilar among different SDI areas, especially during the past two years. In high and high-middle SDI countries, the LPA-IHD grew during the past 2 years, whilst the trend remained stable or declined in other regions. In conclusion, LPA-IHD impairment remains substantial worldwide, leading the way to reinforce current policies aimed at increasing PA volume in the population.
View details for DOI 10.3390/medicines9110055
View details for PubMedID 36355060
A systematic review of prevalence of metabolic syndrome in occupational groups - Does occupation matter in the global epidemic of metabolic syndrome?
Progress in cardiovascular diseases
2022; 75: 69-77
Many occupations can influence the development of metabolic syndrome (MetS). This systematic review aims to evaluate studies on MetS prevalence in different occupational groups from different countries. An integrative review of the literature was conducted within the PubMed and Web of Science databases between January 2005 and February 2022. Only studies with over 3000 subjects that presented data about the prevalence of MetS in different occupational groups were included. The classification of occupational groups was based on the statistical category of economic activities in the European Community (EC). Of a total of 1942 screened records, ten studies were included, showing that MetS is a common health (main) risk factor in all occupational groups. However, the prevalence of MetS varies between nationalities, between and within occupational groups, and between genders. The reasons for this variation appear complex and supported by several causal explanations. The prevalence of MetS was highest among women in a group of Korean skilled agricultural, forestry, and fishery workers (Prevalence: 39.2%). Similarly, among men, the highest prevalence was found in Korean equipment, machine operating, and assembling workers (Prevalence: 35.4%). Male information and communication technology professionals from the Netherlands (Prevalence: 6.2%) and Spanish female catering and hospitality, personal, and security service workers (Prevalence: 5.9%) had the lowest rates of MetS. Overall, the results indicated that valid data on this topic are insufficient, and more randomized controlled trials are needed. Moreover, the different definitions of MetS complicate the accurate comparison between studies, paving the way to achieving consensus on a universal definition of MetS.
View details for DOI 10.1016/j.pcad.2022.09.003
View details for PubMedID 36162483
- Benzodiazepines consumption may have increased during the COVID-19 pandemic JOURNAL OF AFFECTIVE DISORDERS 2022; 314: 124-125
- [Estimacion de la carga del deterioro de la salud mental despues de COVID-19]. Revista de psiquiatria y salud mental 2022
- Atherosclerosis biomarkers and resting heart rate: Active players or simple bystanders? KARDIOLOGIA POLSKA 2022; 80 (10): 972-973
- Increased HDL-C Values and Mortality: Revolutionizing a Historical Paradigm? SEMINARS IN THROMBOSIS AND HEMOSTASIS 2022; 48 (08): 988-990
Coronavirus disease 2019, hypertension, and renin-angiotensin-aldosterone system inhibitors.
Current opinion in cardiology
2022; 37 (5): 419-423
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mostly uses the angiotensin-converting enzyme 2 (ACE-2) as cellular receptor for entering the host cells. Some, but not all, animal studies have shown that renin-angiotensin-aldosterone system (RAAS) inhibitors can increase ACE-2 expression. On that premise, it was hypothesized that these agents could make it more likely to develop coronavirus disease 2019 (COVID-19). On the other hand, there was also evidence that being on these agents could lessen the severity of the lung injury in patients with severe SARS-CoV-2 infection. Herein, we review the available evidence on the role of RAAS inhibitors on SARS-CoV-2 and COVID-19 development.Recent randomized controlled trials demonstrate that RAAS blockade or withdrawal does not influence the severity of COVID-19 in patients who are already on these medications. Currently, there is no evidence to support stopping RAAS inhibitors in patients hospitalized for COVID-19. Several questions still need to be addressed. Ongoing studies are currently evaluating the de novo use of RAAS inhibitors in patients with COVID-19. Another area that needs to be investigated is whether or not using these medications increase the risk of infection.The wealth of evidence indicates that ACE inhibitors and angiotensin-receptor blocker administration has no harmful effects on hospitalizations and severity of COVID-19 in patients already on these medications and might even reduce mortality among hypertensive patients diagnosed with COVID-19. More evidence and data need to be collected, and at this time, these agents should not be discontinued.
View details for DOI 10.1097/HCO.0000000000000982
View details for PubMedID 35913369
- Fit Is It for Longevity Across Populations. Journal of the American College of Cardiology 2022; 80 (6): 610-612
Cytokeratin 18 cell death assays as biomarkers for quantification of apoptosis and necrosis in COVID-19: a prospective, observational study.
Journal of clinical pathology
2022; 75 (6): 410-415
The mechanism by which SARS-CoV-2 triggers cell damage and necrosis are yet to be fully elucidated. We sought to quantify epithelial cell death in patients with COVID-19, with an estimation of relative contributions of apoptosis and necrosis.Blood samples were collected prospectively from adult patients presenting to the emergency department. Circulating levels of caspase-cleaved (apoptosis) and total cytokeratin 18 (CK-18) (total cell death) were determined using M30 and M65 enzyme assays, respectively. Intact CK-18 (necrosis) was estimated by subtracting M30 levels from M65.A total of 52 COVID-19 patients and 27 matched sick controls (with respiratory symptoms not due to COVID-19) were enrolled. Compared with sick controls, COVID-19 patients had higher levels of M65 (p = 0.046, total cell death) and M30 (p = 0.0079, apoptosis). Hospitalised COVID-19 patients had higher levels of M65 (p= 0.014) and intact CK-18 (p= 0.004, necrosis) than discharged patients. Intensive care unit (ICU)-admitted COVID-19 patients had higher levels of M65 (p= 0.004), M30 (p= 0.004) and intact CK-18 (p= 0.033) than hospitalised non-ICU admitted patients. In multivariable logistic regression, elevated levels of M65, M30 and intact CK-18 were associated with increased odds of ICU admission (OR=22.05, p=0.014, OR=19.71, p=0.012 and OR=14.12, p=0.016, respectively).Necrosis appears to be the main driver of hospitalisation, whereas apoptosis and necrosis appear to drive ICU admission. Elevated levels CK-18 levels are independent predictors of severe disease, and could be useful for risk stratification of COVID-19 patients and in assessment of therapeutic efficacy in early-phase COVID-19 clinical trials.
View details for DOI 10.1136/jclinpath-2020-207242
View details for PubMedID 33789919
View details for PubMedCentralID PMC8025250
Physical Activity, Screen Time, Sedentary and Sleeping Habits of Polish Preschoolers during the COVID-19 Pandemic and WHO's Recommendations: An Observational Cohort Study
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
2021; 18 (21)
Restrictions related to the COVID-19 pandemic may lead to a significant decrease in physical activity, an increase in sedentary behavior, and thus also such things as screen time or a change in health behavior patterns. The survey aimed to compare levels of physical activity, screen time, hours spent sitting and sleeping time among Polish children aged 3-5 years of age before and during the COVID-19 pandemic.We identified 3000 respondents under five years of age, at Polish kindergartens. The questionnaire consists of 62 questions according to the recommendations of health behavior in school-aged children. The questionnaire was completed by the parents of these children.Only 30.77% of children complied with WHO criteria before the pandemic. During the pandemic, the percentage of children meeting the recommendations for physical activity decreased even more. Children spent much more time in a sitting position before the restrictions. The children slept as recommended 10-13 h a day, and the pandemic caused an increase in sleep duration of 10-18%. Most children had a limited time allowed for the use of electronic devices already before the pandemic, but during the pandemic the results negatively decreased by 71.54%.The results clearly indicate decreased physical activity and increased screen time. It is also crucial to develop recommendations for prevention management strategies of sedentary lifestyles in the youngest group.
View details for DOI 10.3390/ijerph182111173
View details for Web of Science ID 000718713000001
View details for PubMedID 34769692
View details for PubMedCentralID PMC8583704
Role of non-coding RNAs as biomarkers of deleterious cardiovascular effects in sepsis
PROGRESS IN CARDIOVASCULAR DISEASES
2021; 68: 70-77
The mechanisms occurring during sepsis that produce an increased risk of cardiovascular (CV) disease (CVD) are poorly understood. Even less information exists regarding CV dysfunction as a complication of sepsis, particularly for sepsis-induced cardiomyopathy. However, recent research has demonstrated that non-coding RNAs, including microRNAs, long non-coding RNAs, and circular RNAs, play a crucial role in genetic reprogramming, gene regulation, and inflammation during the development of CVD. Here we describe experimental findings showing the importance of non-coding RNAs mediating relevant mechanisms underlying CV dysfunction after sepsis, so contributing to sepsis-induced cardiomyopathy. Importantly, non-coding RNAs are critical novel regulators of CVD risk factors. Thus, they are potential candidates to improve diagnostics and prognosis of sepsis-induced cardiomyopathy and other CVD events occurring after sepsis and set the basis to design novel therapeutic strategies.
View details for DOI 10.1016/j.pcad.2021.07.005
View details for Web of Science ID 000713012700010
View details for PubMedID 34265333
Exercise Effects On Cardiovascular Disease: From Basic Aspects To Clinical Evidence.
Cardiovascular (CV) disease (CVD) remains the leading cause of major morbidity and CVD- and all-cause mortality in most of the world. It is now clear that regular physical activity (PA) and exercise training (ET) induces a wide range of direct and indirect physiologic adaptations and pleiotropic benefits for human general and CV health. Generally, higher levels of PA, ET, and cardiorespiratory fitness (CRF) are correlated with reduced risk of CVD, including myocardial infarction, CVD-related death, and all-cause mortality. Although exact details regarding the ideal doses of ET, including resistance and, especially, aerobic ET, as well as the potential adverse effects of extreme levels of ET, continue to be investigated, there is no question that most of the world's population have insufficient levels of PA/ET, and many also have lower than ideal levels of CRF. Therefore, assessment and promotion of PA, ET, and efforts to improve levels of CRF should be integrated into all health professionals' practices worldwide. In this state-of-the-art review, we discuss the exercise effects on many areas related to CVD, from basic aspects to clinical practice.
View details for DOI 10.1093/cvr/cvab272
View details for PubMedID 34478520
Link between cardiovascular disease and the risk of falling: a comprehensive review of the evidence.
Polish archives of internal medicine
2021; 131 (4): 369-376
Falls are associated with increased morbidity and mortality, rising hospital readmission rates, decreased patient independence, and strained healthcare resources. In aged populations and individuals with multimorbidity, cardiovascular conditions may contribute towards an increased propensity to fall. The prevalence of cardiovascular conditions generally increases with age, and understanding potential fall risk factors may help to minimize the risk of falls and develop preventive interventions. Acting on even one such risk factor or introducing an appropriate intervention may reduce the overall propensity for a patient to fall. Further prevention strategies primed towards cardiovascular ailments should be elucidated and trialed.
View details for DOI 10.20452/pamw.15849
View details for PubMedID 33629828
- Response to: Is newly diagnosed diabetes a stronger risk factor than pre-existing diabetes for COVID-19 severity? Journal of diabetes 2021; 13 (2): 179-180
- Fit Is It for Cardiovascular Disease Prediction, Prevention, and Treatment CANADIAN JOURNAL OF CARDIOLOGY 2021; 37 (2): 193-195
Place of residence, physical activity, use of electronic devices and health consequences in girls with scoliosis
ANNALS OF AGRICULTURAL AND ENVIRONMENTAL MEDICINE
2021; 28 (3): 509-515
Physical activity has been reduced in the 21st century and is a phenomenon which is now an important problem. The study focuses on the reasons for this lack of physical activity in adolescent girls diagnosed with scoliosis, and the possibility of preventing and effectively promoting a healthy lifestyle. The aim of the study is to investigate the relationship between place of residence (rural and urban) and physical activity in girls with scoliosis.A group of 43 girls aged 16-18 years (x = 16.97 ± 0.88) with AIS (mean Cobb angle = 16.32 ± 3.55) who were rural inhabitants were examined. The control group included 39 young girls in the same age group and AIS who were living in towns (mean Cobb angle = 18.53 ± 4.3). BMI was calculated in percentiles and the IPAQ (International Physical Activity Questionnaire s) was administered.The results showed decreased physical activity and a reduction in total sedentary time each week, which was higher in girls living in the countryside than in those living in towns (P<.001). Electronic devices were commonly used in both groups of girls.The global weekly physical activity in girls living in the countryside was higher than that in girls living in the towns. A lower level of physical activity was noted in the girls exempted from PE at school. Body acceptance and fewer body image issues were noted in girls living in the countryside.
View details for DOI 10.26444/aaem/130268
View details for Web of Science ID 000701684300024
View details for PubMedID 34558277
Consumer wearable technologies to identify and monitor exercise-related arrhythmias in athletes.
Current opinion in cardiology
PURPOSE OF REVIEW: The aim of this study was to synthesize the current evidence supporting and against the use of wearable devices to detect underlying heart conditions in athletes and the most significant limitations.RECENT FINDINGS: Although several large studies have been conducted to evaluate the ability of wearables devices to identify atrial fibrillation among the general population, no studies evaluating their ability to detect other exercise-related arrhythmias in athletes are very sparse. Most of the studies or case reports are focused on the wearables' reliability and accuracy compared with standard ECG. Only small studies evaluating the accuracy of one wearable device in athletes have been carried out to date. Unfortunately, none of them have investigated their ability to detect specific arrhythmias in the athletic population.SUMMARY: Rapidly detecting dangerous arrhythmias in a symptomatic athlete continues to be an elusive goal. The use of smartphone ECG monitors can provide diagnostic data in athletes with symptoms that could represent a helpful instrument. However, many uncertainties remain and need to be addressed and validated in large-scale trials to incorporate these devices into the healthcare system and be part of an athlete's daily monitoring and healthcare.
View details for DOI 10.1097/HCO.0000000000000817
View details for PubMedID 33074935
- Clinical and demographic characteristics of patients dying from COVID-19 in Italy vs China. Journal of medical virology 2020; 92 (10): 1759-1760
Do genetic polymorphisms in angiotensin converting enzyme 2 (ACE2) gene play a role in coronavirus disease 2019 (COVID-19)?
Clinical chemistry and laboratory medicine
2020; 58 (9): 1415-1422
Although some demographic, clinical and environmental factors have been associated with a higher risk of developing coronavirus disease 2019 (COVID-19) and progressing towards severe disease, altogether these variables do not completely account for the different clinical presentations observed in patients with comparable baseline risk, whereby some subjects may remain totally asymptomatic, whilst others develop a very aggressive illness. Some predisposing genetic backgrounds can hence potentially explain the broad inter-individual variation of disease susceptibility and/or severity. It has been now clearly established that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing COVID-19, infects the host cell through biding and being internalized with angiotensin converting enzyme 2 (ACE2), a surface protein expressed in a noticeable number of human cells, especially in those of upper and lower respiratory tracts, heart, kidney, testis, adipose tissue, gastrointestinal system and in lymphocytes. Accumulating evidence now suggests that genetic polymorphisms in the ACE2 gene may modulate intermolecular interactions with the spike protein of SARS-CoV-2 and/or contribute to pulmonary and systemic injury by fostering vasoconstriction, inflammation, oxidation and fibrosis. We hence argue that the development of genetic tests aimed at specifically identifying specific COVID-19-susceptible or -protective ACE2 variants in the general population may be a reasonable strategy for stratifying the risk of infection and/or unfavorable disease progression.
View details for DOI 10.1515/cclm-2020-0727
View details for PubMedID 32598305
- Should atrial fibrillation be considered a cardiovascular risk factor for a worse prognosis in COVID-19 patients? EUROPEAN HEART JOURNAL 2020; 41 (32): 3092-3093
Amiodarone in the COVID-19 Era: Treatment for Symptomatic Patients Only, or Drug to Prevent Infection?
American journal of cardiovascular drugs : drugs, devices, and other interventions
Amiodarone, one of the most widely prescribed antiarrhythmic drugs to treat both ventricular and supraventricular arrhythmias, has been identified as a candidate drug for use against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present the rationale of using amiodarone in the COVID-19 scenario, as well as whether or not amiodarone administration represents a potential strategy to prevent SARS-CoV-2 infection, rather than simply used to treat patients already symptomatic and/or with severe coronavirus disease 2019 (COVID-19), based on current evidence.
View details for DOI 10.1007/s40256-020-00429-7
View details for PubMedID 32737841
- Diabetes Mellitus Association with Coronavirus Disease 2019 (COVID-19) Severity and Mortality: A Pooled Analysis. Journal of diabetes 2020
- In reply-Angiotensin-Converting Enzyme 2 and the Resolution of Inflammation: In Support of Continuation of Prescribed Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers. Mayo Clinic proceedings 2020; 95 (7): 1553-1556
Obesity and Outcomes in COVID-19: When an Epidemic and Pandemic Collide
MAYO CLINIC PROCEEDINGS
2020; 95 (7): 1445-1453
Obesity has reached epidemic proportions in the United States and in much of the westernized world, contributing to considerable morbidity. Several of these obesity-related morbidities are associated with greater risk for death with coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 penetrates human cells through direct binding with angiotensin-converting enzyme 2 receptors on the cell surface. Angiotensin-converting enzyme 2 expression in adipose tissue is higher than that in lung tissue, which means that adipose tissue may be vulnerable to COVID-19 infection. Obese patients also have worse outcomes with COVID-19 infection, including respiratory failure, need for mechanical ventilation, and higher mortality. Clinicians need to be more aggressive when treating obese, especially severely obese, patients with COVID-19 infection.
View details for DOI 10.1016/j.mayocp.2020.05.006
View details for Web of Science ID 000549815300023
View details for PubMedID 32622449
View details for PubMedCentralID PMC7236707
- Active smoking and COVID-19: a double-edged sword. European journal of internal medicine 2020; 77: 123-124
- COVID-19 and obesity: links and risks. Expert review of endocrinology & metabolism 2020; 15 (4): 215-216
COVID-19: unravelling the clinical progression of nature's virtually perfect biological weapon.
Annals of translational medicine
2020; 8 (11): 693
Coronavirus disease 2019 (COVID-19) pandemic has shocked the world and caused morbidity and mortality on an unprecedented level in the era of modern medicine. Evidence generated to-date on the virulence and pathogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) suggests that COVID-19 may be considered a perfect storm, caused by a nature's virtually perfect biological weapon. This conclusion is supported by an updated analysis of pathogenesis and clinical progression of this infectious disease. It is now readily apparent that COVID-19 is not a clear-cut disorder, but is instead a gradually evolving pathology, characterized by a series of stages sustained by different molecular and biological mechanisms. The disease can hence be divided in at least five different phases (incubation, respiratory, pro-inflammatory, pro-thrombotic, and death or remission). Whilst the virus triggers direct cytopathic injury during the initial stage of illness, in the following evolving phases, it is the host itself that undergoes an almost suicidal reaction, sustained, amplified and maintained by the immune, complement and hemostatic systems. Another peculiar property making SARS-CoV-2 a devious and vicious pathogen is the biophysical structure of its receptor biding domain, which needs to be primed by human proteases, thus being less efficiently targetable by the host immune system. The unique pathophysiology of COVID-19 requires the customization of therapy by individual patient characteristics and according to the phase-specific, evolving derangement of the multiple biological pathways.
View details for DOI 10.21037/atm-20-3989
View details for PubMedID 32617313
View details for PubMedCentralID PMC7327324
Metabolic Impacts of Confinement during the COVID-19 Pandemic Due to Modified Diet and Physical Activity Habits
2020; 12 (6)
While the detrimental effects of a chronic positive energy balance due to a sedentary lifestyle have been well established, the impacts of a short period of abruptly reduced physical activity and overeating arising from strict confinement due to the COVID-19 pandemic will soon start to emerge. To reasonably anticipate major consequences according to the available evidence, we hereby review the literature for studies that have explored the health impacts of several weeks of a reduction in physical activity and daily step-count combined with modified eating habits. These studies identify as main metabolic consequences increases in insulin resistance, total body fat, abdominal fat and inflammatory cytokines. All these factors have been strongly associated with the development of metabolic syndrome, which in turn increases the risk of multiple chronic diseases. A plausible mechanism involved in these impacts could be a positive energy balance promoted by maintaining usual dietary intake while reducing energy expenditure. This means that just as calorie intake restriction could help mitigate the deleterious impacts of a bout of physical inactivity, overeating under conditions of home confinement is very likely to exacerbate these consequences. Moreover, hypertension, diabetes, and cardiovascular disease have been identified as potential risk factors for more severely ill patients with COVID-19. Thus, adequate control of metabolic disorders could be important to reduce the risk of severe COVID-19.
View details for DOI 10.3390/nu12061549
View details for Web of Science ID 000549268500001
View details for PubMedID 32466598
View details for PubMedCentralID PMC7352228
- Physical inactivity and cardiovascular disease at the time of coronavirus disease 2019 (COVID-19). European journal of preventive cardiology 2020; 27 (9): 906-908
Angiotensin-Converting Enzyme 2 and Antihypertensives (Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors) in Coronavirus Disease 2019.
Mayo Clinic proceedings
2020; 95 (6): 1222-1230
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, is being defined as the worst pandemic disease of modern times. Several professional health organizations have published position papers stating that there is no evidence to change the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in the management of elevated blood pressure in the context of avoiding or treating COVID-19 infection. In this article, we review the evidence on the relationship between the renin-angiotensin-aldosterone system and COVID-19 infection. In agreement with current guidelines, patients with hypertension should continue taking antihypertensive medications as prescribed without interruption. Because ACEIs and ARBs are also used to retard the progression of chronic kidney disease, we suggest that these recommendations also apply to the use of these agents in chronic kidney disease. No differences generally exist between ARBs and ACEIs in terms of efficacy in decreasing blood pressure and improving other outcomes, such as all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, and end-stage renal disease. The ACEIs are associated with cough secondary to accumulation of bradykinin and angioedema, and withdrawal rates due to adverse events are lower with ARBs. Given their equal efficacy but fewer adverse events, ARBs could potentially be a more favorable treatment option in patients with COVID-19 at higher risk for severe forms of disease.
View details for DOI 10.1016/j.mayocp.2020.03.026
View details for PubMedID 32376099
View details for PubMedCentralID PMC7129862
Health risks and potential remedies during prolonged lockdowns for coronavirus disease 2019 (COVID-19).
Diagnosis (Berlin, Germany)
2020; 7 (2): 85-90
As coronavirus disease 2019 (COVID-19) pandemic continues, an increasing number of countries and territories are adopting restrictive measures based on physical ("social") distancing, aimed at preventing human-to-human transmission and thereby limiting virus propagation. Nationwide lockdowns, encompassing mass quarantine under stay-at-home ordinances, have already been proven effective to contain the COVID-19 outbreak in some countries. Nevertheless, a prolonged homestay may also be associated with potential side effects, which may jeopardize people's health and thus must be recognized and mitigated in a way without violating local ordinances. Some of the most important undesirable consequences of prolonged homestay such as physical inactivity, weight gain, behavioral addiction disorders, insufficient sunlight exposure and social isolation will be critically addressed in this article, which also aims to provide some tentative recommendations for the alleviation of side effects.
View details for DOI 10.1515/dx-2020-0041
View details for PubMedID 32267243
Do Antioxidant Vitamins Prevent Exercise-Induced Muscle Damage? A Systematic Review
2020; 9 (5)
Free radicals produced during exercise play a role in modulating cell signaling pathways. High doses of antioxidants may hamper adaptations to exercise training. However, their benefits are unclear. This review aims to examine whether vitamin C (VitC) and/or vitamin E (VitE) supplementation (SUP) prevents exercise-induced muscle damage. The PubMed, Web of Science, Medline, CINAHL, and SPORTDiscus databases were searched, and 21 articles were included. Four studies examined the effects of acute VitC SUP given pre-exercise: in one study, lower CK levels post-exercise was observed; in three, no difference was recorded. In one study, acute VitE SUP reduced CK activity 1 h post-exercise in conditions of hypoxia. In three studies, chronic VitE SUP did not reduce CK activity after an exercise session. Chronic VitE SUP did not reduce creatine kinase (CK) concentrations after three strength training sessions, but it was effective after 6 days of endurance training in another study. Chronic SUP with VitC + E reduced CK activity post-exercise in two studies, but there was no such effect in four studies. Finally, three studies described the effects of chronic VitC + E SUP and long-term exercise, reporting dissimilar results. To conclude, although there is some evidence of a protective effect of VitC and/or VitE against exercise-induced muscle damage, the available data are not conclusive.
View details for DOI 10.3390/antiox9050372
View details for Web of Science ID 000539284200015
View details for PubMedID 32365669
View details for PubMedCentralID PMC7278664
Coronavirus disease 2019 (COVID-19): the portrait of a perfect storm.
Annals of translational medicine
2020; 8 (7): 497
The "novel" coronavirus disease 2019 (abbreviated "COVID-19") is the third coronavirus outbreak emerging during the past two decades. This infectious disease, sustained by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has been recently declared a global pandemic by the World Health Organization. Despite the concerning epidemiological burden, many people, including some policymakers, are underestimating this pandemic and are remaining enigmatically inactive against a human pathology which, for a combination of reasons, can be reasonably defined as a perfect storm (i.e., the "wrong virus" at the "wrong time"). These many paradigmatic aspects include SARS-CoV-2 structure and peculiar biology of infection, high risk of inter-human transmission, long incubation time combined with early and sustained viral load, existence of asymptomatic or mildly-symptomatic carriers, viral shedding for days after symptom relief, unfavorable progression towards respiratory distress and death in up to 5-10% of patients thus causing dramatic healthcare challenges, as well as environmental contamination. Last but not least, the combination of the current case fatality rate with the extraordinary number of people that could be potentially infected by SARS-CoV-2 would permit to estimate that the worldwide deaths for COVID-19 may even approximate those recorded during World War II if appropriate restrictive measures for preventing human-to-human transmission are not readily undertaken. Everybody should be inexcusably aware that this is not a drill, and that the consequences of inadequate action will be tragedy.
View details for DOI 10.21037/atm.2020.03.157
View details for PubMedID 32395541
View details for PubMedCentralID PMC7210187
- Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis. Progress in cardiovascular diseases 2020; 63 (3): 390-391
Exercise-induced right ventricular injury or arrhythmogenic cardiomyopathy (ACM): The bright side and the dark side of the moon.
Progress in cardiovascular diseases
There is still debate on the range of normal physiologic changes of the right ventricle or ventricular (RV) function in athletes. Genetic links to arrhythmogenic cardiomyopathy (ACM) are well-established. There is no current consensus on the importance of extensive exercise and exercise-induced injury to the RV. During the intensive exercise of endurance sports, the cardiac structures adapt to athletic load over time. Some athletes develop RV cardiomyopathy possibly caused by genetic predisposition, whilst others develop arrhythmias from the RV. Endurance sports lead to increased volume and pressure load in both ventricles and increased myocardial mass. The extent of volume increase and changes in myocardial structure contribute to impairment of RV function and pose a challenge in cardiovascular sports medicine. Genetic predisposition to ACM may play an important role in the risk of sudden cardiac death of athletes. In this review, we discuss and evaluate existing results and opinions. Intensive training in competitive dynamic/power and endurance sports leads to specific RV adaptation, but physiological adaptation without genetic predisposition does not necessarily lead to severe complications in endurance sports. Discriminating between physiological adaptation and pathological form of ACM or RV impairment provoked by reinforced exercise presents a challenge to clinical sports cardiologists.
View details for DOI 10.1016/j.pcad.2020.03.015
View details for PubMedID 32224113
Sex-Specific Ventricular Arrhythmias and Mortality in Cardiac Resynchronization Therapy Recipients.
JACC. Clinical electrophysiology
The study goal was to examine whether there are sex-related differences in the incidence of ventricular arrhythmias and mortality in CRT-defibrillator (CRT-D) recipients.Few studies have evaluated sex-related benefits of cardiac resynchronization therapy (CRT). Moreover, data on sex-related differences in the occurrence of ventricular tachyarrhythmias in this population are limited.A multicenter retrospective study was conducted in 460 patients (355 male subjects and 105 female subjects) from the UMBRELLA (Incidence of Arrhythmia in Spanish Population With a Medtronic Implantable Cardiac Defibrillator Implant) national registry. Patients were followed up through remote monitoring after the first implantation of a CRT-D during a median follow-up of 2.2 ± 1.0 years. Sex differences were analyzed in terms of ventricular arrhythmia-treated incidence and death during the follow-up period, with a particular focus on primary prevention patients.Baseline New York Heart Association functional class was worse in women compared with that in men (67.0% of women in New York Heart Association functional class III vs. 49.7% of men; p = 0.003), whereas women had less ischemic cardiac disease (20.8% vs. 41.7%; p < 0.001). Female sex was an independent predictor of ventricular arrhythmias (hazard ratio: 0.40; 95% confidence interval: 0.19 to 0.86; p = 0.020), as well as left ventricular ejection fraction and nonischemic cardiomyopathy. Mortality in women was one-half that of men, although events were scarce and without significant differences (2.9% vs. 5.6%; p = 0.25).Women with left bundle branch block and implanted CRT have a lower rate of ventricular tachyarrhythmias than men. All-cause mortality in patients is, at least, similar between female and male subjects.
View details for DOI 10.1016/j.jacep.2020.10.009
View details for PubMedID 33358670