https://doi.org/10.1016/j.jacc.2022.02.003

2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play

Abstract Emerging as a new epidemic, long COVID or post-acute sequelae of coronavirus disease 2019 (COVID-19), a condition characterized by the persistence of COVID-19 symptoms beyond 3 months, is anticipated to substantially alter the lives of millions of people globally. Cardiopulmonary symptoms including chest pain, shortness of breath, fatigue, and autonomic manifestations such as postural orthostatic tachycardia are common and associated with significant disability, heightened anxiety, and public awareness. A range of cardiovascular (CV) abnormalities has been reported among patients beyond the acute phase and include myocardial inflammation, myocardial infarction, right ventricular dysfunction, and arrhythmias. Pathophysiological mechanisms for delayed complications are still poorly understood, with a dissociation seen between ongoing symptoms and objective measures of cardiopulmonary health. COVID-19 is anticipated to alter the long-term trajectory of many chronic cardiac diseases which are abundant in those at risk of severe disease. In this review, we discuss the definition of long COVID and its epidemiology, with an emphasis on cardiopulmonary symptoms. We further review the pathophysiological mechanisms underlying acute and chronic CV injury, the range of post-acute CV sequelae, and impact of COVID-19 on multiorgan health. We propose a possible model for referral of post-COVID-19 patients to cardiac services and discuss future directions including research priorities and clinical trials that are currently underway to evaluate the efficacy of treatment strategies for long COVID and associated CV sequelae.

https://academic.oup.com/eurheartj/advance-article-pdf/doi/10.1093/eurheartj/ehac031/42541089/ehac031.pdf

Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus

Role of polyphenols in combating Type 2 Diabetes and insulin resistance.

Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review.

Received 20th January 2021. Revised 26th January 2021. Accepted 26th January 2021. Journal Pre-proof online 1st February 2021.

Persisting Adverse Ventricular Remodeling in COVID-19 Survivors: A Longitudinal Echocardiographic Study.

Echocardiographic Comparison of COVID-19 Patients with or without Prior Biochemical Evidence of Cardiac Injury after Recovery.

Hypertension and type 2 diabetes (T2D) are closely associated with each other, but whether a direct causal effect links the two conditions is unclear. A recent Mendelian randomization (MR) analysis on over 300,000 subjects free of cardiovascular disease has provided some evidence. While T2D is causal for hypertension development, the same is not proven for the reversed relationship. Further studies should disentangle the complex network of molecular pathways that link hypertension and T2D. Specific targets with causal relevance to preventing the codevelopment of the two conditions are needed, and hyperinsulinemia might be a good candidate. According to the World Health Organization, after obesity, arterial hypertension and T2D are the two cardiovascular risk factors most prevalent in the global population. This is remarkable because both diseases are responsible for the high number of cardiovascular events and deaths worldwide [1]. In the last 30 years, the prevalence of hypertension has decreased to one-fourth of the global population [2], but that of diabetes has continued to increase from 4.7 to 8.5%, and a projection for the future shows another dramatic increment [3]. Improving awareness, treatment, and control of these diseases is a major goal of the global health system. Despite their single roles as independent cardiovascular risk factors, hypertension and T2D often coexist in the same patient. This coexistence multiplies the patient’s risk of experiencing major acute cardiovascular events and accelerates the development of chronic heart and kidney failure [4]. Authors have analyzed the simultaneous presence of hypertension and T2D in Western countries and in Japan. It emerged that 20% of patients with hypertension had T2D and 50% of patients with T2D had hypertension. Having one of the two conditions increases the risk of developing the other by 1.5–2.0 times [5]. However, which condition develops first, increasing the risk of developing the other, remains unclear. Prospective studies have documented a potential reciprocal relationship between hypertension and T2D in which they elicit each other. Nondiabetic hypertensive patients have a high prevalence of prediabetes [6], and the incidence of T2D in the general population is high as baseline blood pressure values are generally elevated [7]. A meta-analysis of 30 prospective studies confirmed that each 20 mmHg increment of systolic blood pressure increased the risk of new-onset T2D by 77% [7]. Other studies analyzed risk factors for developing T2D in patients with hypertension. In these studies, fasting plasma glucose, body mass index, and the class of antihypertensive drugs used were independent determinants of T2D [8]. T2D can also be a risk factor for developing hypertension. In the Multi-Ethnic Study of Atherosclerosis, baseline T2D, high fasting glucose levels, and high insulin levels were independent risk factors for hypertension [9]. Although hypertension and T2D conditions influence each other reciprocally, the nature of this relationship remains to be defined. Hypertension and T2D share several pathophysiological mechanisms that justify their coexistence. Insulin resistance, hyperinsulinemia, increased oxidative stress, and subclinical chronic inflammation are the most studied mechanisms. Hyperinsulinemia is induced by insulin resistance and predicts hypertension development in normotensive nondiabetic patients [10]. Hyperinsulinemia causes arterial remodeling and arterial stiffness, increases sympathetic nervous activity, enhances the renin-angiotensin-aldosterone system, and stimulates renal sodium reabsorption [11]. In addition, excessive oxidative stress and inflammation are determinants of endothelial dysfunction, impaired vascular reactivity, increased peripheral vascular resistance, and abnormal glucose and lipid metabolism. All mechanisms that lead to increased levels of blood pressure and plasma glucose by changing hemodynamic and glycolipid metabolism [12]. * GianLuca Colussi gianluca.colussi@uniud.it

/pdf/hypertension-and-type-2-diabetes-lights-and-shadows-about-3kaz43cezp.pdf

Hypertension and type 2 diabetes: lights and shadows about causality

COVID-19 has caused considerable morbidity and mortality worldwide and cardiac involvement has been reported during infection. The short-term cardiac outcome in survivors of COVID-19 is not known. To examine the heart of patients who survived COVID-19 and to compare the cardiac outcome between patients who recovered from mild-to-moderate or severe illness. With use of ECG and echocardiography, we examined the heart of 105 patients who had been hospitalized with COVID-19 and were consecutively recruited after hospital discharge while attending follow-up visits. Survivors of COVID-19 were compared with 105 matched controls. We also compared the cardiac outcome and lung ultrasound scan between COVID-19 patients who had mild-to-moderate or severe illness. Cardiac data were collected a median of 41 days from the first detection of COVID-19. Symptoms were present in a low percentage of patients. In comparison with matched controls, no considerable structural or functional differences were observed in the heart of survivors of COVID-19. Lung ultrasound scan detected significantly greater residual pulmonary involvement in COVID-19 patients who had recovered from severe than mild-to-moderate illness. No significant differences were detected in ECG tracings nor were found in the left and right ventricular function of patients who had recovered from mild-to-moderate or severe illness. In a short-term follow-up, no abnormalities were identified in the heart of survivors of COVID-19, nor cardiac differences were detected between patients who had different severity of illness. With the limitations of a cross-sectional study, these findings suggest that patients who recover from COVID-19 do not have considerable cardiac sequelae.

/pdf/short-term-cardiac-outcome-in-survivors-of-covid-19-a-1ucte3a13g.pdf

Short-term cardiac outcome in survivors of COVID-19: a systematic study after hospital discharge.

Type 2 diabetes is an increasing health concern worldwide. Both genetic and environmental risk factors as improper dietary habits or physical inactivity are known to be crucial in the pathogenesis of type 2 diabetes. Polyphenols are a group of plant-derived compounds with anti-inflammatory and antioxidant properties that are associated with a low prevalence of metabolic conditions characterized by insulin resistance, including obesity, diabetes, and hypertension. Moreover, there is now full awareness that foods that are rich in phytochemicals and polyphenols could play an important role in preserving human cardiovascular health and substantial clinical evidence indicates that regular dietary consumption of such foods affects favorably carbohydrate metabolism. This review briefly summarizes the evidence relating dietary patterns rich in polyphenols with glucose metabolism and highlights the potential benefits of these compounds in the prevention of type 2 diabetes.

Polyphenols Rich Diets and Risk of Type 2 Diabetes

Aims Binge eating disorder (BED) is the most common eating disorder in the United States and Europe and is associated with obesity and type 2 diabetes (T2D). Presence and severity of BED have been associated with worse metabolic control and greater BMI in T2D patients. Glucagon Like Peptide-1 (GLP1) receptors are present in central nervous system areas involved in appetite regulation and treatment with GLP-1 receptor agonists modulates appetite and reward-related brain areas in humans. We evaluated the effects of treatment with dulaglutide on eating behavior in T2D outpatients with BED. Methods This was a pilot open label, prospective controlled study. Inclusion criteria were: Age ≤65, HbA1c between 7.5 and 9% on metformin therapy alone, normal renal function and diagnosis of BED. Patients were randomly assigned to receive either Dulaglutide 1,5 mg/sett or Gliclazide 60 mg for 12 weeks. We evaluated baseline binge eating scale score (BES), weight, BMI, percentage fat mass, HbA1c and their changes after treatment. A multivariate linear regression model was used to verify the association between Δ BES from baseline with Δ Hba1c and variation of anthropometric parameters after treatment. Results After 12 weeks patients treated with dulaglutide had grater reduction of binge eating behaviour (p  Conclusion Dulaglutide treatment reduces binge eating behaviour in T2D patients with BED.

Andrea Da Porto

Papers

Echocardiographic Comparison of COVID-19 Patients with or without Prior Biochemical Evidence of Cardiac Injury after Recovery.

Hypertension and type 2 diabetes: lights and shadows about causality

Short-term cardiac outcome in survivors of COVID-19: a systematic study after hospital discharge.

Polyphenols Rich Diets and Risk of Type 2 Diabetes

Dulaglutide reduces binge episodes in type 2 diabetic patients with binge eating disorder: A pilot study