Aims: Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been... Show moreAims: Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19. Methods and results: A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19. Conclusion: This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities. Show less
Aims: Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been... Show moreAims: Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular disease (CVD) in association with COVID-19. Methods and results: A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, reported here, focuses on the epidemiology, pathophysiology, and diagnosis of cardiovascular (CV) conditions that may be manifest in patients with COVID-19. The second part, which will follow in a later edition of the journal, addresses the topics of care pathways, treatment, and follow-up of CV conditions in patients with COVID-19. Conclusion: This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities. Show less
Aims: Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been... Show moreAims: Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular disease (CVD) in association with COVID-19. Methods and results: A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, reported here, focuses on the epidemiology, pathophysiology, and diagnosis of cardiovascular (CV) conditions that may be manifest in patients with COVID-19. The second part, which will follow in a later edition of the journal, addresses the topics of care pathways, treatment, and follow-up of CV conditions in patients with COVID-19. Conclusion: This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities. Show less
Aims: Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been... Show moreAims: Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19. Methods and results: A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19. Conclusion: This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities. Show less
Mach, F.; Baigent, C.; Catapano, A.L.; Koskinas, K.C.; Casula, M.; Badimon, L.; ... ; ESC Comm Practice Guidelines CPG 2020
Background Lowering of LDL cholesterol with standard statin regimens reduces the risk of occlusive vascular events in a wide range of individuals We aimed to assess the safety and efficacy of more... Show moreBackground Lowering of LDL cholesterol with standard statin regimens reduces the risk of occlusive vascular events in a wide range of individuals We aimed to assess the safety and efficacy of more intensive lowering of LDL cholesterol with statin therapy Methods We undertook meta analyses of individual participant data from randomised trials involving at least 1000 participants and at least 2 years' treatment duration of more versus less intensive statin regimens (five trials 39 612 individuals, median follow up 5 1 years) and of statin versus control (21 trials 129 526 individuals, median follow up 4 8 years) For each type of trial we calculated not only the average risk reduction, but also the average risk reduction per 1 0 mmol/L LDL cholesterol reduction at 1 year after randomisation Findings In the trials of more versus less intensive statin therapy the weighted mean further reduction in LDL cholesterol at 1 year was 0 51 mmol/L Compared with less intensive regimens more intensive regimens produced a highly significant 15% (95% CI 11-18, p<0 0001) further reduction in major vascular events consisting of separately significant reductions in coronary death or non fatal myocardial infarction of 13% (95% CI 7-19, p<0 0001) in coronary revasculansation of 19% (95% CI 15-24, p<0 0001) and in ischaemic stroke of 16% (95% CI 5-26 p=0 005) Per 1 0 mmol/L reduction in LDL cholesterol these further reductions in risk were similar to the proportional reductions in the trials of statin versus control When both types of trial were combined similar proportional reductions in major vascular events per 1 0 mmol/L LDL cholesterol reduction were found in all types of patient studied (rate ratio [RR] 0 78 95% CI 0 76-0 80 p<0 0001) including those with LDL cholesterol lower than 2 mmol/L on the less intensive or control regimen Across all 26 trials, all cause mortality was reduced by 10% per 1 0 mmol/L LDL reduction (RR 0 90, 95% CI 0 87-0 93, p<0 0001), largely reflecting significant reductions in deaths due to coronary heart disease (RR 0 80, 99% CI 0 74-0 87 p<0 0001) and other cardiac causes (RR 0 89 99% CI 0 81-0 98 p=0 002) with no significant effect on deaths due to stroke (RR 0 96 95% CI 0 84-1 09, p=0 5) or other vascular causes (RR 0 98, 99% CI 0 81-1 18, p=0 8) No significant effects were observed on deaths due to cancer or other non vascular causes (RR 0 97 95% CI 0 92-1 03, p=0 3) or on cancer incidence (RR 1 00, 95% CI 0 96-1 04, p=0 9), even at low LDL cholesterol concentrations Interpretation Further reductions in LDL cholesterol safely produce definite further reductions in the incidence of heart attack, of revasculansation and of ischaemic stroke, with each 1 0 mmol/L reduction reducing the annual rate of these major vascular events by just over a fifth There was no evidence of any threshold within the cholesterol range studied suggesting that reduction of LDL cholesterol by 2-3 mmol/L would reduce risk by about 40-50% Show less
