COVID-19 Outcomes Stratified by Control Status of Hypertension and Diabetes: Preliminary Findings From PCORnet, U.S.

Jackson, Sandra; Block, Jason P.; Rolka, Deborah B.; Pavkov, Meda E.; Chevinsky, Jennifer; Lekiachvili, Akaki; Carton, Thomas; Thacker, Deepika; Denson, Joshua L.; Paranjape, Anuradha; Kappelman, Michael D.; Boehmer, Tegan K.; Twentyman, Evelyn

doi:10.1016/j.focus.2022.100012

Cited by 2 publications

(2 citation statements)

References 15 publications

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“…For example, acute encephalopathy has been linked with severe cases of COVID-19, which was attributed to COVID-19-induced hypoxic brain damage [9]. Another predictor of COVID-19 outcomes was also attributed to the presence of other cardiovascular comorbidities, such as hypertension and diabetes [18][19][20][21][22]. In particular, diabetic populations are among the top comorbidities that lead to poor outcomes of COVID-19 [23,24].…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Spike Protein Intensifies Cerebrovascular Complications in Diabetic hACE2 Mice through RAAS and TLR Signaling Activation

Burnett,

Coucha,

Bolduc

et al. 2023

IJMS

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Diabetics are more vulnerable to SARS-CoV-2 neurological manifestations. The molecular mechanisms of SARS-CoV-2-induced cerebrovascular dysfunction in diabetes are unclear. We hypothesize that SARS-CoV-2 exacerbates diabetes-induced cerebrovascular oxidative stress and inflammation via activation of the destructive arm of the renin–angiotensin-aldosterone system (RAAS) and Toll-like receptor (TLR) signaling. SARS-CoV-2 spike protein was injected in humanized ACE2 transgenic knock-in mice. Cognitive functions, cerebral blood flow, cerebrovascular architecture, RAAS, and TLR signaling were used to determine the effect of SARS-CoV-2 spike protein in diabetes. Studies were mirrored in vitro using human brain microvascular endothelial cells treated with high glucose-conditioned media to mimic diabetic conditions. Spike protein exacerbated diabetes-induced cerebrovascular oxidative stress, inflammation, and endothelial cell death resulting in an increase in vascular rarefaction and diminished cerebral blood flow. SARS-CoV-2 spike protein worsened cognitive dysfunction in diabetes compared to control mice. Spike protein enhanced the destructive RAAS arm at the expense of the RAAS protective arm. In parallel, spike protein significantly exacerbated TLR signaling in diabetes, aggravating inflammation and cellular apoptosis vicious circle. Our study illustrated that SAR-CoV-2 spike protein intensified RAAS and TLR signaling in diabetes, increasing cerebrovascular damage and cognitive dysfunction.

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Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Spike Protein Intensifies Cerebrovascular Complications in Diabetic hACE2 Mice through RAAS and TLR Signaling Activation

Burnett,

Coucha,

Bolduc

et al. 2023

IJMS

View full text Add to dashboard Cite

show abstract

“… 10 , 11 , 12 A prior study described greater prevalence of severe COVID‐19 outcomes across higher strata of BP and HbA1c; however, these results did not account for differences in demographic and clinical characteristics across patient populations by BP or HbA1c level. 13 In this study, we build on these previous descriptive analyses by assessing the independent association between hypertension control and diabetes control and severe COVID‐19 outcomes among a large multisite US cohort of adults with COVID‐19 from March 2020 to February 2022. We hypothesized that patients with hypertension who had the highest preinfection BP levels and patients with diabetes who had the highest preinfection HbA1c levels would have greater odds of severe COVID‐19 outcomes relative to those with the lowest respective levels, after adjusting for demographic and clinical characteristics.…”

mentioning

confidence: 99%

Association Between Hypertension and Diabetes Control and COVID‐19 Severity: National Patient‐Centered Clinical Research Network, United States, March 2020 to February 2022

Jackson,

Woodruff,

Nagavedu

et al. 2023

JAHA

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Background Hypertension and diabetes are associated with increased COVID‐19 severity. The association between level of control of these conditions and COVID‐19 severity is less well understood. Methods and Results This retrospective cohort study identified adults with COVID‐19, March 2020 to February 2022, in 43 US health systems in the National Patient‐Centered Clinical Research Network. Hypertension control was categorized as blood pressure (BP) <130/80, 130 to 139/80 to 89, 140 to 159/90 to 99, or ≥160/100 mm Hg, and diabetes control as glycated hemoglobin <7%, 7% to <9%, ≥9%. Adjusted, pooled logistic regression assessed associations between hypertension and diabetes control and severe COVID‐19 outcomes. Among 1 494 837 adults with COVID‐19, 43% had hypertension and 12% had diabetes. Among patients with hypertension, the highest baseline BP was associated with greater odds of hospitalization (adjusted odds ratio [aOR], 1.30 [95% CI, 1.23–1.37] for BP ≥160/100 versus BP <130/80), critical care (aOR, 1.30 [95% CI, 1.21–1.40]), and mechanical ventilation (aOR, 1.32 [95% CI, 1.17–1.50]) but not mortality (aOR, 1.08 [95% CI, 0.98–1.12]). Among patients with diabetes, the highest glycated hemoglobin was associated with greater odds of hospitalization (aOR, 1.61 [95% CI, 1.47–1.76] for glycated hemoglobin ≥9% versus <7%), critical care (aOR, 1.42 [95% CI, 1.31–1.54]), mechanical ventilation (aOR, 1.12 [95% CI, 1.02–1.23]), and mortality (aOR, 1.18 [95% CI, 1.09–1.27]). Black and Hispanic adults were more likely than White adults to experience severe COVID‐19 outcomes, independent of comorbidity score and control of hypertension or diabetes. Conclusions Among 1.5 million patients with COVID‐19, higher BP and glycated hemoglobin were associated with more severe COVID‐19 outcomes. Findings suggest that adults with poorest control of hypertension or diabetes might benefit from efforts to prevent and initiate early treatment of COVID‐19.

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COVID-19 Outcomes Stratified by Control Status of Hypertension and Diabetes: Preliminary Findings From PCORnet, U.S.

Cited by 2 publications

References 15 publications

SARS-CoV-2 Spike Protein Intensifies Cerebrovascular Complications in Diabetic hACE2 Mice through RAAS and TLR Signaling Activation

SARS-CoV-2 Spike Protein Intensifies Cerebrovascular Complications in Diabetic hACE2 Mice through RAAS and TLR Signaling Activation

Association Between Hypertension and Diabetes Control and COVID‐19 Severity: National Patient‐Centered Clinical Research Network, United States, March 2020 to February 2022

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