BACKGROUND
The efficacy of simvastatin in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear.


METHODS
In an ongoing international, multifactorial, adaptive platform, randomized, controlled trial, we evaluated simvastatin (80 mg daily) as compared with no statin (control) in critically ill patients with Covid-19 who were not receiving statins at baseline. The primary outcome was respiratory and cardiovascular organ support-free days, assessed on an ordinal scale combining in-hospital death (assigned a value of -1) and days free of organ support through day 21 in survivors; the analyis used a Bayesian hierarchical ordinal model. The adaptive design included prespecified statistical stopping criteria for superiority (>99% posterior probability that the odds ratio was >1) and futility (>95% posterior probability that the odds ratio was <1.2).


RESULTS
Enrollment began on October 28, 2020. On January 8, 2023, enrollment was closed on the basis of a low anticipated likelihood that prespecified stopping criteria would be met as Covid-19 cases decreased. The final analysis included 2684 critically ill patients. The median number of organ support-free days was 11 (interquartile range, -1 to 17) in the simvastatin group and 7 (interquartile range, -1 to 16) in the control group; the posterior median adjusted odds ratio was 1.15 (95% credible interval, 0.98 to 1.34) for simvastatin as compared with control, yielding a 95.9% posterior probability of superiority. At 90 days, the hazard ratio for survival was 1.12 (95% credible interval, 0.95 to 1.32), yielding a 91.9% posterior probability of superiority of simvastatin. The results of secondary analyses were consistent with those of the primary analysis. Serious adverse events, such as elevated levels of liver enzymes and creatine kinase, were reported more frequently with simvastatin than with control.


CONCLUSIONS
Although recruitment was stopped because cases had decreased, among critically ill patients with Covid-19, simvastatin did not meet the prespecified criteria for superiority to control. (REMAP-CAP ClinicalTrials.gov number, NCT02735707.).

Simvastatin in Critically Ill Patients with Covid-19.

http://www.ijidonline.com/article/S1201971222003484/pdf

Benefits of plasma exchange on mortality in patients with COVID-19: a systematic review and meta-analysis

RATIONALE
Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular (CV) morbidity and mortality, but the benefit of continuous positive airway pressure (CPAP) is uncertain. However, most randomized-controlled trials have focused on the role of CPAP in secondary prevention although there is growing evidence of a potential benefit on early CV disease. Weight loss in combination with CPAP may be superior but is difficult to achieve and maintain with conventional measures alone.


OBJECTIVE
Aim of this study was to gain insights into the effect of CPAP on early atherosclerotic processes and to compare it to a glucagon-like-peptide (GLP)-1-mediated weight loss regimen in OSA.


METHODS
We performed a randomized proof-of-concept study comparing CPAP, a GLP-1-mediated weight loss regimen (Liraglutide [Lir]) and both in combination for 24 weeks in 30 consecutive patients with OSA (apnea-hypopnea index [AHI] >15/hr, body-mass index [BMI] 30-40 kg/m2, without history of diabetes, heart failure or unstable CV disease). Beside extensive evaluation for CV risk factors and endothelial function at baseline and end of study, subjects underwent FDG-PET-CT for measurement of aortic wall inflammation (target-to-background ratio [TBR]) and coronary CT angiography (CCTA) for semi-automated coronary plaque analysis.


RESULTS
Baseline characteristics were similar between groups. CPAP alone and in combination resulted in greater reduction in AHI than Lir alone (mean difference -45/hr and -43/hr, respectively, vs -12/hr, p<0.05). Both Lir and combination treatment led to significant weight loss but only CPAP alone resulted in significant decrease in vascular inflammation (aortic wall TBR from 2.03±0.34 to 1.84±0.43, p 0.010) associated with improvement in endothelial function and decrease in C-reactive protein. Low-attenuation coronary artery plaque volume as marker of unstable plaque also decreased with CPAP (from 571±490 to 334±185mm3) and with combination therapy (from 401±145 to 278±126mm3) but not with Lir.


CONCLUSIONS
These data suggest that CPAP therapy, but not GLP-1 mediated weight loss, improves vascular inflammation and reduces unstable plaque volume in OSA patients. Further large randomized-controlled study are warrant to assess the benefit of CPAP therapy in modifying early CV disease.


CLINICAL TRIALS
gov: NCT04186494 Primary Source of Funding: Health Research Board (HRB) of Ireland.

CPAP but Not GLP1-mediated Weight Loss Improves Early Cardiovascular Disease in Obstructive Sleep Apnea: A Randomized Proof-of-Concept Study.

This review centres around the recent evidence in examining the intersection of sleep and cardiovascular disease (CVD). Sleep in this review will be further subdivided to consider both sleep quantity and quality along and will also consider some of the more common sleep disorders, such as insomnia and obstructive sleep apnoea, in the context of CVD. Sleep disorders have been further explored in several specific populations which are both at risk of sleep disorders and CVD. Secondly, the review will present some of the risk factors for CVD that are affected by sleep and sleep disorders which include hypertension, diabetes, and obesity. It will also examine the potential underlying mechanisms including inflammation, appetite control, endocrine, and genetic processes that are affected by sleep and sleep disorders leading to increased risk of CVD development. In addition, we will consider the observed bi-directional relationships between sleep and cardiovascular risk factors. For example, obesity, a risk factor for CVD can be affected by sleep, but in turn can increase the risk of certain sleep disorder development which disrupts sleep, leading to further risk of obesity development and increased CVD risk. Finally, the review will explore emerging evidence around lifestyle interventions that have included a sleep component and how it impacts the management of CVD risk factor. The need for increased awareness of the health effects of poor sleep and sleep disorders will be discussed alongside the need for policy intervention to improve sleep to facilitate better health and well-being.

Sleep and cardiovascular disease.

This systematic review and meta‐analysis aimed to determine the efficacy of statins in hospitalized patients with coronavirus disease‐2019 (COVID‐19). A systematic search was made of PubMed, Embase, Cochrane Library, and clinicaltrials.gov, without language restrictions. Randomized controlled trials (RCTs) on treatment of COVID‐19 with statins, compared with placebo or standard of care, were reviewed. Seven RCTs (enrolling 1830 participants) met the inclusion criteria. There was no statistically significant difference in all‐cause mortality (risk ratio [RR]: 0.92, 95% confidence interval [CI]: 0.75–1.13), length of hospital stay (weighted mean difference: −0.21 days, 95% CI: −1.01 to 0.59 days), intensive care unit (ICU) admission (RR: 1.84, 95% CI: 0.45–7.55), and mechanical ventilation (RR: 1.09, 95% CI: 0.70–1.70) between the two groups. Statins failed to reduce mortality, ICU admission, mechanical ventilation, and length of stay in hospitalized patients with COVID‐19. Statins probably should not be used routinely in COVID‐19 patients.

Statins in hospitalized COVID‐19 patients: A systematic review and meta‐analysis of randomized controlled trials

Benefits of continuous positive airway pressure on blood pressure in patients with hypertension and obstructive sleep apnea: a meta-analysis

The safety of long-term use of inhaled corticosteroids in patients with asthma: A systematic review and meta-analysis.

Selexipag in patients with pulmonary hypertension: a systematic review and meta-analysis of randomized controlled trials.

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Dong-Chul Han

Author Tools

Chat about Author