RESUMEN

BACKGROUND: High body mass index (BMI) is a risk factor for type 2 diabetes and cardiovascular disease. However, its relationships with indices of carotid stiffness and plaque volume are unclear. We investigated associations of long-term measurements of BMI with indices of carotid stiffness and atherosclerosis among non-demented diabetes patients from the Israel Diabetes and Cognitive Decline (IDCD) study. METHODS: Carotid ultrasound indices [carotid intima media thickness (cIMT), distensibility, elastography and plaque volume] were assessed in N = 471 participants. Mean BMI across all MHS diabetes registry measurements and trajectories of BMI were calculated. BMI was categorized into three trajectory groups representing: a relatively stable normal weight (n = 185, 44%), overweight trajectory (n = 188, 44.8%) and a trajectory of obesity (n = 47, 11.2%). Linear and logistic regressions estimated associations of carotid indices with mean BMI and BMI trajectories. RESULTS: Compared to the normal weight trajectory, an obesity trajectory was associated with carotid distensibility (ß = - 3.078, p = 0.037), cIMT (ß = 0.095, p = 0.004), and carotid elastography (ß = 0.181, p = 0.004) but not with plaque volume (ß = 0.066, p = 0.858). Compared with the normal weight trajectory, an obesity trajectory was associated with increased odds for impaired carotid distensibility (OR = 2.790, p = 0.033), impaired cIMT (OR = 5.277, p = 0.001) and large carotid plaque volume (OR = 8.456, p = 0.013) but not with carotid elastography (OR = 1.956, p = 0.140). Mean BMI was linearly associated with Distensibility (ß = - 0.275, p = 0.005) and cIMT (ß = 0.005, p = 0.026). CONCLUSIONS: Long-term measurements of adiposity are associated with indices of carotid stiffness and plaque volume among older type 2 diabetes adults.

Asunto(s)

Trayectoria del Peso Corporal , Arterias Carótidas/fisiopatología , Enfermedades de las Arterias Carótidas/fisiopatología , Diabetes Mellitus Tipo 2/fisiopatología , Obesidad/fisiopatología , Placa Aterosclerótica/diagnóstico por imagen , Rigidez Vascular/fisiología , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/complicaciones , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Estudios de Cohortes , Diabetes Mellitus Tipo 2/complicaciones , Diagnóstico por Imagen de Elasticidad , Femenino , Humanos , Imagenología Tridimensional , Modelos Lineales , Modelos Logísticos , Masculino , Obesidad/complicaciones , Placa Aterosclerótica/complicaciones

RESUMEN

BackgroundSince December 2019, Coronavirus Disease 2019 (COVID-19) has become a global pandemic, causing mass morbidity and mortality. Prior studies in other respiratory infections suggest that convalescent plasma transfusion may offer benefit to some patients. Here, the outcomes of thirty-nine hospitalized patients with severe to life-threatening COVID-19 who received convalescent plasma transfusion were compared against a cohort of retrospectively matched controls. MethodsPlasma recipients were selected based on supplemental oxygen needs at the time of enrollment and the time elapsed since the onset of symptoms. Recipients were transfused with convalescent plasma from donors with a SARS-CoV-2 (severe acute respiratory disease coronavirus 2) anti-spike antibody titer of 31:320 dilution. Matched control patients were retrospectively identified within the electronic health record database. Supplemental oxygen requirements and survival were compared between plasma recipients and controls. ResultsConvalescent plasma recipients were more likely than control patients to remain the same or have improvements in their supplemental oxygen requirements by post-transfusion day 14, with an odds ratio of 0.86 (95% CI: 0.75[~]0.98; p = 0.028). Plasma recipients also demonstrated improved survival, compared to control patients (log-rank test: p = 0.039). In a covariates-adjusted Cox model, convalescent plasma transfusion improved survival for non-intubated patients (hazard ratio 0.19 (95% CI: 0.05 [~]0.72); p = 0.015), but not for intubated patients (1.24 (0.33[~]4.67); p = 0.752). ConclusionsConvalescent plasma transfusion is a potentially efficacious treatment option for patients hospitalized with COVID-19; however, these data suggest that non-intubated patients may benefit more than those requiring mechanical ventilation.