This finding suggests that vascular dysfunction may play a role in the pathogenesis of cognitive impairment and underlines the lack of therapeutic strategies targeted to such dysfunctions.

Background: The clinical course of COVID-19 is more severe in elderly patients with cardio-metabolic co-morbidities. Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death in a sample of consecutive COVID-19 hospitalized patients. Methods: We retrospectively evaluated clinical records of a consecutive sample of hospitalized COVID-19 patients. A total of 231 patients were considered for statistical analysis. The whole sample was divided in two groups on the basis of eGFR value, e.g., ≥ or <60 mL/min/1.73 m2. Patients with low eGFR were further divided among those with a history of chronic kidney disease (CKD) and those without (AKI, acute kidney injury). The primary outcome was a composite of admission to ICU or death, whichever occurred first. The single components were secondary outcomes. Results: Seventy-nine (34.2%) patients reached the composite outcome. A total of 64 patients (27.7%) died during hospitalization, and 41 (17.7%) were admitted to the ICU. A significantly higher number of events was present among patients with low eGFR (p < 0.0001). Age (p < 0.001), SpO2 (p < 0.001), previous anti-platelet treatment (p = 0.006), Charlson’s Comorbidities Index (p < 0.001), serum creatinine (p < 0.001), eGFR (p = 0.003), low eGFR (p < 0.001), blood glucose levels (p < 0.001), and LDH (p = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95% CI 1.02–2.63, p = 0.040) and age (HR per 5 years 1.22, 95% CI 1.10–1.36, p < 0.001) were significantly and independently associated with the main outcome in the multivariate model. Patients with AKI showed an increased hazard ratio to reach the combined outcome (p = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (p < 0.001). Conclusions: Patients with reduced eGFR at admission should be considered at high risk for clinical deterioration and death, requiring the best supportive treatment in order to prevent the worst outcome.

This study was carried out to assess whether endothelial dysfunction, evaluated by flow-mediated dilation (FMD), is related to the occurrence of the Metabolic Syndrome (MetS) in old age. Eighty patients (25 men and 55 women), mean age 74.1±7.4 years (range 65-99 yrs) were studied. Information on all subjects, medical history and regular medications was obtained. Subjects underwent a clinical examination and laboratory tests. The presence of MetS was evaluated according to the revised NCEP-ATP III criteria. An ultrasound vascular examination (US) of the carotid and brachial arteries was performed in all patients. Intima-media thickness (IMT), presence of plaques (PL), endothelium-dependent (EDV) and -independent vasodilation (EIDV) were also evaluated. Patients were divided into two groups according to the presence/absence of MetS. Significant differences were found between MetS and non MetS patients in: EDV (p<0.01), EIDV (p<0.05) and Homeostatic model assessment index (HOMA) (p<0.02), but not in IMT or PL. MetS was significantly associated with FMD reduction (R 0.4, p<0.005) independently of all possible confounding factors other than EIDV, IMT and PL.