Chronic inflammation and endothelium dysfunction are present in diabetic patients. COVID-19 has a high mortality rate in association with diabetes, partially due to the development of thromboembolic events in the context of coronavirus infection. The purpose of this review is to present the most important underlying pathomechanisms in the development of COVID-19-related coagulopathy in diabetic patients. The methodology consisted of data collection and synthesis from the recent scientific literature by accessing different databases (Cochrane, PubMed, Embase). The main results are the comprehensive and detailed presentation of the very complex interrelations between different factors and pathways involved in the development of arteriopathy and thrombosis in COVID-19-infected diabetic patients. Several genetic and metabolic factors influence the course of COVID-19 within the background of diabetes mellitus. Extensive knowledge of the underlying pathomechanisms of SARS-CoV-2-related vasculopathy and coagulopathy in diabetic subjects contributes to a better understanding of the manifestations in this highly vulnerable group of patients; thus, they can benefit from a modern, more efficient approach regarding diagnostic and therapeutic management.

Introduction: Hypertension and diabetes mellitus affect a large number of patients and can significantly influence their life expectancy. Changes in metabolic and oxidative stress parameters are common in these pathologies, contributing to associated complications. The aim of the study was assessment of relationship between laboratory parameters and their role in evaluation of cardiovascular risk, and possible gender-related differences in the protective factors. Material and methods: Blood samples were collected from hypertensive patients with/without diabetes mellitus admitted to the Cardiovascular Rehabilitation Clinic in Tîrgu Mureș and controls without these pathologies. Biochemical analyses were performed on Konelab analyzer (glycemia, lipid profile, kidney function tests, zinc, hsCRP). Oxidative stress markers, such as serum malondialdehyde (MDA), oxidized (GSSG) and reduced glutathione (GSH) were evaluated using an HPLC-UV/VIS technique at GEP UMPhST. Statistical analysis was performed by GraphPad InStat3. Results: Mean age of hypertensive patients (n=131) was 69.44 ± 9.02 years, 45.8% males, 31.3% being diabetics. 74.1% of the studied patients had zinc deficiency, 19.8% presented slightly elevated hsCRP. The control group included 24 nonhypertensive/nondiabetic patients of similar age. Average GSH was significantly lower (p=0.0002) in hypertensive patients, 1.89 ± 0.82 µg/ml, compared to the control group (3.23 ± 0.49 µg/ml), and no correlation could be observed between GSH and MDA values. GSH concentration was significantly higher in males (p=0.0395) and HDL-cholesterol significantly higher in females (p=0.0132). A negative correlation was observed between serum triglyceride and HDL-cholesterol concentration. Conclusions: Gender differences are present in the level of protective factors against cardiovascular diseases, while oxidative stress is intensified in hypertensive/diabetic patients.

The course of COVID-19 is highly dependent on the associated cardiometabolic comorbidities of the patient, which worsen the prognosis of coronavirus infection, mainly due to systemic inflammation, endothelium dysfunction, and thrombosis. A search on the recent medical literature was performed in five languages, using the PubMed, Embase, Cochrane, and Google Scholar databases, for the review of data regarding the management of patients with a high risk for severe COVID-19, focusing on the associated coagulopathy. Special features of COVID-19 management are presented, based on the underlying conditions (obesity, diabetes mellitus, and cardiovascular diseases), emphasizing the necessity of a modern, holistic approach to thromboembolic states. The latest findings regarding the most efficient therapeutic approaches are included in the article, offering guidance for medical professionals in severe, complicated cases of SARS-CoV-2 infection. We can conclude that severe COVID-19 is closely related to vascular inflammation and intense cytokine release leading to hemostasis disorders. Overweight, hyperglycemia, cardiovascular diseases, and old age are important risk factors for severe outcomes of coronavirus infection, involving a hypercoagulable state. Early diagnosis and proper therapy in complicated SARS-CoV-2-infected cases could reduce mortality and the need for intensive care during hospitalization in patients with cardiometabolic comorbidities.

Background: Statin therapy is commonly used on the long term in hypertensive patients with dyslipidemia and can interfere with vitamin D metabolism. Overweight/obesity and type 2 diabetes mellitus (DM) are frequently associated with hypertension. The aim of the study was the assessment of vitamin D status in elderly hypertensive patients with metabolic comorbidities with/without statin therapy, in relation to body mass index (BMI) and lipid profile parameters. Material and methods: The study group included 89 hypertensive patients (61 statin-treated) admitted to the Cardiovascular Rehabilitation Clinical Hospital in Târgu Mureș between 2019 and 2021. Vitamin D levels were measured by ELISA method, lipid profile parameters by photometric procedures. Calculated values were LDL-cholesterol and BMI. Results: Obesity and DM were present in association with hypertension in 51% of the subjects. A total of 89% of the enrolled hypertensive patients had hypovitaminosis D. Average serum vitamin D of the studied subjects was 14.27 ± 11.96 ng/mL. No significant difference was obtained in vitamin D levels depending on gender, the presence/absence of statin therapy, and DM as a comorbidity. A negative correlation was seen between serum HDL-cholesterol and triglyceride concentrations (r = –0.3988, p = 0.0008) and between HDL levels and BMI (r = –0.3114, p = 0.0475). Conclusions: Suboptimal vitamin D levels were present in the majority of the studied hypertensive patients regardless of the statin therapy, which reveals the importance of concomitant assessment of vitamin D levels, especially in elderly subjects presenting chronic metabolic comorbidities.

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