ABSTRACT Objective To evaluate deaths, hospitalizations, and persistence of symptoms in patients with COVID-19 after infection in an outpatient setting during the first COVID-19 wave in Brazil. Methods This prospective cohort was between April 2020 and February 2021. Hospitalized or non-hospitalized COVID-19 patients until five days after symptom onset were included. The outcomes measured were incidence of death, hospitalization, and persistence of more than two symptoms 60 days after discharge. Results Out of 1,198 patients enrolled in the study, 66.7% were hospitalized. A total of 289 patients died (1 [0.3%] non-hospitalized and 288 [36%] hospitalized). At 60 days, patients non-hospitalized during admission had more persistent symptoms (16.2%) compared to hospitalized (37.1%). The COVID-19 severity variables associated with the persistence of two or more symptoms were increased age (OR= 1.03; p=0.015), respiratory rate at hospital admission (OR= 1.11; p=0.005), length of hospital stay of more than 60 days (OR= 12.24; p=0.026), and need for intensive care unit admission (OR= 2.04; p=0.038). Conclusion COVID-19 survivors who were older, tachypneic at admission, had a hospital length of stay >60 days, and were admitted to the intensive care unit had more persistent symptoms than patients who did not require hospitalization in the early COVID-19 waves. ClinicalTrials.gov Identifier: NCT04479488. deaths hospitalizations COVID19 COVID 19 COVID-1 Brazil 202 2021 nonhospitalized non included death 6 discharge 1198 1 198 1,19 study 667 66 7 66.7 28 ( 0.3% 03 0 3 [0.3% 36% 36 [36% . hospitalized) 16.2% 162 16 2 (16.2% 37.1%. 371 37.1% 37 (37.1%) OR= OR (OR 1.03 103 p=0.015, p0015 p p=0.015 , 015 p=0.015) 1.11 111 11 p=0.005, p0005 p=0.005 005 p=0.005) 12.24 1224 12 24 p=0.026, p0026 p=0.026 026 p=0.026) 2.04 204 04 p=0.038. p0038 p=0.038 038 p=0.038) older >6 waves ClinicalTrialsgov ClinicalTrials gov Identifier NCT04479488 NCT COVID1 COVID- 20 119 1,1 66. 0.3 [0.3 [36 16.2 (16.2 37.1 (37.1% 1.0 10 p001 p=0.01 01 1.1 p000 p=0.00 00 12.2 122 p002 p=0.02 02 2.0 p003 p=0.03 > NCT0447948 1, 0. [0. [3 16. (16. 37. (37.1 1. p00 p=0.0 12. 2. NCT044794 [0 [ (16 (37. p0 p=0. NCT04479 (37 p=0 NCT0447 (3 p= NCT044 NCT04 NCT0

Resumo Fundamento Indivíduos com hipercolesterolemia grave (HG) são considerados sob alto risco de desenvolverem aterosclerose e devem ser intensivamente tratados com medicamentos hipolipemiantes, visando uma redução nos níveis de LDL-Colesterol ≥50% e uma meta <70 mg/dL. Objetivos Este estudo teve como objetivo avaliar o controle dos níveis de colesterol em indivíduos com HG (LDL-C ≥ 190 mg/dL ou 160-189 mg/dL usando medicamentos hipolipemiantes) acompanhados em um programa de avaliação da saúde. Métodos Foram avaliados 55 000 indivíduos, dos quais 2214 (4%) apresentavam HG, e 1016 (45,8%) foram submetidos a avaliações repetidas. O alcance das metas de LDL-C foi o desfecho primário do estudo. Um valor de p<0,05 foi considerado significativo. Resultados A idade média (±DP) foi 44,9±8,8 anos; 84,2% dos participantes eram do sexo masculino, e 0,5% relataram infarto do miocárdio prévio. A concentração média de LDL-C foi 203,0±22,0 mg/dL, e apesar de 62,5% dos pacientes terem referido dislipidemia, somente 19% estavam usando drogas hipolipemiantes (5,9% nos casos de LDL-C ≥ 190 mg/dL). Durante um seguimento de 4,1±2,8 anos, o uso de medicamentos hipolipemiantes aumentou de 18,1% para 48,4% (p<0,00001); de 5,9% para 45,4% naqueles com LDL-C ≥ 190 mg/dL (p< 0,00001), embora 31% dos casos com LDL-C 160-189 mg/dL terem interrompido o uso desses fármacos. No geral, observou-se uma redução média de 26,7% nos níveis de LDL-C (p<0,0001). Reduções ≥50% no LDL-C foram alcançadas por 19,2%, 19,1%, e 19,7 % de todos os indivíduos, e naqueles com LDL-C > 190 mg/dL e 160-189 mg/dL, respectivamente. Somente 3,1% atingiram concentrações de LDL-C < 70 mg/dL (2,7% naqueles com LDL-C ≥ 190 e 5,3% naqueles com 160-189 mg/dL). Conclusões Uma séria lacuna foi encontrada entre as recomendações de tratamento e a realidade em indivíduos com elevado risco aterosclerótico por HG. (HG LDLColesterol LDL Colesterol 50 ≥50 <7 mgdL mg dL LDLC C 19 160189 160 189 160-18 saúde 5 00 221 4% 4 (4% 101 45,8% 458 45 8 (45,8% repetidas p005 p 0 05 p<0,0 significativo ±DP DP (±DP 44988 44 9 44,9±8, anos 842 84 2 84,2 masculino 0,5 prévio 2030220 203 22 203,0±22, 625 62 62,5 dislipidemia 59 (5,9 . mg/dL) 4128 1 4,1±2, 181 18 18,1 484 48 48,4 p<0,00001 p000001 00001 (p<0,00001) 5,9 454 45,4 p< (p 0,00001, 000001 0,00001 , 0,00001) 31 fármacos geral observouse observou se 267 26 7 26,7 p<0,0001. p00001 p<0,0001 0001 (p<0,0001) 192 19,2% 191 19,1% 197 19, respectivamente 3 3,1 2,7% 27 (2,7 53 5,3 ≥5 16018 16 160-1 (4 10 45,8 (45,8 p00 p<0, 4498 44,9±8 84, 0, 203022 20 203,0±22 6 62, (5, 412 4,1±2 18, 48, p<0,0000 p00000 0000 (p<0,00001 5, 45, 00000 0,0000 26, p0000 p<0,000 (p<0,0001 19,2 19,1 3, 2,7 (2, 1601 160- ( (45, p0 p<0 449 44,9± 20302 203,0±2 (5 41 4,1± (p<0,0000 0,000 p000 p<0,00 (p<0,000 2, (2 (45 44,9 2030 203,0± 4,1 0,00 (p<0,00 44, 203,0 4, 0,0 (p<0,0 203, (p<0, (p<0

Abstract Background Individuals with severe hypercholesterolemia (SH) are considered at high atherosclerosis risk and should be intensively treated with lipid-lowering drugs aiming for an LDL-C reduction of≥50% and a goal of <70 mg/dL. Objectives This study aimed to evaluate cholesterol control in individuals with SH (LDL-C ≥ 190 mg/dL or 160-189 mg/dL using lipid-lowering drugs) followed in a health evaluation program. Methods 55,000 individuals were evaluated, of which 2,214 (4%) had SH, and 1,016 (45.8%) had repeated assessments. Achievement of recommended LDL-C goals was the primary study endpoint. A p-value < 0.05 was considered significant. Results Mean age (± SD) was 44.9±8.8 years, 84.2% were men, and 0.5% reported previous myocardial infarction. Mean LDL-C was 203.0±22.0 mg/dL, and although 62.5% referred dyslipidemia, only 19% were using lipid-lowering drugs (5.9% in cases with LDL-C ≥ 190 mg/dL). During a 4.1±2.8-year follow-up, use of lipid-lowering drugs increased from 18.1% to 48.4% (p<0.00001), 5.9% to 45.4% in those with LDL-C ≥ 190 mg/dL (p< 0.00001) though 31% of cases with LDL-C 160-189 mg/dL stopped taking medications. Overall, there was a mean 26.7% reduction in LDL-C (p<0.0001), and LDL-C reductions ≥50% were attained in 19.2%, 19.1%, and 19.7 % of all individuals, and in those with LDL-C > 190 mg/dL and 160-189 mg/dL respectively. Only 3.1% reached LDL-C < 70 mg/dL (2.7% in those with LDL-C ≥ 190 and 5.3% in those with 160-189 mg/dL). Conclusions A serious gap was found between treatment recommendations and reality in individuals at high atherosclerosis risk due to SH. (SH lipidlowering lipid lowering LDLC LDL C of50 50 of≥50 <7 mgdL mg dL 19 160189 160 189 160-18 program 55000 55 000 55,00 evaluated 2214 2 214 2,21 4% 4 (4% 1016 1 016 1,01 45.8% 458 45 8 (45.8% assessments endpoint pvalue p value 005 0 05 0.0 significant ± ( SD 44988 44 9 44.9±8. years 842 84 84.2 men 5 0.5 infarction 2030220 203 22 203.0±22. 625 62 62.5 dyslipidemia 59 (5.9 . mg/dL) 4.1±2.8year 4128year year 4.1±2.8 followup, followup follow up, up follow-up 181 18 18.1 484 48 48.4 p<0.00001, p000001 p<0.00001 , 00001 (p<0.00001) 5.9 454 45.4 p< (p 0.00001 000001 31 medications Overall 267 26 7 26.7 p<0.0001, p00001 p<0.0001 0001 (p<0.0001) ≥50 192 19.2% 191 19.1% 197 19. respectively 3 3.1 2.7% 27 (2.7 53 5.3 of5 of≥5 16018 16 160-1 5500 00 55,0 221 21 2,2 (4 101 01 1,0 45.8 (45.8 0. 4498 44.9±8 84. 203022 20 203.0±22 6 62. (5. 8year 4128 4.1±2. 18. 48. p00000 p<0.0000 0000 (p<0.00001 5. 45. 0.0000 00000 26. p0000 p<0.000 (p<0.0001 ≥5 19.2 19.1 3. 2.7 (2. of≥ 1601 160- 550 55, 2, 10 1, (45. 449 44.9± 20302 203.0±2 (5 412 4.1±2 (p<0.0000 0.000 p000 p<0.00 (p<0.000 2. (2 (45 44.9 2030 203.0± 41 4.1± 0.00 p00 p<0.0 (p<0.00 44. 203.0 4.1 p0 p<0. (p<0.0 203. 4. p<0 (p<0. (p<0