Metabolic syndrome (MetS) represents a cluster of metabolic abnormalities that include hypertension, central obesity, insulin resistance, and atherogenic dyslipidemia, and is strongly associated with an increased risk for developing diabetes and atherosclerotic and nonatherosclerotic cardiovascular disease (CVD). The pathogenesis of MetS involves both genetic and acquired factors that contribute to the final pathway of inflammation that leads to CVD. MetS has gained significant importance recently due to the exponential increase in obesity worldwide. Early diagnosis is important in order to employ lifestyle and risk factor modification. Here, we review the epidemiology and pathogenesis of MetS, the role of inflammation in MetS, and summarize existing natural therapies for MetS.
Background
Severe coronavirus disease (COVID‐19) is characterized by a pro‐inflammatory state with high mortality. Statins have anti‐inflammatory effects and may attenuate the severity of COVID‐19.
Methods and Results
An observational study of all consecutive adult patients with COVID‐19 from March 1, 2020 to May 2, 2020 admitted to a single‐center located in Bronx, New York. Patients were grouped as those that did and did not receive a statin and in‐hospital mortality was compared by competing events regression. In addition, propensity score matching and inverse probability treatment weighting (IPTW) were used in survival models to examine the association between statin use and death during hospitalization. A total of 4,252 patients were admitted with COVID‐19. Diabetes modified the association between statin use and in‐hospital mortality. Patient with diabetes on a statin (n=983) were older (69±11 vs. 67±14 years, p<0.01), had lower inflammatory markers (C‐reactive protein: 10.2, IQR: 4.5‐18.4 vs. 12.9, IQR: 5.9‐21.4 mg/dl, p<0.01) and reduced cumulative in‐hospital mortality (24% vs. 39%, p<0.01) than those not on a statin (n=1,283). No difference in hospital mortality was noted in patients without diabetes on or off statin (20% vs. 21%, p=0.82). Propensity score matching (HR=0.88, 95% CI 0.83‐0.94, p<0.01) and IPTW (HR=0.88, 95% CI 0.8
4
‐0.92, p<0.01) showed a 12% lower risk of death during hospitalization for statin users than non‐users.
Conclusions
Statin use was associated with reduced in‐hospital mortality from COVID‐19 in patients with diabetes. These findings, if validated, may further reemphasize administration of statins to patients with diabetes during the COVID‐19 era.
Cardiovascular disease represents a massive healthcare burden worldwide. Gender differences in the pathophysiology, presentation and prognosis of cardiovascular disease have been described in the literature. Metabolic syndrome, characterized by a cluster of metabolic abnormalities is associated with increased risk for type 2 diabetes mellitus and atherosclerotic cardiovascular disease. With the global obesity epidemic, the prevalence of metabolic syndrome is rising rapidly in the developed as well as developing world. However, there is considerable variation in the prevalence based on geography, age, sex and, definition used for diagnosis. Data on gender related differences in metabolic syndrome is relatively scarce. Here, we aim to review the gender differences in epidemiology and pathophysiology of metabolic syndrome as well as its individual components. Knowledge of gender differences in metabolic syndrome can help design gender specific preventative and therapeutic strategies that will have a positive impact on overall population health.
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