Coronavirus and Cardiometabolic Syndrome

Abstract

The coronavirus disease 2019 (COVID-19) pandemic exposes unexpected cardiovascular vulnerabilities and the need to improve cardiometabolic health. Four cardiometabolic drivers—abnormal adiposity, dysglycemia, dyslipidemia, and hypertension—are examined in the context of COVID-19. Specific recommendations are provided for lifestyle change, despite social distancing restrictions, and pharmacotherapy, particularly for those with diabetes. Inpatient recommendations emphasize diligent and exclusive use of insulin to avert hyperglycemia in the face of hypercytokinemia and potential islet cell injury. Continuation of statins is advised, but initiating statin therapy to treat COVID-19 is as yet unsubstantiated by the evidence. The central role of the renin-angiotensin system is discussed. Research, knowledge, and practice gaps are analyzed with the intent to motivate prompt action. An emerging model of COVID-related cardiometabolic syndrome encompassing events before, during the acute phase, and subsequently in the chronic phase is presented to guide preventive measures and improve overall cardiometabolic health so future viral pandemics confer less threat.

Clinical Nutrition Research and the COVID‐19 Pandemic: A Scoping Review of the ASPEN COVID‐19 Task Force on Nutrition Research

“…The prevalence of malnutrition with COVID‐19 in Wuhan, China, was 52.7%, 34 with detriment hypothesized to be due to nutrition deficiencies from abnormal eating patterns, leading to decreased immune function (innate and adaptive) and impaired resistance to infection 35–38 . Further, obesity‐associated insulin resistance interacts with a SARS‐CoV‐2–induced decrease in angiotensin‐converting enzyme‐2 and its resulting decrease in pancreatic β‐cell reserve and counterregulatory renin‐angiotensin system cardioprotective pathway, resulting in severe hyperglycemia, cardiovascular complications, and adverse outcomes 18,39 …”

“…[2][3][4][5][6][7][8][9][10][11][12][13][14] Each of these risk factors can be interpreted in terms of associational to causal relationships, depending on the nature of supporting scientific evidence (Table 2). [15][16][17][18][19] By focusing on nutrition risk factors in COVID-19, specific clinically relevant Population, Intervention, Comparator, Outcome, and Time (PICO-T)-formatted questions can be formulated to identify gaps in the current literature. In this scoping review, 56 PICO-T questions were formulated as a group consensus (Table 3).…”

Statins and clinical outcomes with COVID-19: Meta-analyses of observational studies

“…Both meta-analyses of retrospective observational studies investigating the effects of previous statin therapy on in-hospital mortality associated with COVID-19 and severity of the infection (admission to ICU, need for IMV) revealed no reductions in statin users compared with non-users, whereas a substantial yet poorly explained heterogeneity was observed between studies. In any case, these results should be interpreted with caution because statin users are generally patients who have additional risk factors, such as older age, male gender, DM, hypertension and CV disease [8] , all of which have been reported to worsen COVID-19 prognoses [7] , [9] , [38] . This difference in patients’ characteristics between statin users and non-users explains why the fully adjusted and multivariate analyses gave more favourable results than univariate analyses ( Table 1 , Table 2 ).…”

“…However, as there is still no evidence that lipid-lowering therapy is unsafe in patients with COVID-19, such treatments should not be interrupted just because of the pandemic or in patients at increased risk of COVID-19 infection. Patients exposed to SARS-CoV-2 who are already using statin therapy should continue the treatment if not contraindicated by European Society of Cardiology guidelines [76] and other US recommendations [38] . On the other hand, great care should be taken to avoid any adverse interactions between lipid-lowering medications and drugs that might be used to treat COVID-19 (for instance, some antiviral agents) [59] , especially in patients with abnormal liver function tests or myopathies [77] .…”

“…On the other hand, great care should be taken to avoid any adverse interactions between lipid-lowering medications and drugs that might be used to treat COVID-19 (for instance, some antiviral agents) [59] , especially in patients with abnormal liver function tests or myopathies [77] . One caveat is that, while there is no reason to stop statin therapy in patients hospitalized for COVID-19, the level of evidence remains too low—in the absence of RCTs, some of which are ongoing as reported elsewhere [38] , [78] , [79] , although the impact of their results may be attenuated by successful vaccine strategies in the future—to justify initiating statin therapy in statin-free patients in hopes of reducing the burden of disease and improving clinical outcomes [38] , [80] .…”