Coronavirus Disease 2019 and Cardiometabolic Disease

Abstract

Cardiometabolic disease describes a combination of metabolic abnormalities that increases the risk of type 2 diabetes and cardiovascular diseases, including pathological changes such as insulin resistance, hyperglycemia, dyslipidemia, abdominal obesity, and hypertension, and environmental risk factors such as smoking, sedentary lifestyle, poor diet, and poverty. As the number of coronavirus disease 2019 (COVID-19) patients continues to rise, type 2 diabetes, cardiovascular disease, hypertension, and obesity, all components of, or sequelae of cardiometabolic disease, were identified among others as key risk factors associated with increased mortality in these patients. Numerous studies have been done to further elucidate this relationship between COVID-19 and cardiometabolic disease. Cardiometabolic disease is associated with both increased susceptibility to COVID-19 and worse outcomes of COVID-19, including intensive care, mechanical ventilation, and death. The proinflammatory state of cardiometabolic disease specifically obesity, has been associated with a worse prognosis in COVID-19 patients. There has been no evidence to suggest that antihypertensives and antidiabetic medications should be discontinued in COVID-19 patients but these patients should be closely monitored to ensure that their blood pressure and blood glucose levels are stable. Assessment of vaccination efficacy in cardiometabolic disease patients is also discussed.

Micronutrient Deficiency as a Confounder in Ascertaining the Role of Obesity in Severe COVID-19 Infection

“…Chronic conditions linked to food insecurity, including diabetes, hypertension, chronic kidney and pulmonary diseases, high cholesterol, and even depression, are associated with increased oxidative stress and immune dysregulation, which may be worsened in the presence of obesity and micronutrient deficiency [103,104]. As noted earlier, obesity may also be associated with increased risk of COVID-19 infection and complications due to its role in mediating a pro-inflammatory state, which can lead to sub-optimal immune responses via immune system dysregulation [7]. An array of inflammatory cytokines are increased in obese tissues, such as tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), plasminogen activator inhibitor-1 (PAI-1), interleukin (IL)-6, IL-1β, CCL2, and Toll-like receptors (TLRs) of the innate immune system, which may have additional implications in responses to vaccination and viral infections [105,106].…”

“…Besides the activation of inflammatory cytokines and signaling factors, there are several additional pathways through which obesity may influence risk of COVID-19 infection and complications. The sequelae of being overweight and obese including metabolic, respiratory, cardiovascular, and thrombotic disorders may not only increase a patient's risk of COVID-19 infection but also COVID-19 complications by impairing the body's ability to cope with the initial infection [7,112]. Obesity can have a significant clinical impact due to structural changes in the body that can lead to a reduction in cardiorespiratory reserve (e.g., decreased expiratory reserve volume and functional residual capacity), thereby decreasing cardiorespiratory fitness and increasing susceptibility to immune-driven vascular and thrombotic effects [112].…”

“…As efforts to increase vaccine uptake continue, it is important to reinforce the message that overweight/obesity and resultant micronutrient deficiencies are important risk factors, and research studies need to continue to monitor the COVID-19 vaccine immune response in high-risk populations including those with overweight/obesity and micronutrient deficiency, and to recognize that this clinical profile is even more common in low-income and racial and ethnic minority groups. This monitoring should include checking for early clinical signs of COVID-19 in overweight/obese persons so that early intervention can be promptly managed [7]. Close attention to micronutrient deficiency is also warranted.…”

“…From 1999 to 2016, this population has doubled and the association between adiposity and food insecurity has increased [4]. People who are classified as being overweight or obese, defined as an increased body mass index (BMI ≥ 25 kg/m 2 or ≥30 kg/m 2 ), have a nearly two-fold increased likelihood of having COVID-19 infection or complications [5][6][7]. Richardson and colleagues reported that over 40% of patients hospitalized with COVID-19 in the New York area in March and April of 2020 were overweight (BMI ≥ 25 kg/m 2 ) or obese (BMI ≥ 30 kg/m 2 ) [8].…”

Leptin in the Respiratory Tract: Is There a Role in SARS-CoV-2 Infection?

“…High leptin concentrations are directly associated with obesity and/or the subsequent development of metabolic disease sequelae, such as insulin resistance, type 2 diabetes, and cardiovascular diseases ( Ghadge and Khaire, 2019 ), all key risk factors associated with increased coronavirus disease 2019 (COVID-19) mortality ( Kim et al, 2021 ; Mohammad et al, 2021 ). In addition, it has been assessed that an increased leptinemia is observed not only in patients with obesity and metabolic syndrome but also in patients who are not obese but affected by other inflammatory diseases, such as sepsis and respiratory infections ( Vernooy et al, 2013 ; Birlutiu and Boicean, 2021 ; Karampela et al, 2021 ).…”