Coronavirus and Cardiometabolic Syndrome: JACC Focus Seminar
Jeffrey I Mechanick1, Robert S Rosenson1, Sean P Pinney1
1Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
The COVID-19 pandemic highlights cardiovascular risks, emphasizing the need for better cardiometabolic health. This study offers guidance on lifestyle, medications, and managing hyperglycemia to mitigate these risks and prepare for future pandemics.
Area of Science:
- Cardiology
- Endocrinology
- Infectious Diseases
Background:
- The COVID-19 pandemic revealed significant cardiovascular vulnerabilities.
- Cardiometabolic health is crucial for managing COVID-19 outcomes.
- Key drivers include abnormal adiposity, dysglycemia, dyslipidemia, and hypertension.
Purpose of the Study:
- To examine cardiometabolic drivers in the context of COVID-19.
- To provide recommendations for lifestyle changes and pharmacotherapy.
- To present a model for COVID-related cardiometabolic syndrome.
Main Methods:
- Review of existing literature and clinical observations.
- Analysis of cardiometabolic risk factors and their interaction with COVID-19.
- Development of a conceptual model for COVID-related cardiometabolic syndrome.
Main Results:
- Specific recommendations for lifestyle modification and pharmacotherapy, especially for diabetic patients.
- Emphasis on insulin for hyperglycemia management in hospitalized patients.
- Statin continuation advised, but initiation for COVID-19 treatment lacks evidence.
Conclusions:
- Addressing cardiometabolic health is essential for mitigating COVID-19's impact.
- A proactive approach to managing cardiometabolic syndrome can improve resilience to future pandemics.
- Further research and action are needed to fill knowledge and practice gaps.
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.
