JACC Focus Seminar: Coronavirus Disease 2019 in 2020
JACC Focus Seminar
Coronavirus and Cardiometabolic Syndrome: JACC Focus Seminar

https://doi.org/10.1016/j.jacc.2020.07.069Get rights and content
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Highlights

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    COVID-19 exposes epidemiological and mechanistic relationships with cardiometabolic links (abnormal adiposity, dysglycemia, dyslipidemia, and hypertension).

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    Lifestyle, glycemic control, and regulation of the RAS have important implications for management of patients with COVID-19.

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    CIRCS applies to all stages of COVID-19 illness, including prevention, acute management, and long-term outcomes.

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    Further research should address gaps in current knowledge and clinical implementation of available strategies to mitigate the adverse consequences of CIRCS.

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.

Key Words

adiposity
angiotensin-converting enzyme 2
cardiometabolic
cardiovascular disease
chronic disease
COVID-19
diabetes
dysglycemia
dyslipidemia
hypertension
lifestyle
lipids
obesity
prevention
SARS-CoV-2
statin

Abbreviations and Acronyms

BMI
body mass index
CIRCS
coronavirus disease–related cardiometabolic syndrome
CMBCD
cardiometabolic-based chronic disease
COVID-19
coronavirus disease 2019
HCP
health care professional
ICU
intensive care unit
RAS
renin-angiotensin system
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2

Cited by (0)

Dr. Mechanick has received honoraria for lectures and program development from Abbott Nutrition. Dr. Rosenson has received research grants to institution from Amgen, The Medicines Company, Novartis, and Regeneron; has served on consulting/advisory boards for Amgen, C5, Corvidia, CVS Caremark, and The Medicines Company; has received honoraria from Angen, Kowa, Pfizer, and Regeneron; has received royalties from UpToDate; and has stock holdings in MediMergent, LLC. Dr. Pinney has received consulting fees from Abbott, CareDx, Medtronic, and Procyrion. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Muthiah Vaduganathan, MD, served as Guest Editor for this paper. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.

Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.

© 2020 by the American College of Cardiology Foundation. Published by Elsevier.