Cluster of high BP, diabetes and obesity linked to 4-fold greater mortality risk from Covid-19

Metabolic syndrome proved to be a much stronger risk factor for death from Covid-19 than obesity, hypertension and diabetes individually among predominantly African American patients in New Orleans during the peak of the pandemic outbreak in that city.

Patients with metabolic syndrome exhibited an almost 4-times greater odds of fatal Covid-19 outcomes, compared to patients without metabolic syndrome in the multivariable analysis.

Among the patients hospitalized for Covid-19, having three common comorbidities associated with metabolic syndrome – hypertension, obesity and diabetes – was associated with an almost 5-fold increase in risk for requiring treatment in an ICU, being placed on mechanical ventilation and developing acute respiratory distress syndrome (ARDS).

The findings suggest that metabolic syndrome is a “composite predictor of Covid-19 lethal outcome,” wrote researcher Joshua Denson, MD, of Tulane University School of Medicine, New Orleans, and colleagues.

Their findings were published online this week in the journal Diabetes Care.

In an interview with BreakingMED, Denson said the link between metabolic disease and death from Covid-19 has proven to be stronger than for chronic pulmonary diseases and heart disease.

“With influenza — cancer, advanced lung disease, heart disease and immunosuppression are traditional risk factors for death,” he said. “But what we are seeing with this virus — which is very atypical for a respiratory virus — is that having metabolic risk factors seems to be more of a factor. These conditions typically increase someone’s risk for a heart attack, but not death from a respiratory virus.”

He added that this observation suggests that inflammation associated with metabolic syndrome may be strongly related to Covid-19 severity.

Denson noted that New Orleans was an early epicenter for Covid-19 in the United States, with what was identified as the highest death rate per capita in the U.S. (38 per 100,000 population) in early April.

In the newly reported retrospective study, Denson and colleagues followed 287 patients hospitalized for Covid-19 at Tulane Medical Center and University Medical Center New Orleans from March 30 through April 5, which was the peak of the Covid-19 pandemic in New Orleans.

The mean age of the patients was 61 years, 57% were female, and 85% were Black.

The most common comorbidities among the hospitalized patients were hypertension (80%), obesity (65%) , diabetes (54%) and low HDL (39%).

Two-thirds (66%) of the patients in the study had metabolic syndrome. After controlling for age, sex, race, hospital location and Charleston Comorbidity Index, patients with metabolic syndrome were 3.4 times more likely to die from Covid-19 as other patients. Among the other main findings:

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  • Metabolic syndrome was significantly associated with mortality (adjusted odds ratio [aOR] 3.42 [95% CI 1.52-7.69]), treatment in the ICU (aOR 4.59 [CI 2.53-8.32]), invasive mechanical ventilation (IMV) (aOR 4.71 [CI 2.50-8.87]), and ARDS (aOR 4.70 [CI 2.25-9.82]) compared with non-metabolic syndrome.
  • Multivariable analyses of hypertension, obesity, and diabetes individually showed no individual association with mortality.
  • Obesity was associated with ICU (aOR 2.18 [CI, 1.25-3.81]), ARDS (aOR 2.44 [CI 1.28-4.65]), and invasive mechanical ventilation (IMV) (aOR 2.36 [CI 1.33-4.21]).
  • Diabetes was associated with ICU (aOR 2.22 [CI 1.24-3.98]) and IMV (aOR 2.12 [CI 1.16-3.89]).
  • Hypertension was not significantly associated with any outcome.

The inflammatory biomarkers associated with metabolic syndrome C-reactive protein (CRP), and lactate dehydrogenase (LDH) were associated with mortality (CRP [aOR 3.66] [CI 1.22-10.97] and LDH [aOR 3.49] [CI 1.78-6.83]).

A study limitation cited by the researchers included the observational study design, which precluded conclusions regarding causation.

But Denson said the finding that a cluster of hypertension, obesity, and diabetes was a stronger predictor of death from Covid-19 than the conditions individually has clinical implications for clinicians caring for Covid-19 patients.

“Having 3 or 4 of the conditions associated with metabolic syndrome puts people at a much greater risk for death from Covid-19, but many people with metabolic syndrome may not recognize this risk or even know that they have this combination of risk factors,” he said, adding that physicians need to be especially vigilant about identifying and treating these risk factors during the Covid-19 pandemic.

  1. Metabolic syndrome proved to be a much stronger risk factor for death from Covid-19 than obesity, hypertension and diabetes individually among predominantly African American patients in New Orleans.

  2. Among the patients hospitalized for Covid-19, having three common comorbidities associated with metabolic syndrome – hypertension, obesity and diabetes – was associated with an almost 5-fold increase in risk for requiring treatment in an ICU, being placed on mechanical ventilation and developing acute respiratory distress syndrome (ARDS).

Salynn Boyles, Contributing Writer, BreakingMED™

Funding for this study was provided by Tulane University, the American Diabetes Association, the National Institute of General Medicine Sciences and others.

The researchers reported no relevant conflicts of interest related to this study.

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