COVID-19 and Metabolic Syndrome: An Ignored Paradigm


Video Presentation


The rapid and aggressive nature of the SARS-COV-2 pandemic has created an urgent need to identify the comorbidities that impact the course and outcomes of this viral illness. Metabolic syndrome, a distinct clinical entity characterized by obesity, type 2 diabetes and insulin resistance, hyperlipidemia, and hypertension, is exceedingly prevalent in the United States and around the world and contributes profoundly to overall morbidity and mortality. Because of this, it is crucial that the medical community fully understands the implication of metabolic syndrome as a clinical entity on patients with COVID-19, including impact on disease progression and outcome.

This scoping review aims to analyze current research surrounding patient outcomes, morbidity, and mortality on patients with COVID-19 by posing the question: Is metabolic syndrome an independent risk factor for the prognosis of patients with COVID-19, or are the components of metabolic syndrome independent risk factors individually? Each individual feature of metabolic syndrome is addressed in this review: hypertension, type 2 diabetes, hyperlipidemia, and central obesity. Each of the factors is analyzed in the literature individually as well as an analysis of metabolic syndrome as a disease entity in the hopes of characterizing the current research and guiding future research regarding metabolic syndrome and COVID-19.

The researchers selected a scoping review due to the rapid rate at which new literature surrounding COVID-19 has been published. To examine the literature surrounding COVID-19 and metabolic syndrome, specific search terms were used to search two medical databases: PubMed and LitCOVID. These databases contained the most up-to-date data regarding the SARS-COV-2 pandemic. Each database was independently reviewed by two reviewers to select relevant articles. The relevant articles were selected based upon specific inclusion and exclusion criteria, with any discrepancies resolved by consensus of the reviewers.

A total of 71 articles with categories of diabetes, obesity, hypertension, metabolic syndrome, hyperlipidemia, and a combination of diabetes and obesity were included in the review. Diabetes-focused topics consisted of 44%, while 38% were on obesity, 8% on hypertension, and 1% on hyperlipidemia, with 3% being a combination of diabetes and obesity. There were significantly fewer articles currently published on hypertension and hyperlipidemia and their relationship to COVID-19 compared to diabetes and obesity. Of all papers found, only 4% researched metabolic syndrome as a distinct syndrome among COVID-19 patients.

Literature analyzed in this scoping review focused specifically on obesity, diabetes mellitus, and hypertension being independently associated with an increased need for hospitalization and intubation. Additionally, metabolic syndrome patients are at an increased risk of acute respiratory distress syndrome. There is insufficient literature to properly evaluate the risk of hyperlipidemia among COVID-19 patient outcomes. The fact that metabolic syndrome is comprised of four independent risk factors should lead to further research on how metabolic syndrome as a clinical entity affects the disease course and prognosis of COVID-19 infection. Several studies suggested utilizing information about metabolic syndrome risks to create a COVID-19 risk stratification system that could be utilized by physicians.