COVID-19 Comorbidity Interplayers: Diabetes and Atherogenic Dyslipidemia

Abstract

Diabetes mellitus is considered an important independent risk factor for coronary artery disease. Atherosclerosis is the most frequent cause of premature death in this group of patients, doubling the risk of coronary disease, tripling the risk of stroke and quadrupling the possibility of peripheral vascular insufficiency symptomatic. Coronavirus (COVID-19) diagnosed patients can do worse when comorbidities are associates. In this paper we present two of them and their interplay that can act addingly to worsen COVID-19 outcome. The two factors can interplay in this role are diabetes and hyperlipidemia. Metabolic syndrome can be a possible precursor of type 2 diabetes: the prevalence of dyslipidemia in patients with type 2 diabetes mellitus is 75%. The components of dyslipidemia in type 2 diabetes mellitus are characterized by quantitative, qualitative and kinetic alterations, all contributing to the risk of cardiovascular disease, the main cause of mortality in this population, mainly related to insulin resistance. Relatively normal cholesterol “hides” an atherogenic lipid profile, with increased intermediate density lipoproteins, small and dense LDL lipoproteins, and small, dense and dysfunctional HDLs. Lipid-lowering drugs for LDL-c have the best documented risk reduction with HMGCoAredutase inhibitors: (statins). Other medications are: inhibitors of intestinal cholesterol absorption (Ezetimibe, Cholestyramine and Cholesevelam), nicotinic acid, fibrates (Gemfibrozil, Phenofibrate and Pemafibrate), omega 3 fatty acids (docosaexaenoic acid and eicosapentaenoic acid) plus new drugs such as and PCSK9 inhibitors. Lifestyle changes, which include the elaboration of an adequate diet, regular practice of physical exercises and control of the common state of anxiety in a large number of patients, should be the first step in the diabetic dyslipidemia therapeutic approach. Unnecessary to emphasize that prior to the institution of lipid therapy, adequate blood glucose control should be achieved.