Every day I see patients with varying health challenges, many of whom are additionally metabolically unhealthy. With the risk of COVID-19, poor cardiometabolic health has gained more attention, and some experts are even referring to it as a pandemic within the pandemic. As a preventive integrative physician, I see this as an opportunity for many to focus on metabolic health and, hopefully, make lemonade from lemons.
According to a National Health and Nutrition Examination Survey study conducted by the University of North Carolina (UNC) at Chapel Hill’s Gillings School of Public Health, only one in eight adults (just 12%) are considered metabolically healthy. This study is quite concerning, as poor cardiometabolic health increases our risk for a number of diseases that are preventable and, in some cases, reversible, such as diabetes, cancer, heart disease, stroke, dementia and more. In addition, those with poor cardiometabolic health are also at a higher risk of developing serious illness from coronavirus. So while avoiding exposure to the coronavirus is of course important, reducing risk should you become infected is of utmost importance.
Cardiometabolic Disease (CMD) has evolved to include the classic components of Metabolic Syndrome – parameters that were used in the study. These include central obesity (waist circumference, visceral adipose), hyperglycemia (elevated blood sugar and insulin resistance), low HDL, high triglycerides, and elevated blood pressure.
Cardiometabolic Disease/Metabolic Syndrome: The Danger Zone
- Waist circumference: greater than 40 inches for men and 35 inches for women
- High LDL (bad) cholesterol: greater than 100 mg/dL
- Low HDL (good) cholesterol: less than 40 mg/dL for men and 50 mg/dL for women
- High triglycerides (blood fat): greater than 150 mg/dL
- Fasting blood glucose: greater than 100 md/dl or already diagnosed type 2 diabetes
- High blood pressure: systolic 130 mmHg or greater; diastolic 85 mmHg or greater (130/85)
What ties these risk factors together?
- Insulin resistance
- Hormone dysregulation
- Sympathetic nerve overactivity
The good news is that most of the risk factors for CMD are preventable with diet and lifestyle changes. As numbers associated with these health issues often creep up slowly, much of the time physicians only take action when a patient’s lab results reach the abnormal or “unhealthy” range, a point when medication may be needed and/or other, more drastic, action is necessary. These measures can be avoided if we focus on prevention.
My recommendation is that we should strive for optimal cardiometabolic health, which may include narrower parameters, additional biomarkers that explore cardiovascular inflammation and coagulability, and measures of physical fitness, quality of diet, stress, and sleep. By lowering the risks of most chronic diseases, we benefit by decreasing the chances of serious complications and illness if exposed to COVID-19.
PREVENTION IS CRUCIAL
- 647,000 die of heart disease each year
- 500,000 premature deaths each year are associated with poor diet
- 30 million Americans have diabetes
- 100,000 million Americans have prediabetes
- At least 45% of Americans have at least one condition that is associated with greater risk of severe infection from coronavirus.
Araujo, Joana, Cai, Jianwen, Stevens, June, Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016, Mary Ann Liebert, Inc./2019
Bae, Ji Cheol, Kim, Jong Dae, Lee, Min Kyung, et al., Metabolic Health Is a More Important Determinant for Diabetes Development than Simple Obesity: A 4-Year Retrospective Longitudinal Study, NCBI/2014
Banerjee, Amitava, Checchi, Francesco, Clark, Andrew, et al., Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modeling study, Lancel Global Health/2020
Brabaw, Kasandra, Only 1 in 8 Americans are Metabolically Healthy. What That Means for You, Health/2018
Ly-Pen, D., Saban-Ruiz, J., COVID-19: A Personalized Cardiometabolic Approach for Reducing Complications and Costs. The Role of Aging Beyond Topics, NCBI/2020
Sweet, Joni, Think You’re Metabolically Healthy? Only 12% of Americans Fit the Bill, Healthline/2018