{"id":252871,"date":"2024-12-30T18:26:43","date_gmt":"2024-12-30T17:26:43","guid":{"rendered":"https:\/\/r3i.org\/editoriales-r3i\/editorial-21-04-sindrome-metabolico-y-covid-19\/"},"modified":"2025-02-15T00:46:15","modified_gmt":"2025-02-14T23:46:15","slug":"editorial-21-04-sindrome-metabolico-y-covid-19","status":"publish","type":"page","link":"https:\/\/r3i.org\/es\/editoriales-r3i\/editorial-21-04-sindrome-metabolico-y-covid-19\/","title":{"rendered":"Editorial 21\/04 – S\u00edndrome metab\u00f3lico y COVID-19"},"content":{"rendered":"

[et_pb_section fb_built=\u00bb1″ admin_label=\u00bbHeader\u00bb _builder_version=\u00bb4.27.4″ _module_preset=\u00bb35f37621-1062-4ae6-955d-76a3167a2aa8″ background_image=\u00bbhttps:\/\/r3i.org\/wp-content\/uploads\/2024\/12\/pexels-pixabay-267582.jpg\u00bb parallax=\u00bbon\u00bb min_height=\u00bb157.9px\u00bb min_height_tablet=\u00bb100px\u00bb min_height_phone=\u00bb100px\u00bb min_height_last_edited=\u00bbon|phone\u00bb height=\u00bb116px\u00bb height_tablet=\u00bb153px\u00bb height_phone=\u00bb130px\u00bb height_last_edited=\u00bbon|phone\u00bb custom_margin_tablet=\u00bb\u00bb custom_margin_phone=\u00bb-17px||||false|false\u00bb custom_margin_last_edited=\u00bbon|phone\u00bb custom_padding=\u00bb0vw||0vw||true|false\u00bb collapsed=\u00bbon\u00bb global_colors_info=\u00bb{%22gcid-primary-color%22:%91%22quote_text_color%22,%22background_color_gradient_stops%22%93}\u00bb][et_pb_row _builder_version=\u00bb4.27.4″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.27.0″ _module_preset=\u00bbdefault\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_text _builder_version=\u00bb4.27.4″ _module_preset=\u00bbdefault\u00bb text_text_color=\u00bb#FFFFFF\u00bb header_2_text_color=\u00bb#FFFFFF\u00bb custom_padding=\u00bb1px|||||\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n

Editoriales R3i<\/h2>\n

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Abril 2021<\/span><\/h5>\n
S\u00edndrome metab\u00f3lico y COVID-19<\/span><\/h5>\n
Prof. Jean-Charles Fruchart, Prof. Michel Hermans, Prof. Pierre Amarenco<\/span><\/h6>\n

Desde los primeros casos de infecci\u00f3n por SARS-CoV-2 asociados con la enfermedad respiratoria grave de COVID-19 en Wuhan, China, el mundo ha estado atravesando momentos singularmente inciertos. El r\u00e1pido surgimiento de esta pandemia ha suscitado investigaciones intensivas de los principales factores de riesgo, las estrategias de atenci\u00f3n y tratamientos terap\u00e9uticos innovadores para el COVID-19 grave.<\/p>\n

Uno de los \u00e9nfasis principales de los estudios ha sido el riesgo que plantean los factores metab\u00f3licos, respaldados por evidencia de que las personas obesas o con diabetes tienen un riesgo mayor de desenlaces adversos relacionados con el COVID-19 1,2. Tanto la obesidad como la diabetes suponen un mayor riesgo de mortalidad relacionada con el COVID-19 3,4, que se ve acentuado adem\u00e1s por la edad 4,5. Dado que la disfunci\u00f3n metab\u00f3lica subyacente \u2014representada por el s\u00edndrome metab\u00f3lico\u2014 es com\u00fan entre los pacientes obesos o diab\u00e9ticos, es prioritario identificar cu\u00e1les de estos factores est\u00e1n vinculados con los desenlaces adversos.<\/p>\n

La dislipidemia ha sido un elemento al cual prestarle atenci\u00f3n, puesto que se han presentado datos que indican disminuciones en el colesterol total, el colesterol de lipoprote\u00edna de baja densidad (C-LDL) y el colesterol de lipoprote\u00edna de alta densidad (C-HDL), junto con efectos variables en los triglic\u00e9ridos, en pacientes con COVID-19 grave 6,7. Para profundizar esta investigaci\u00f3n, Hilser y colegas estudiaron si los niveles previos a la infecci\u00f3n de C-HDL y triglic\u00e9ridos tienen un rol causal en las consecuencias del COVID-19, con datos de UK Biobank 8. Como se analiz\u00f3 en el art\u00edculo de Enfoque de este mes, los niveles de C-HDL previos a la infecci\u00f3n parec\u00edan tener un efecto protector del riesgo de infecci\u00f3n grave, con un aumento de 10 mg\/dl en los niveles de C-HDL (a partir de la mediana) asociado con ~10 % de reducci\u00f3n del riesgo de infecci\u00f3n por SARS-CoV-2. El riesgo de mortalidad por COVID-19 tambi\u00e9n era superior con niveles de C-HDL m\u00e1s bajos antes de la infecci\u00f3n. No obstante, no hab\u00eda relaci\u00f3n entre los niveles de triglic\u00e9ridos previos a la infecci\u00f3n y el riesgo de COVID-19 grave 8, en comparaci\u00f3n con otros informes 9.<\/p>\n

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\u00bfEl efecto protector de la concentraci\u00f3n m\u00e1s elevada de C-HDL es causal? Con un dise\u00f1o con aleatorizaci\u00f3n mendeliana, Hisler y colegas no lograron demostrar ninguna asociaci\u00f3n entre los niveles de C HDL m\u00e1s elevados gen\u00e9ticamente y el riesgo de infecci\u00f3n por SARS-CoV-2 8. Sin embargo, hay respaldo s\u00f3lido de otros estudios que involucran muestras mucho m\u00e1s amplias que muestran una relaci\u00f3n causal entre el C-HDL y la infecci\u00f3n (10,11). Por cierto, estos resultados est\u00e1n en sinton\u00eda con el conocimiento actual de la funcionalidad inmunoinflamatoria de la HDL 12 y su rol en la modulaci\u00f3n de la inmunidad innata y adaptativa para aumentar la resistencia a la infecci\u00f3n viral y los efectos antivirales, incluso contra el SARS-CoV-2 (12-14).<\/p>\n

La posible vinculaci\u00f3n de los triglic\u00e9ridos con el riesgo de COVID-19 grave justifica estudios adicionales.<\/p>\n

Con el avance de esta pandemia, se ha hecho evidente que las particularidades del s\u00edndrome metab\u00f3lico, incluida la obesidad y la disglucemia, predisponen a un aumento del riesgo de complicaciones graves de COVID-19. La pandemia de la obesidad y la diabetes son, por tanto, causales de desenlaces adversos del COVID-19, con consecuencias devastadoras para las personas, los sistemas sanitarios y las sociedades. Dado lo que ya se sabe sobre los or\u00edgenes \u00e9tnicos, la precariedad econ\u00f3mica y la susceptibilidad a enfermedad cardiometab\u00f3lica, no es sorprendente que el riesgo de infecci\u00f3n por SARS-CoV-2 y COVID-19 grave sea mayor entre la minor\u00eda \u00e9tnica y los grupos socioecon\u00f3micos m\u00e1s vulnerables. Con esta \u00abtormenta perfecta\u00bb magnificada por la crisis en la salud p\u00fablica suscitada por el COVID-19, es prioritario tomar medidas urgentes para abordar disparidades existentes en la prevalencia y las consecuencias de la diabetes tipo 2, la obesidad y el s\u00edndrome metab\u00f3lico.<\/p>\n

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Referencias<\/strong><\/p>\n

    \n
  1. Apicella M, Campopiano MC, Mantuano M, et al. COVID-19 in people with diabetes: understanding the reasons for worse outcomes. Lancet Diabetes Endocrinol 2020;8:782\u201392.
    2. Centers for Disease Control and Prevention. COVID-19: People with Certain Medical Conditions https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/need-extra-precautions\/people-with-medical-conditions.html<\/a>. (19 de marzo de 2021)
    3. Tartof SY, Qian L, Hong V, et al. Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization. Ann Intern Med 2020;173:773\u201381.
    4. Barron E, Bakhai C, Kar P, et al. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. Lancet Diabetes Endocrinol 2020;8:813-22.
    5. Holman N, Knighton P, Kar P, et al. Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. Lancet Diabetes Endocrinol 2020;8:823-833.
    6. Tanaka S, De Tymowski C, Assadi M, et al. Lipoprotein concentrations over time in the intensive care unit COVID-19 patients: Results from the ApoCOVID study. PLoS One 2020;15:e0239573.
    7. Wei X, Zeng W, Su J, et al. Hypolipidemia is associated with the severity of COVID-19 2020. J Clin Lipidol 14: 297-304.
    8. Hilser JR, Han Y, Biswas S et al. Association of serum HDL cholesterol and apolipoprotein A1 levels with risk of severe SARS-CoV-2 infection. J Lipid Res 2021; doi: 10.1016\/j.jlr.2021.100061.
    9. Zhang Y, Yang H, Li S, et al. Association analysis framework of genetic and exposure risks for COVID-19 in middle-aged and elderly adults. Mech Ageing Dev 2021;194: 111433.
    10. Madsen CM, Varbo A, Tybjaerg-Hansen A, et al. U-shaped relationship of HDL and risk of infectious disease: two prospective population-based cohort studies. Eur Heart J 2018;9:1181-90.
    11. Trinder M, Walley KR, Boyd JH, Brunham LR. Causal inference for genetically determined levels of high-density lipoprotein cholesterol and risk of infectious disease. Arterioscler Thromb Vasc Biol 2020;40: 267-78.
    12. Catapano AL, Pirillo A, Bonacina F, et al. HDL in innate and adaptive immunity. Cardiovascular Res 2014;103: 372-83.
    13. Singh IP, Chopra AK, Coppenhaver DH, Ananatharamaiah GM, Baron S. Lipoproteins account for part of the broad non-specific antiviral activity of human serum. Antiviral Res 1999;42:211-8.
    14. Cho KH, Kim JR, Lee IC, Kwon HJ. Native high-density lipoproteins (HDL) with higher paraoxonase exerts a potent antiviral effect against SARS-CoV-2 (COVID-19), while glycated HDL lost the antiviral activity. Antioxidants (Basel) 2021;102:209.<\/li>\n<\/ol>\n

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