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For most patients who test positive for COVID-19, symptoms improve or resolve within days or weeks. However, recent data indicates that more than 40% of US adults reported having COVID-19 in the past, and of those adults, nearly one in five continue to experience symptoms.^1,2 When COVID-19 symptoms persist beyond three months, or twelve weeks from the onset of infection, and they cannot be explained by alternative or prior diagnoses, this is known as long COVID or post-COVID-19 condition, according to the World Health Organization.³

Reported symptoms of long COVID vary in number and degree but often include fatigue, memory and concentration problems, sleep disturbances, joint pain, anxiety and depression, labored breathing, and chest pain.^4-7 Studies also continue to indicate associations with new-onset cardiometabolic disorders for some patients with post-COVID condition.^8-10 How might an increased risk of new-onset type 2 diabetes or persistent cardiovascular symptoms after a COVID-19 infection impact your patients’ post-COVID clinical care?

Potential Impacts on Heart and Metabolic Health

During the acute phase of COVID-19, and following an acute COVID infection, an increased incidence of cardiometabolic disorders from type 2 diabetes to cardiovascular diseases such as hypertension has been reported in observational studies.^11-13 Specific to long COVID, new research continues to elucidate potential cardiometabolic health impacts. A large 2022 meta-analysis of four observational studies (n=5,787,027) found a 59% higher risk of developing incident diabetes during post-COVID-19, and the majority of studies had a median follow-up period of approximately four months.¹⁴ A smaller 2022 Chinese cohort study followed 534 COVID-19 hospitalized patients for a median time of 460 days and compared outcomes between severe COVID-19 cases (n=114) and non-severe cases (n=420).¹⁵ Sleep disturbance and fatigue were the most common persistent symptoms across both groups, with approximately 17-18% of the patients reporting these impacts. In addition, at the 15-month follow-up, 3.56% of all included study participants (2.86% of non-severe cases and 6.14% of severe cases) without previous history of diabetes were found to have a new fasting blood glucose above 7 mmol/L (126 mg/dL) or HbA1c levels greater than or equal to 6.5%.¹⁵ Noted limitations of this preliminary study included a lack of data from outpatients for outcome comparisons and reduced generalizability due to the single-center study design.

Specific to heart health, a 2022 systematic review of 67 original studies found that for some patients, the reported long-lasting effects of COVID-19 included myocardial inflammation, abnormal cardiac MRI findings, increased resting heart rate, and palpitations.¹⁶ In addition, a 2022 systematic review investigated residual clinical signs associated with potential cardiovascular and metabolic disorders after a COVID-19 infection.¹⁷ Using descriptive statistics only, researchers summarized several cardiovascular outcomes experienced by some patients who also experienced common long-COVID symptoms.¹⁷

• Elevation in systolic blood pressure one to three months after recovery was reported for some patients.
• Compared to patients who had a milder infection, some patients who were hospitalized had significant increases in triglycerides, LDL-C, and total cholesterol levels three to six months after they were discharged from hospital care.
• Several months after their initial COVID-19 infection, some patients showed continuous hyperglycemia.

Studies have highlighted that multiple organs and body systems are impacted by COVID-19 infection.¹⁸ However, long-COVID research is a developing area of investigation, with many details not yet fully known, and mechanisms that explain potential development of new-onset cardiometabolic disorders for some patients after acute COVID-19 infection or those with long COVID continue to be explored.^19,20

Conclusion

As additional research clarifies possible links between long COVID and new onsets of cardiometabolic disorders, monitoring patients for long-term cardiometabolic consequences after a COVID-19 infection may be appropriate. Alterations in glucose levels, blood pressure, and lipid profiles may inform a patient’s post-COVID clinical care, and a personalized therapeutic approach helps to address those factors most important for an individual patient’s recovery and continued health.

IFM has assembled a wealth of COVID-related resources for functional medicine clinicians, including clinical recommendations and mechanisms of action; virus-specific nutraceuticals and botanical agents, nutrition, and lifestyle practices for strengthening host defense; practice considerations; testing; and COVID-19 vaccines.

To learn more about cardiometabolic disorders and effective, lifestyle-based therapeutic strategies, hear from functional medicine experts at IFM’s upcoming Cardiometabolic Advanced Practice Module (APM).

Related Articles

Gastrointestinal Involvement in COVID-19: Research & Interventions

Mitochondrial Impairment in Long COVID-19

The Right Food Plan for Cardiometabolic Patients

Lifestyle Interventions to Modify Cardiovascular Disease Risk

References

1. National Center for Health Statistics. Nearly one in five American adults who have had COVID-19 still have “long COVID.” Centers for Disease Control and Prevention. Reviewed June 22, 2022. Accessed October 5, 2023. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220622.htm
2. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. Post-COVID conditions: information for healthcare providers. Centers for Disease Control and Prevention. Updated September 11, 2023. Accessed October 5, 2023. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-conditions.html
3. World Health Organization. Post COVID-19 condition. Published June 23, 2022. October 5, 2023. https://www.who.int/teams/health-care-readiness/post-covid-19-condition
4. Chen C, Haupert SR, Zimmermann L, Shi X, Fritsche LG, Mukherjee B. Global prevalence of post-coronavirus disease 2019 (COVID-19) condition or long COVID: a meta-analysis and systematic review. J Infect Dis. 2022;226(9):1593-1607. doi:1093/infdis/jiac136
5. Peter RS, Nieters A, Kräusslich HG, et al. Post-acute sequelae of COVID-19 six to 12 months after infection: population based study. BMJ. 2022;379:e071050. doi:1136/bmj-2022-071050
6. Barreto APA, Barreto Filho MA, Duarte LC, et al. Metabolic disorders and post-acute hospitalization in Black/mixed-race patients with long COVID in Brazil: a cross-sectional analysis. PLoS One. 2022;17(10):e0276771. doi:1371/journal.pone.0276771
7. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. Long COVID or post-COVID conditions. Centers for Disease Control and Prevention. Updated July 20, 2023. Accessed October 5, 2023. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
8. Rathmann W, Kuss O, Kostev K. Incidence of newly diagnosed diabetes after COVID-19. Diabetologia. 2022;65(6):949-954. doi:1007/s00125-022-05670-0
9. Matsumoto C, Shibata S, Kishi T, et al. Long COVID and hypertension-related disorders: a report from the Japanese Society of Hypertension Project Team on COVID-19. Hypertens Res. 2023;46(3):601-619. doi:1038/s41440-022-01145-2
10. Harding JL, Oviedo SA, Ali MK, et al. The bidirectional association between diabetes and long-COVID-19 – a systematic review. Diabetes Res Clin Pract. 2023;195:110202. doi:1016/j.diabres.2022.110202
11. Rezel-Potts E, Douiri A, Sun X, Chowienczyk PJ, Shah AM, Gulliford MC. Cardiometabolic outcomes up to 12 months after COVID-19 infection. A matched cohort study in the UK. PLoS Med. 2022;19(7):e1004052. doi:1371/journal.pmed.1004052
12. Vyas P, Joshi D, Sharma V, et al. Incidence and predictors of development of new onset hypertension post COVID-19 disease. Indian Heart J. 2023;75(5):347-351. doi:1016/j.ihj.2023.06.002
13. Lai H, Yang M, Sun M, et al. Risk of incident diabetes after COVID-19 infection: a systematic review and meta-analysis. Metabolism. 2022;137:155330. doi:1016/j.metabol.2022.155330
14. Banerjee M, Pal R, Dutta S. Risk of incident diabetes post-COVID-19: a systematic review and meta-analysis. Prim Care Diabetes. 2022;16(4):591-593. doi:1016/j.pcd.2022.05.009
15. Sun LL, Wang J, Wang YS, et al. 15-month health outcomes and the related risk factors of hospitalized COVID-19 patients from onset: a cohort study. Front Med (Lausanne). 2022;9:854788. doi:3389/fmed.2022.854788
16. Akbarialiabad H, Taghrir MH, Abdollahi A, et al. Long COVID, a comprehensive systematic scoping review. Infection. 2021;49(6):1163-1186. doi:1007/s15010-021-01666-x
17. Wrona M, Skrypnik D. New-onset diabetes mellitus, hypertension, dyslipidaemia as sequelae of COVID-19 infection—systematic review. Int J Environ Res Public Health. 2022;19(20):13280. doi:3390/ijerph192013280
18. Menezes RG, Rizwan T, Saad Ali S, et al. Postmortem findings in COVID-19 fatalities: a systematic review of current evidence. Leg Med (Tokyo). 2022;54:102001. doi:1016/j.legalmed.2021.102001
19. Cao H, Baranova A, Wei X, Wang C, Zhang F. Bidirectional causal associations between type 2 diabetes and COVID-19. J Med Virol. 2023;95(1):e28100. doi:1002/jmv.28100
20. Chourasia P, Goyal L, Kansal D, et al. Risk of new-onset diabetes mellitus as a post-COVID-19 condition and possible mechanisms: a scoping review. J Clin Med. 2023;12(3):1159. doi:3390/jcm12031159