Hypolipidemia was found to be associated with coronavirus disease 2019 (COVID-19), and to worsen with disease severity, according to a study published in the Journal of Clinical Lipidology.
Organ dysfunctions have been observed in individuals with COVID-19, and it remains unclear whether these patients also develop dyslipidemia. In this study, researchers sought to investigate the pathological modifications of low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and total cholesterol (TC) and their relationships with COVID-19 severity.
In this retrospective study, the data of 597 patients with COVID-19 (51% men) who were treated at a single cancer center in Wuhan, China between February 1 and March 3, 2020, were examined. Patients were classified into 3 groups, according to COVID-19 severity: mild (n=394), severe (n=171), and critical (n=32). Age- and gender-matched healthy subjects (n=50; average age, 62; age range, 53-69 years) who had routine laboratory lipid tests conducted between October and November 2019, were included as the control group. Electronic data on demographic and epidemiologic factors, clinical symptoms and diagnosis, laboratory tests (including LDL-c, HDL-c, and TC serum levels), and treatments were analyzed.
The median age in this cohort was 66 years (interquartile range [IQR], 59-72). Patients with critical and severe COVID-19 were found to be older than those with mild cases (critical: median, 69 years; IQR, 61-83; severe: median, 69 years; IQR, 64-77; mild: median, 64 years; IQR, 53-69; P <.05).
The main symptoms at disease onset included fever, cough, fatigue, shortness of breath, which occurred in 59%, 38%, 13% and 9% of patients, respectively.
The levels of LDL-c, HDL-c and TC were found to be lower in patients with vs without COVID-19 (LDL-c: median, 88 mg/dL; IQR, 74-102 vs median, 110 mg/dL; IQR, 96-147, respectively; P <.001; HDL-c: median, 49 mg/dL; IQR, 41-58 vs median, 52 mg/dL; IQR, 40-65, respectively; P <.05; TC: median, 169 mg/dL; IQR, 143-199 vs median, 184 mg/dL; IQR, 166-221 mg/dL, respectively; P <.001).
In addition, there were significant and gradual reductions in the levels of LDL-c (P <.02) and TC (P <.05) in patients with COVID-19, from mild to critical severity. HDL-c levels were reduced in patients with critical COVID-19 (P <.05), but not with mild or severe cases. Lastly, levels of LDL-c and TC were found to inversely correlate with levels of C-reactive protein and interleukin-6, and to positively correlate with the number of lymphocytes in patients.
Limitations of the study include the analysis of data from different stages of the disease course, and the lack of monitoring of the dynamics of lipid profiles during the disease course.
“Collectively, our data demonstrate that the development of hypolipidemia can start in patients with mild symptoms. The degree of hypolipidemia positively correlates with the disease severity,” concluded the study authors.
Wei X, Zeng W, Su J, Wan H, Yu X, Cao X, et al. Hypolipidemia is associated with the severity of COVID-19 (published online April 30, 2020). J Clin Lipidol. doi:10.1016/j.jacl.2020.04.008