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Horm Metab Res 2022; 54(08): 514-521
DOI: 10.1055/a-1860-2610
Review

COVID-19 and Lipid Disorders

Ulrich Julius
1   Lipidology and Center for Extracorporeal Therapy, Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
Ulrike Schatz
1   Lipidology and Center for Extracorporeal Therapy, Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
Sergey Tselmin
1   Lipidology and Center for Extracorporeal Therapy, Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
Henning Morawietz
2   Division of Vascular Endothelium and Microcirculation, Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Abstract

An elevated cholesterol concentration has been suspected to increase the susceptibility for SARS-COV-2 infection. Cholesterol plays a central role in the mechanisms of the SARS-COV-2 infection. In contrast, higher HDL-cholesterol levels seem to be protective. During COVID-19 disease, LDL-cholesterol and HDL-cholesterol appear to be decreased. On the other hand, triglycerides (also in different lipoprotein fractions) were elevated. Lipoprotein(a) may increase during this disease and is most probably responsible for thromboembolic events. This lipoprotein can induce a progression of atherosclerotic lesion formation. The same is suspected for the SARS-COV-2 infection itself. COVID-19 patients are at increased risk of incident cardiovascular diseases, including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure, and thromboembolic disorders. An ongoing lipid-lowering therapy, including lipoprotein apheresis, is recommended to be continued during the COVID-19 disease, though the impact of lipid-lowering drugs or the extracorporeal therapy on prognosis should be studied in further investigations.

Key words

cardiovascular diseases - COVID-19 - high-density lipoprotein - lipid-lowering therapy - lipoprotein(a) - low-density lipoprotein


Publication History

Received: 17 March 2022

Accepted after revision: 12 May 2022

Article published online:
14 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Katsoularis I, Fonseca-Rodriguez O, Farrington P. et al. Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study. Lancet 2021; 398: 599-607
    CrossrefPubMedSearch in Google Scholar
  • 2 Xie Y, Xu E, Bowe B. et al. Long-term cardiovascular outcomes of COVID-19. Nat Med 2022; 28: 583-590
    CrossrefPubMedSearch in Google Scholar
  • 3 Cure E, Cumhur Cure M. Strong relationship between cholesterol, low-density lipoprotein receptor, Na(+)/H(+) exchanger, and SARS-COV-2: this association may be the cause of death in the patient with COVID-19. Lipids Health Dis 2021; 20: 179
    CrossrefPubMedSearch in Google Scholar
  • 4 Hofmann A, Brunssen C, Wolk S. et al. Soluble LOX-1: a novel biomarker in patients with coronary artery disease, stroke, and acute aortic dissection?. J Am Heart Assoc 2020; 9: e013803
    CrossrefPubMedSearch in Google Scholar
  • 5 Punch E, Klein J, Diaba-Nuhoho P. et al. Effects of PCSK9 targeting: alleviating oxidation, inflammation, and atherosclerosis. J Am Heart Assoc 2022; 11: e023328
    CrossrefPubMedSearch in Google Scholar
  • 6 Feingold KR. Lipid and lipoprotein levels in patients with COVID-19 infections. In: Feingold KR, Anawalt B, Boyce A et al. (eds), Endotext. South Dartmouth (MA). 2020
    Search in Google Scholar
  • 7 Morawietz H, Julius U, Bornstein SR. Cardiovascular diseases, lipid-lowering therapies and European registries in the COVID-19 pandemic. Cardiovasc Res 2020; 116: e122-e125
    CrossrefPubMedSearch in Google Scholar
  • 8 Bornstein SR, Voit-Bak K, Schmidt D. et al. Is there a role for environmental and metabolic factors predisposing to severe COVID-19?. Horm Metab Res 2020; 52: 540-546
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Demiray A, Kanbay A, Kanbay M. Long-term effect of COVID-19 infection on hemodialysis patients: should we follow hemodialysis patients more closely?. Clin Kidney J 2022; 15: 369-371
    CrossrefPubMedSearch in Google Scholar
  • 10 Stumpf J, Siepmann T, Lindner T. et al. Humoral and cellular immunity to SARS-CoV-2 vaccination in renal transplant versus dialysis patients: a prospective, multicenter observational study using mRNA-1273 or BNT162b2 mRNA vaccine. Lancet Reg Health Eur 2021; 9: 100178
    CrossrefPubMedSearch in Google Scholar
  • 11 Sarmadi M, Ahmadi-Soleimani SM, Fararouei M. et al. COVID-19, body mass index and cholesterol: an ecological study using global data. BMC Public Health 2021; 21: 1712
    CrossrefPubMedSearch in Google Scholar
  • 12 Vuorio A, Kovanen PT, Santos RD. et al. Prevention of cardiovascular burden in COVID-19 patients suffering from familial hypercholesterolemia: a global challenge. Cardiol Ther 2021; 11: 1-7
    CrossrefPubMedSearch in Google Scholar
  • 13 Myers KD, Wilemon K, McGowan MP. et al. COVID-19 associated risks of myocardial infarction in persons with familial hypercholesterolemia with or without ASCVD. Am J Prev Cardiol 2021; 7: 100197
    CrossrefPubMedSearch in Google Scholar
  • 14 Scalsky RJ, Chen YJ, Desai K. et al. Baseline cardiometabolic profiles and SARS-CoV-2 infection in the UK biobank. PLoS One 2021; 16: e0248602
    CrossrefPubMedSearch in Google Scholar
  • 15 Sun Y, Chatterjee R, Ronanki A. et al. Circulating polyunsaturated fatty acids and COVID-19: a prospective cohort study and Mendelian randomization analysis. medRxiv 2022;
    CrossrefPubMedSearch in Google Scholar
  • 16 Salabei JK, Asnake ZT, Ismail ZH. et al. COVID-19 and the cardiovascular system: an update. Am J Med Sci 2022; S0002-9629(22)00069-6
    CrossrefPubMedSearch in Google Scholar
  • 17 Henein MY, Cameli M, Pastore MC. et al. COVID-19 severity and cardiovascular disease: an inseparable link. J Clin Med 2022; 11: 479
    CrossrefPubMedSearch in Google Scholar
  • 18 Youn JY, Zhang Y, Wu Y. et al. Therapeutic application of estrogen for COVID-19: attenuation of SARS-CoV-2 spike protein and IL-6 stimulated, ACE2-dependent NOX2 activation, ROS production and MCP-1 upregulation in endothelial cells. Redox Biol 2021; 46: 102099
    CrossrefPubMedSearch in Google Scholar
  • 19 Catar R, Chen L, Zhao H. et al. Native and oxidized low-density lipoproteins increase the expression of the LDL receptor and the LOX-1 receptor, respectively, in arterial endothelial cells. Cells 2022; 11: 204
    CrossrefPubMedSearch in Google Scholar
  • 20 Catar RA, Muller G, Heidler J. et al. Low-density lipoproteins induce the renin-angiotensin system and their receptors in human endothelial cells. Horm Metab Res 2007; 39: 801-805
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Montiel V, Lobysheva I, Gerard L. et al. Oxidative stress-induced endothelial dysfunction and decreased vascular nitric oxide in COVID-19 patients. EBioMedicine 2022; 77: 103893
    CrossrefPubMedSearch in Google Scholar
  • 22 Hofmann A, Brunssen C, Morawietz H. Contribution of lectin-like oxidized low-density lipoprotein receptor-1 and LOX-1 modulating compounds to vascular diseases. Vascul Pharmacol 2018; 107: 1-11
    CrossrefPubMedSearch in Google Scholar
  • 23 Hu X, Chen D, Wu L. et al. Declined serum high density lipoprotein cholesterol is associated with the severity of COVID-19 infection. Clin Chim Acta 2020; 510: 105-110
    CrossrefPubMedSearch in Google Scholar
  • 24 Zinellu A, Paliogiannis P, Fois AG. et al. Cholesterol and triglyceride concentrations, COVID-19 severity, and mortality: a systematic review and meta-analysis with meta-regression. Front Public Health 2021; 9: 705916
    CrossrefPubMedSearch in Google Scholar
  • 25 Zhao M, Luo Z, He H. et al. Decreased low-density lipoprotein cholesterol level indicates poor prognosis of severe and critical COVID-19 patients: a retrospective, single-center study. Front Med (Lausanne) 2021; 8: 585851
    CrossrefPubMedSearch in Google Scholar
  • 26 Wang G, Deng J, Li J. et al. The role of high-density lipoprotein in COVID-19. Front Pharmacol 2021; 12: 720283
    CrossrefPubMedSearch in Google Scholar
  • 27 Wang Y, Zhang J, Li H. et al. Prognostic value of leucocyte to high-density lipoprotein-cholesterol ratios in COVID-19 patients and the diabetes subgroup. Front Endocrinol (Lausanne) 2021; 12: 727419
    CrossrefPubMedSearch in Google Scholar
  • 28 Aparisi A, Iglesias-Echeverria C, Ybarra-Falcon C. et al. Low-density lipoprotein cholesterol levels are associated with poor clinical outcomes in COVID-19. Nutr Metab Cardiovasc Dis 2021; 31: 2619-2627
    CrossrefPubMedSearch in Google Scholar
  • 29 Masana L, Correig E, Ibarretxe D. et al. Low HDL and high triglycerides predict COVID-19 severity. Sci Rep 2021; 11: 7217
    CrossrefPubMedSearch in Google Scholar
  • 30 Bruzzone C, Bizkarguenaga M, Gil-Redondo R. et al. SARS-CoV-2 infection dysregulates the metabolomic and lipidomic profiles of serum. iScience 2020; 23: 101645
    CrossrefPubMedSearch in Google Scholar
  • 31 Schmelter F, Foh B, Mallagaray A. et al. Metabolic and lipidomic markers differentiate COVID-19 from non-hospitalized and other intensive care patients. Front Mol Biosci 2021; 8: 737039
    CrossrefPubMedSearch in Google Scholar
  • 32 Valdes A, Moreno LO, Rello SR. et al. Metabolomics study of COVID-19 patients in four different clinical stages. Sci Rep 2022; 12: 1650
    CrossrefPubMedSearch in Google Scholar
  • 33 Lippi G, Szergyuk I, de Oliveira MHS. et al. The role of lipoprotein(a) in coronavirus disease 2019 (COVID-19) with relation to development of severe acute kidney injury. J Thromb Thrombolysis 2022; 53: 581-585
    CrossrefPubMedSearch in Google Scholar
  • 34 Vuorio A, Kaste M, Kovanen PT. Elevated lipoprotein(a) and cerebral venous sinus thrombosis in COVID-19. J Stroke Cerebrovasc Dis 2021; 30: 105865
    CrossrefPubMedSearch in Google Scholar
  • 35 Nurmohamed NS, Collard D, Reeskamp LF. et al. Lipoprotein(a), venous thromboembolism and COVID-19: A pilot study. Atherosclerosis 2021; 341: 43-49
    CrossrefPubMedSearch in Google Scholar
  • 36 Moriarty PM, Gorby LK, Stroes ES. et al. Lipoprotein(a) and its potential association with thrombosis and inflammation in COVID-19: a testable hypothesis. Curr Atheroscler Rep 2020; 22: 48
    CrossrefPubMedSearch in Google Scholar
  • 37 Evans PC, Rainger GE, Mason JC. et al. Endothelial dysfunction in COVID-19: a position paper of the ESC working group for atherosclerosis and vascular biology, and the ESC council of basic cardiovascular science. Cardiovasc Res 2020; 116: 2177-2184
    CrossrefPubMedSearch in Google Scholar
  • 38 Task Force for the management of COVID-19 of the European Society of Cardiology. European society of cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. Cardiovasc Res 2021;
    CrossrefPubMedSearch in Google Scholar
  • 39 Iqbal Z, Ho JH, Adam S. et al. Managing hyperlipidaemia in patients with COVID-19 and during its pandemic: An expert panel position statement from HEART UK. Atherosclerosis 2020; 313: 126-136
    CrossrefPubMedSearch in Google Scholar
  • 40 Muller G, Morawietz H. NAD(P)H oxidase and endothelial dysfunction. Horm Metab Res 2009; 41: 152-158
    Thieme ConnectPubMedSearch in Google Scholar
  • 41 Kovanen PT, Raal F, Vuorio A. Patients with familial hypercholesterolemia and COVID-19: Efficient and ongoing cholesterol lowering is paramount for the prevention of acute myocardial infarction. Am J Prev Cardiol 2021; 7: 100224
    CrossrefPubMedSearch in Google Scholar
  • 42 Audrey J, Wisnu W, Tahapary DL. Association between statin use and poor outcomes in COVID-19 patients with diabetes mellitus: a systematic review. Curr Diabetes Rev 2022; Online ahead of print
    CrossrefPubMedSearch in Google Scholar
  • 43 Vinciguerra M, Romiti S, Sangiorgi GM. et al. SARS-CoV-2 and atherosclerosis: should COVID-19 be recognized as a new predisposing cardiovascular risk factor?. J Cardiovasc Dev Dis 2021; 8: 130
    CrossrefPubMedSearch in Google Scholar
  • 44 Tan WYT, Young BE, Lye DC. et al. Statin use is associated with lower disease severity in COVID-19 infection. Sci Rep 2020; 10: 17458
    CrossrefPubMedSearch in Google Scholar
  • 45 Byttebier G, Belmans L, Alexander M. et al. Hospital mortality in COVID-19 patients in Belgium treated with statins, ACE inhibitors and/or ARBs. Hum Vaccin Immunother 2021; 17: 2841-2850
    CrossrefPubMedSearch in Google Scholar
  • 46 Almeida SO, Budoff M. Effect of statins on atherosclerotic plaque. Trends Cardiovasc Med 2019; 29: 451-455
    CrossrefPubMedSearch in Google Scholar
  • 47 Vuorio A, Raal F, Klingel R. et al. Why continued lipoprotein apheresis is vital for homozygous familial hypercholesterolemia patients with COVID-19. J Clin Lipidol 2021; 15: 379-380
    CrossrefPubMedSearch in Google Scholar