HDL cholesterol levels and susceptibility to COVID-19
Vignesh Chidambaram,
Amudha Kumar,
Marie Gilbert Majella,
Bhavna Seth,
Ranjith Kumar Sivakumar,
Dinesh Voruganti,
Mahesh Bavineni,
Ahmad Baghal,
Kim Gates,
Annu Kumari,
Subhi J. Al'Aref,
Panagis Galiatsatos,
Petros C. Karakousis,
Jawahar L. Mehta
Affiliations
Vignesh Chidambaram
Department of Internal Medicine, University of Arkansas for Medical Sciences, AR, USA
Amudha Kumar
Department of Internal Medicine, University of Arkansas for Medical Sciences, AR, USA
Marie Gilbert Majella
Department of Community Medicine, Sri Venkateshwaraa Medical College Hospital & Research Centre, Pondicherry, India
Bhavna Seth
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
Ranjith Kumar Sivakumar
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
Dinesh Voruganti
Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Mahesh Bavineni
Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Ahmad Baghal
Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Kim Gates
Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Annu Kumari
Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Subhi J. Al'Aref
Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Panagis Galiatsatos
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
Petros C. Karakousis
Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Jawahar L. Mehta
Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Division of Cardiovascular Medicine, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA; Corresponding author at: Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Summary: Background: Host cell-membrane cholesterol, an important player in viral infections, is in constant interaction with serum high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C). Low serum lipid levels during hospital admission are associated with COVID-19 severity. However, the effect of antecedent serum lipid levels on SARS-CoV-2 infection risk has not been explored. Methods: From our retrospective cohort from the Arkansas Clinical Data-Repository, we used log-binomial regression to assess the risk of SARS-CoV-2 infection among the trajectories of lipid levels during the 2 years antecedent to COVID-19 testing, identified using group-based-trajectory modelling. We used mixed-effects linear regression to assess the serum lipid level trends followed up to the time of, and 2-months following COVID-19 testing. Findings: Among the 11001 individuals with a median age of 59 years (IQR 46-70), 1340 (12.2%) tested positive for COVID-19. The highest trajectory for antecedent serum HDL-C was associated with the lowest SARS-CoV-2 infection risk (RR 0.63, 95%CI 0.46-0.86). Antecedent serum LDL-C, total cholesterol (TC), and triglycerides (TG) were not independently associated with SARS-CoV-2 infection risk. In COVID-19 patients, serum HDL-C (-7.7, 95%CI -9.8 to -5.5 mg/dL), and LDL-C (-6.29, 95%CI -12.2 to -0.37 mg/dL), but not TG levels, decreased transiently at the time of testing. Interpretation: Higher antecedent serum HDL-C, but not LDL-C, TC, or TG, levels were associated with a lower SARS-CoV-2 infection risk. Serum HDL-C, and LDL-C levels declined transiently at the time of infection. Further studies are needed to determine the potential role of lipid-modulating therapies in the prevention and management of COVID-19. Funding: Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1 TR003107.
