The bidirectional link between HDL and COVID-19 infections
Kenneth R. Feingold
Abstract
It is well recognized that gram positive and negative bacterial infections, tuberculosis, fungal infections, and parasitic infections result in changes in plasma lipid levels (1Alvarez C. Ramos A. Lipids, lipoproteins, and apoproteins in serum during infection.Clin. Chem. 1986; 32: 142-145Crossref PubMed Scopus (245) Google Scholar, 2Cappi S.B. Noritomi D.T. Velasco I.T. Curi R. Loureiro T.C.A. Soriano F.G. Dyslipidemia: a prospective controlled randomized trial of intensive glycemic control in sepsis.Intensive Care Med. 2012; 38: 634-641Crossref PubMed Scopus (22) Google Scholar, 3Gallin J.I. Kaye D. O'Leary W.M. Serum lipids in infection.N. Engl. J. Med. 1969; 281: 1081-1086Crossref PubMed Scopus (282) Google Scholar, 4Gordon B.R. Parker T.S. Levine D.M. Saal S.D. Wang J.C.L. Sloan B.-J. Barie P.S. Rubin A.L. Low lipid concentrations in critical illness.Critical Care Medicine. 1996; 24: 584-589Crossref PubMed Scopus (154) Google Scholar, 5Kerttula Y. Weber T.H. 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Care Med. 2003; 31: 1359-1366Crossref PubMed Scopus (270) Google Scholar). With recovery from infection, the alterations in plasma lipid levels return toward the baseline. The greater the severity of the infection, the greater the decrease in total cholesterol, LDL-C, and HDL-C levels (16Deniz O. Gumus S. Yaman H. Ciftci F. Ors F. Cakir E. Tozkoparan E. Bilgic H. Ekiz K. Serum total cholesterol, HDL-C and LDL-C concentrations significantly correlate with the radiological extent of disease and the degree of smear positivity in patients with pulmonary tuberculosis.Clin. Biochem. 2007; 40: 162-166Crossref PubMed Scopus (62) Google Scholar, 17Deniz O. Tozkoparan E. Yaman H. Cakir E. Gumus S. Ozcan O. Bozlar U. Bilgi C. Bilgic H. Ekiz K. Serum HDL-C levels, log (TG/HDL-C) values and serum total cholesterol/HDL-C ratios significantly correlate with radiological extent of disease in patients with community-acquired pneumonia.Clin. 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It is estimated that approximately 80% of COVID-19 infections are either asymptomatic or result in only mild symptoms, but in a significant percentage of patients, the infection leads to a severe respiratory illness requiring hospital care and respiratory support (26Gandhi R.T. Lynch J.B. Del Rio C. Mild or moderate Covid-19.N. Engl. J. Med. 2020; 383: 1757-1766Crossref PubMed Scopus (900) Google Scholar, 27Berlin D.A. Gulick R.M. Martinez F.J. Severe Covid-19.N. Engl. J. Med. 2020; 383: 2451-2460Crossref PubMed Scopus (916) Google Scholar). As of January 20, 2021, there have been over 2 million deaths worldwide according to the John Hopkins Coronavirus Resource Center. Older age, obesity, diabetes, cardiovascular disease, hypertension, and male gender are some of the factors that increase the risk of severe infection and death (26Gandhi R.T. Lynch J.B. Del Rio C. Mild or moderate Covid-19.N. Engl. J. Med. 2020; 383: 1757-1766Crossref PubMed Scopus (900) Google Scholar, 27Berlin D.A. Gulick R.M. Martinez F.J. Severe Covid-19.N. Engl. J. Med. 2020; 383: 2451-2460Crossref PubMed Scopus (916) Google Scholar). As observed with other infections, numerous studies have reported a decrease in total cholesterol, LDL-C, and HDL-C levels and variable changes in triglycerides in patients with COVID-19 infections (28Fan J. Wang H. Ye G. Cao X. Xu X. Tan W. Zhang Y. Letter to the Editor: Low-density lipoprotein is a potential predictor of poor prognosis in patients with coronavirus disease 2019.Metabolism. 2020; 107: 154243Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar, 29Hu X. Chen D. Wu L. He G. Ye W. Declined serum high density lipoprotein cholesterol is associated with the severity of COVID-19 infection.Clin. Chim. Acta. 2020; 510: 105-110Crossref PubMed Scopus (100) Google Scholar, 30Tanaka S. De Tymowski C. Assadi M. Zappella N. Jean-Baptiste S. Robert T. Peoc'h K. Lortat-Jacob B. Fontaine L. Bouzid D. Tran-Dinh A. Tashk P. Meilhac O. Montravers P. 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Declined serum high density lipoprotein cholesterol is associated with the severity of COVID-19 infection.Clin. Chim. Acta. 2020; 510: 105-110Crossref PubMed Scopus (100) Google Scholar, 31Wei X. Zeng W. Su J. Wan H. Yu X. Cao X. Tan W. Wang H. Hypolipidemia is associated with the severity of COVID-19.J. Clin. Lipidol. 2020; 14: 297-304Abstract Full Text Full Text PDF PubMed Scopus (213) Google Scholar, 32Wang D. Li R. Wang J. Jiang Q. Gao C. Yang J. Ge L. Hu Q. Correlation analysis between disease severity and clinical and biochemical characteristics of 143 cases of COVID-19 in Wuhan, China: a descriptive study.BMC Infect. Dis. 2020; 20: 519Crossref PubMed Scopus (75) Google Scholar, 33Wang G. Zhang Q. Zhao X. Dong H. Wu C. Wu F. Yu B. Lv J. Zhang S. Wu G. Wu S. Wang X. Wu Y. Zhong Y. Low high-density lipoprotein level is correlated with the severity of COVID-19 patients: an observational study.Lipids Health Dis. 2020; 19: 204Crossref PubMed Scopus (92) Google Scholar, 34Zhang Q. Wei Y. Chen M. Wan Q. Chen X. Clinical analysis of risk factors for severe COVID-19 patients with type 2 diabetes.J. Diabetes Complications. 2020; 34: 107666Crossref PubMed Scopus (52) Google Scholar, 35Lv Z. Wang W. Qiao B. Cui X. Feng Y. Chen L. Ma Q. Liu X. The prognostic value of general laboratory testing in patients with COVID-19.J. Clin. Lab. Anal. 2020; 35e23668PubMed Google Scholar, 36Zhang B. Dong C. Li S. Song X. Wei W. Liu L. Triglyceride to high-density lipoprotein cholesterol ratio is an important determinant of cardiovascular risk and poor prognosis in coronavirus disease-19: a retrospective case series study.Diabetes Metab. Syndr. Obes. 2020; 13: 3925-3936Crossref PubMed Scopus (24) Google Scholar, 38Turgay Yildirim O. Kaya S. The atherogenic index of plasma as a predictor of mortality in patients with COVID-19.Heart Lung. 2021; 50: 329-333Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, C. H. Z. L. of lipid profile and value of lipids in the of the of hospital in COVID-19 pneumonia Sci. 2020; PubMed Scopus Google Scholar, W. Li C. Wang Z. Wang H. N. Jiang J. L. Zhang Wang Decreased serum level poor prognosis of COVID-19 patients: analysis from Sci. 2020; PubMed Scopus Google Scholar, Chen Z. P. Ge H. L. Yang F. Y. Wang W. Zhang M. J. Lipid profile and with disease severity and mortality in patients with Med. 2020; PubMed Scopus Google Scholar). LDL-C and HDL-C levels are correlated with protein levels, that the the levels, the lower the LDL-C or HDL-C level (28Fan J. Wang H. Ye G. Cao X. Xu X. Tan W. Zhang Y. Letter to the Editor: Low-density lipoprotein is a potential predictor of poor prognosis in patients with coronavirus disease 2019.Metabolism. 2020; 107: 154243Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar, 29Hu X. Chen D. Wu L. He G. Ye W. Declined serum high density lipoprotein cholesterol is associated with the severity of COVID-19 infection.Clin. Chim. Acta. 2020; 510: 105-110Crossref PubMed Scopus (100) Google Scholar, 31Wei X. Zeng W. Su J. Wan H. Yu X. Cao X. Tan W. Wang H. Hypolipidemia is associated with the severity of COVID-19.J. Clin. Lipidol. 2020; 14: 297-304Abstract Full Text Full Text PDF PubMed Scopus (213) Google Scholar, Chen Z. P. Ge H. L. Yang F. Y. Wang W. Zhang M. J. Lipid profile and with disease severity and mortality in patients with Med. 2020; PubMed Scopus Google Scholar). Low LDL-C HDL-C levels to the hospital predict an increased risk of a severe mortality observed in patients with total cholesterol, LDL-C, HDL-C levels to the and in patients, lipid levels to during the (28Fan J. Wang H. Ye G. Cao X. Xu X. Tan W. Zhang Y. Letter to the Editor: Low-density lipoprotein is a potential predictor of poor prognosis in patients with coronavirus disease 2019.Metabolism. 2020; 107: 154243Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar, 36Zhang B. Dong C. Li S. Song X. Wei W. Liu L. Triglyceride to high-density lipoprotein cholesterol ratio is an important determinant of cardiovascular risk and poor prognosis in coronavirus disease-19: a retrospective case series study.Diabetes Metab. Syndr. Obes. 2020; 13: 3925-3936Crossref PubMed Scopus (24) Google Scholar, 38Turgay Yildirim O. Kaya S. The atherogenic index of plasma as a predictor of mortality in patients with COVID-19.Heart Lung. 2021; 50: 329-333Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 41Ressaire Q. Dudoignon E. N. M. F. Low total cholesterol level is correlated with pulmonary severity in COVID-19 critical Crit. Care Med. 2020; 39: Full Text Full Text PDF PubMed Scopus Google Scholar, Rao Liu Zhong B. Chen X. changes in laboratory of and of with Infect. Dis. 2020; 20: PubMed Scopus Google Scholar, W. Li C. Wang Z. Wang H. N. Jiang J. L. Zhang Wang Decreased serum level poor prognosis of COVID-19 patients: analysis from Sci. 2020; PubMed Scopus Google Scholar, Chen Z. P. Ge H. L. 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This an increased risk of infection with high HDL-C Walley and also reported that and that decrease LDL-C levels were associated with an increase in mortality of sepsis K.R. Boyd J.H. Kong H.J. Russell J.A. Low low-density lipoprotein levels are associated but increased mortality in sepsis.Crit. Care Med. 2019; PubMed Scopus (24) Google Scholar). studies that HDL-C levels a in infections. the of the of Lipid Y. S. J. Z. R. A. J.A. H. of serum and apolipoprotein levels with risk of severe SARS-CoV-2 infection.J. Res. 2021; Full Text Full Text PDF PubMed Google the to the of HDL-C between and and the of COVID-19 infections in patients positive for COVID-19 with severe COVID-19 with patients negative for COVID-19 infections in either or hospital Results in the were and an analysis to cases a ratio of on age, obesity, hypertension, type 2 diabetes, and The of that increased HDL-C or apolipoprotein levels the of COVID-19 infections associated with a reduced risk of COVID-19 increase in HDL-C or apolipoprotein levels associated with reduced risk of COVID-19 an increased risk of death from COVID-19 infections also to HDL-C and apolipoprotein some increased triglyceride levels were also associated with an increased risk of COVID-19 infections. increased LDL-C and apolipoprotein B levels were associated with an increased risk of COVID-19 infections. HDL-C from COVID-19 infections the also the of increased HDL-C a risk on and but an of increased HDL-C levels and a decreased risk of COVID-19 infections. This to an be to the small of in with the studies of and which a between HDL-C and infections but a of studies or of studies are to there is a between HDL-C levels and the risk of COVID-19 infections. Y. S. J. Z. R. A. J.A. H. of serum and apolipoprotein levels with risk of severe SARS-CoV-2 infection.J. Res. 2021; Full Text Full Text PDF PubMed Google also studies that with for apolipoprotein have a to increased risk of severe COVID-19 infections C.-L. J. D. and mortality with COVID-19 in Sci. Med. Sci. 2020; PubMed Scopus Google Scholar, C.-L. J. D. severe COVID-19 in the Sci. Med. Sci. 2020; PubMed Scopus Google and that to or have shown that patients are apolipoprotein have an increased to with patients are apolipoprotein which result in an increased risk of a severe to COVID-19 infections Gao L. C. N. T. J.H. Ge W. L. is associated with in in human Clin. 2014; Full Text Full Text PDF PubMed Scopus Google Scholar). have an increased of the which be factor that to the increased severity of COVID-19 infections in Liu K. of apolipoprotein with plasma lipoproteins in and The J. PubMed Scopus Google Scholar). in patients with HIV, apolipoprotein is associated with an disease and death with apolipoprotein T.D. B.K. He W. H. M. Huang Y. R.W. in and the HIV disease Sci. PubMed Scopus Google Scholar). other studies the have also that HDL-C were associated with an increased risk of COVID-19 infections C.A. Gray C. C. N. P. and risk factors for and to risk factors for and Results from a prospective 2020; PubMed Scopus Google Scholar, N. for obesity, profile and COVID-19 2020; 11: PubMed Scopus Google Scholar, Chen K. J.A. C.C. and SARS-CoV-2 infection in the One. 2021; PubMed Scopus (22) Google Scholar, Y. Yang H. Li S. Li Wang J. 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