Lipid and Lipoprotein Levels in Patients with COVID-19 Infections
Kenneth R. Feingold
Abstract
A number of studies have observed a decrease in total cholesterol, LDL-C, and HDL-C levels in patients with COVID-19 infections. In most studies the decrease in LDL-C and/or HDL-C was more profound the greater the severity of the illness. LDL-C and HDL-C levels were inversely correlated with C-reactive protein (CRP) levels i.e. the lower the LDL-C or HDL-C level the higher the CRP levels. Patients with low HDL-C levels at admission to the hospital were at an increased risk of developing a severe disease compared to patients with high HDL-C levels. With recovery from COVID-19 infections the serum lipid levels return towards levels present prior to infection. In patients that failed to survive, total cholesterol, LDL-C, and HDL-C levels were lower at admission to the hospital and continued to decline during the hospitalization. In patients with COVID-19 infections the serum triglyceride levels were variable. In a study using the UK Biobank it was observed that elevated HDL-C and Apo A levels were associated with a reduced risk of testing positive for SARS-CoV-2 while LDL-C, Apo B, and triglyceride levels were not found to be significantly associated with an increased risk. During the COVID-19 pandemic, diet, exercise, and lipid lowering therapy should be continued. For those who become symptomatic, lipid lowering therapy, if feasible, should also be continued throughout the duration of the illness. Individuals who are naive to treatment but for whom lipid lowering therapy is indicated should be started on treatment. In patients with severe symptoms of COVID-19 who are too ill to take oral medications, lipid lowering medications may be temporarily suspended. Medications should be re-started when the patient has recovered and able to take oral medications. One needs to be aware that certain drugs that are used to treat COVID-19 infections may interact with lipid lowering drugs. Remdesivir is metabolized by the Cyp3A4 pathway and statins that are also metabolized by this pathway should be avoided (atorvastatin, simvastatin, and lovastatin). With the antiretroviral drugs (lopinavir/ritonavir) it is recommended to use low dose rosuvastatin therapy. Tocilizumab interferes with both the CYP3A4 and CYP2C9 pathways of metabolism and therefore it is recommended to temporarily suspend treatment with statins. Because drug therapy for patients with COVID-19 infections is rapidly evolving one needs to be alert for potential drug interactions. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG .