American Society of Preventive Cardiology Elevated HDL may improve resistance to SARS-CoV-2 infection

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LOUISVILLE, Ky. – Changes in HDL level may be related to the risk of SARS-CoV-2 infection and subsequent outcomes of COVID-19, a speaker reported.

Vignesh Chidambaram, MD MPHinternal medicine resident in the laboratory of Jawahar L. MehtaMD, PhD, The Stebbins Chair and professor of medicine at the University of Arkansas for Medical Sciences School of Medicine, won the first Early Career Research Award at the American Society of Preventive Cardiology Congress on CVD Prevention for evaluating the ‘association between previous lipid levels and risk. for SARS-CoV-2 infection.

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“It was already hypothesized that patients with CVD, diabetes, and hypertension have a higher risk of severity and mortality from COVID-19. And we already know that high LDL cholesterol and low HDL can lead to CVD. We wanted to see what effect the lipid levels to affect the outcomes of COVID-19,” Chidambaram told Healio. “Based on our initial systematic review, all of these lipid levels went down. We wanted to see if that was really the case. One association is that HDL is very important for inflammatory cells, especially macrophages and lymphocytes. We thought that HDL would be one of the factors influencing infection. We also thought that LDL might also carry a risk of infection, but we found no direct association between LDL results and COVID-19. But when we did In a subgroup analysis based on LDL and HDL, the subgroup with the highest LDL and lowest HDL had the highest risk of infection.”

Citing the World Health Organization’s COVID-19 Dashboard, as of July 29, 2022, there have been more than 572 million confirmed cases of COVID-19, more than 6.3 million deaths, and as of July 26, 2022, more than 12 billion vaccines. doses administered.

Chidambaram explained that CVD, diabetes and hypertension are associated with poor outcomes in COVID-19, and each of these risk factors is influenced by LDL and HDL levels.

Therefore, Chidambaram said, cholesterol within the host’s cell membrane may play an important role in SARS-CoV-2 infection because of the constant interaction of LDL and HDL with lipid rafts. ‘these cell membranes.

In a study published in 2022 a Frontiers in Cardiovascular MedicineChidambaram and colleagues assessed whether lipid levels were associated with SARS-CoV-2 infection, severity of COVID-19, and mortality.

They observed that adjustment for age, sex, diabetes, hypertension, or the presence of CAD did not attenuate the association between lipid levels and SARS-CoV-2 infection, COVID-19 severity, and mortality; however, Chidambaram stated that their findings suffered from possible reverse causality due to the acute inflammatory response to COVID-19.

Therefore, Chidambaram and colleagues conducted another analysis assessing the association between low background lipids and an increased risk of SARS-CoV-2 infection.

The patient cohort consisted of 1,340 individuals who tested positive for COVID-19, of which 27.3% required hospitalization. Among patients who required hospitalization, 28.9% had serious illness at any time, and of those, 16.1% died from COVID-19.

Chidambaram and colleagues noted that elevated LDL (p = 0.331) and total cholesterol (p – .115) were not significantly related to SARS-CoV-2 infection; however, low HDL was associated with risk of infection (p <.001).

“The most likely biological possibility is that patients with higher HDL, between 50 and 150 mg/dL, had a better inflammatory response and a lower risk of infection,” Chidambaram told Healio. “The infection was confirmed by the PCR test. If the patients did not have the appropriate load … it could show a negative test. A negative test may mean that the infection is already under control before it is detected by a positive test. We believe that HDL acts as an immunomodulator and modifies inflammatory and immune responses and decreases the risk of infection.”

In other findings, the researchers observed that HDL decreased during SARS-CoV-2 infection and returned to pre-infection levels 60 days after infection, while total cholesterol was unaffected during SARS-CoV-2 infection.

“There may not be any direct implication from this, but it opens up many avenues for future research,” Chidambaram told Healio. “If we are able to establish the causality of this association, seeing that HDL is an important target for future preclinical studies … we can actually use HDL-raising agents. [to prevent or treat infection]. It has not been studied before.

“It could be more than just COVID-19; it may be useful for infections in general, and there is a lot of clinical data on how statins are used in TB, HIV and these chronic infections as an additional agent, but it may not be directly useful as monotherapy” , Chidambaram said. Healio. “If they are added to HIV medication, TB medication, or maybe other medications, maybe they can enhance the effects of those medications and maybe reduce the length of treatment, or maybe reduce the dose HIV medications have many side effects. Maybe if they add a particular statin, they can lower the dose of those other medications. That said, it still needs to be proven and still needs to go through clinical trials. This could be an exciting avenue to explore in the future.”

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