Baseline cardiometabolic profiles and SARS-CoV-2 infection in the UK Biobank

Abstract

Background SARS-CoV-2 is a rapidly spreading coronavirus responsible for the Covid-19 pandemic, which is characterized by severe respiratory infection. Many factors have been identified as risk factors for SARS-CoV-2, with much early attention being paid to body mass index (BMI), which is a well-known cardiometabolic risk factor. Objective This study seeks to examine the impact of additional baseline cardiometabolic risk factors including high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), Apolipoprotein A-I (ApoA-I), Apolipoprotein B (ApoB), triglycerides, hemoglobin A1c (HbA1c) and diabetes on the odds of testing positive for SARS-CoV-2 in UK Biobank (UKB) study participants. Methods We examined the effect of BMI, lipid profiles, diabetes and alcohol intake on the odds of testing positive for SARS-Cov-2 among 9,005 UKB participants tested for SARS-CoV-2 from March 16 through July 14, 2020. Odds ratios and 95% confidence intervals were computed using logistic regression adjusted for age, sex and ancestry. Results Higher BMI, Type II diabetes and HbA1c were associated with increased SARS-CoV-2 odds (p < 0.05) while HDL-C and ApoA-I were associated with decreased odds (p < 0.001). Though the effect of BMI, Type II diabetes and HbA1c were eliminated when HDL-C was controlled, the effect of HDL-C remained significant when BMI was controlled for. LDL-C, ApoB and triglyceride levels were not found to be significantly associated with increased odds. Conclusion Elevated HDL-C and ApoA-I levels were associated with reduced odds of testing positive for SARS-CoV-2, while higher BMI, type II diabetes and HbA1c were associated with increased odds. The effects of BMI, type II diabetes and HbA1c levels were no longer significant after controlling for HDL-C, suggesting that these effects may be mediated in part through regulation of HDL-C levels. In summary, our study suggests that baseline HDL-C level may be useful for stratifying SARS-CoV-2 infection risk and corroborates the emerging picture that HDL-C may confer protection against sepsis in general and SARS-CoV-2 in particular.

Factors Associated With a Persistent Seronegative Status 1 Year After a SARS-CoV-2 Massive Infection Outbreak in Community Dwellers Living in Rural Ecuador: A Prospective Population-based Study

“…A recent study based on more than 9000 individuals enrolled in the UK Biobank disclosed several factors associated with an increased risk of infection, but also revealed important interactions between them. 35 In the current study, most of the investigated cardiovascular risk factors were not associated with a modification in the risk of being infected by the virus. A notable exception was the presence of high total blood cholesterol, which was inversely associated with the possibility of remaining seronegative.…”

Efficacy and safety of direct-acting oral anticoagulants compared to vitamin K antagonists in COVID-19 outpatients with cardiometabolic diseases

“…Previous studies have shown that cardiometabolic multimorbidity is common among patients with COVID-19, and it is associated with a higher risk of hospitalization and a worsened prognosis [ 29 – 32 ]. In particular, diabetes is frequent in these patients [ 33 , 34 ], and associated with an increased risk of complications, likely due to clustering with other conditions [ 29 ]. Simultaneously, several cardiovascular diseases, including hypertension, cerebrovascular disease and coronary artery disease, are prevalent in COVID-19 patients, and are associated with a higher risk of adverse outcomes [ 35 ].…”

Estimating causal effects of atherogenic lipid-related traits on COVID-19 susceptibility and severity using a two-sample Mendelian randomization approach

“…Observational studies have reported contradictory results. A study among 9005 UKBB participants (1508 patients testing positive for SARS-CoV-2 and 7497 controls) reported that Apo-B, LDL-C, and TGs were not significantly associated with SARS-CoV-2 infection [ 7 ]. A systematic review and meta-analysis including 23 studies involving 10,122 COVID-19 patients showed that hospitalized patients with severe disease or non-survivor status had significantly lower serum LDL-C but not TG levels compared to patients with milder disease or survivor status; however, only a few studies of those with European ancestry were included [ 8 ].…”

“…Observational studies have reported that the severity of COVID-19 depends on risk factors such as obesity, coronary artery disease (CAD), and diabetes [ 2 , 3 ]. Although dyslipidemia is associated with these risk factors [ 4 – 6 ], different results from observational studies have been reported with regard to an association between dyslipidemia and COVID-19 risk [ 7 – 11 ]. Moreover, observational studies tend to suffer from bias due to possible confounders and reverse causation [ 12 ].…”