<p>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</p>

Abstract

Background Acute myocardial injury and heart failure characterized by elevated cardiac troponin and decreased heart pump function are significant clinical features and prognostic factors of coronavirus disease-19 (COVID-19). Triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio is an indicator of insulin resistance. This study aimed to explore the association of the TG/HDL-C ratio with cardiovascular risk and prognosis in COVID-19. Methods Ninety-eight laboratory-confirmed patients with COVID-19 admitted in a tertiary teaching hospital in Wuhan, China, were enrolled in this retrospective study. Regression models were used to investigate the association between TG/HDL-C ratio with myocardial injury, heart failure, severity, and mortality in COVID-19. Results Among the 98 patients, the mean age was 63.9±1.4 years, and male sex (58, 59%) was predominant. Forty-six patients (47%) were admitted to the intensive care unit (ICU), 32 (33%) and 46 (47%) patients suffered from myocardial injury and heart failure, respectively, and 36 (37%) patients died. The TG/HDL-C ratio was increased in patients with myocardial injury, heart failure, severe illness, and fatal outcome ( P <0.05 for each). Baseline TG/HDL-C ratio significantly correlated with log transformed levels of plasma high-sensitivity cardiac troponin I (r=0.251, P =0.018), N-terminal brain natriuretic propeptide (r=0.274, P =0.008), glycated hemoglobin (r=0.239, P =0.038), and interleukin-6 (r=0.218, P =0.042). Multivariate logistic regression analysis showed that an increased TG/HDL-C ratio was independently associated with the risk of myocardial injury [odds ratio (OR)=2.73; P =0.013], heart failure (OR=2.64; P =0.019), disease severity (OR=3.01; P =0.032), and fatal outcome (OR=2.97; P =0.014). Conclusion Increased TG/HDL-C ratio was independently associated with myocardial injury, heart failure, disease severity, and mortality in patients with COVID-19, and it may be a useful marker for early identification of patients with high risk and poor outcome.

The bidirectional link between HDL and COVID-19 infections

“…With recovery from COVID-19 infection the lipid levels return towards levels present prior to infection ( 28 , 29 , 30 , 42 , 43 ). As expected, the greater the severity of the illness the greater the reduction in LDL-C and/or HDL-C levels ( 29 , 31 , 32 , 33 , 34 , 35 , 36 , 38 , 42 , 44 , 45 ). LDL-C and HDL-C levels are inversely correlated with C-reactive protein (CRP) levels i.e., the higher the CRP levels the lower the LDL-C or HDL-C level ( 28 , 29 , 31 , 45 ).…”

“…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 ( 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ). As expected, apolipoprotein A-I and B were also decreased ( 39 , 40 , 41 ).…”

“…Low LDL-C and/or HDL-C levels at admission to the hospital predict an increased risk of developing a severe disease. Increased mortality was observed in patients with low total cholesterol, LDL-C, and/or HDL-C levels at admission to the hospital and in these very ill patient’s lipid levels continued to decline during the hospitalization ( 28 , 36 , 38 , 41 , 43 , 44 , 45 ). A single study reported that the time to develop a negative RT-PCR test for SARs-CoV-2 was increased in patients with low HDL-C levels ( 46 ).…”

B-Type Natriuretic Peptide Concentrations, COVID-19 Severity, and Mortality: A Systematic Review and Meta-Analysis With Meta-Regression

“…Thirty-two studies were retrospective ( 7 , 21 – 23 , 27 , 29 , 31 – 39 , 41 – 45 , 48 , 50 , 51 , 53 , 55 , 57 – 63 ), eight prospective ( 24 , 30 , 46 , 47 , 49 , 52 , 54 , 56 ), whereas the remaining four did not report the study design ( 25 , 26 , 28 , 40 ). Clinical endpoints included disease severity based on current clinical guidelines in 15 studies ( 21 , 24 , 33 , 39 – 41 , 43 , 48 , 54 , 55 , 57 – 59 , 62 , 63 ), hospitalization in one ( 37 ), ICU transfer in three ( 32 , 44 , 49 ), or need for mechanical ventilation in one ( 23 ), and survival status in 24 studies ( 7 , 22 , 25 – 31 , 34 – 36 , 38 , 42 , 45 – 47 , 50 – 53 , 56 , 60 , 61 ). Sixteen studies reported plasma BNP concentrations ( 23 , 24 , 26 , 33 , 35 …”

Risk factors and potential outcomes of COVID-2019 — a narrative review with focus on cardiovascular health

“…Retrospective American study analyzed 6,439 patients hospitalized due to COVID-19 presented that patients previously diagnosed with heart failure had poorer outcome, stayed in the hospital longer and had a higher risk of mechanical ventilation and mortality, regardless of left ventricle ejection fraction [16]. Zhang et al confirmed that inappropriate lipid parameters described as increased triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) ratio had been considered as risk factors of myocardial injury, heart failure, COVID-19 severity and fatal outcome [17].…”