The Influence of SARS-CoV-2 Infection on Lipid Metabolism—The Potential Use of Lipid-Lowering Agents in COVID-19 Management

Abstract

Several studies have indicated lipid metabolism alterations during COVID-19 infection, specifically a decrease in high-density lipoprotein (HDL) and low-density lipoprotein (LDL) concentrations and an increase in triglyceride (TG) levels during the infection. However, a decline in triglycerides can also be observed in critical cases. A direct correlation can be observed between a decrease in serum cholesterol, HDL-C, LDL-C and TGs, and the severity of the disease; these laboratory findings can serve as potential markers for patient outcomes. The transmission of coronavirus increases proportionally with rising levels of cholesterol in the cell membrane. This is due to the fact that cholesterol increases the number of viral entry spots and the concentration of angiotensin-converting enzyme 2 (ACE2) receptor, crucial for viral penetration. Studies have found that lower HDL-C levels correspond with a higher susceptibility to SARS-CoV-2 infection and infections in general, while higher HDL-C levels were related to a lower risk of developing them. However, extremely high HDL-C levels in serum increase the risk of infectious diseases and is associated with a higher risk of cardiovascular events. Low HDL-C levels are already accepted as a marker for risk stratification in critical illnesses, and higher HDL-C levels prior to the infection is associated with a lower risk of death in older patients. The correlation between LDL-C levels and disease severity is still unclear. However, TG levels were significantly higher in non-surviving severe patients compared to those that survived; therefore, elevated TG-C levels in COVID-19 patients may be considered an indicator of uncontrolled inflammation and an increased risk of death.

SARS-CoV-2 infection-related deregulation of blood lipids in a patient with -/-LDLR familial homozygous hypercholesterolemia: A case report

“…As shown by the present case, hepatic injury may result from SARS-CoV-2 infection as well as from interactions with hypolipidemic drugs administered in HoFH and their up-titration due to rebound increases after infection 18 , 19 . Based on current literature, suggesting that liver stiffness may precipitate after SARS-CoV-2 infection 19 , and on our observations, it would be reasonable for HoFH patients after SARS-CoV-2 infection to be more closely monitored than already recommended for liver function and signs of fibrosis or steatosis particularly when considering up-titration of lomitapide.…”

Extracellular vesicle proteomics and phosphoproteomics identify pathways for increased risk in patients hospitalized with COVID-19 and type 2 diabetes mellitus

“…Interestingly, some classical exosomal markers such as Annexin-V and RAB7 (albeit in opposite directions), as well as some presumably contaminating proteins such as Calnexin showed significantly deregulated levels in circulating EVs from the COVID-19 groups. Because the method we employed for EV purification has been demonstrated to produce highly enriched EV preparations, we reasoned that the presence of specific proteins generally considered to be contaminating proteins may underlie relevant biological changes of EV composition and/or EV corona, induced by COVID-19 and possibly viral infections in general [35] , [36] , [37] . However, as a limitation of our study, we are not able to confirm this because we do not have a comparable control group exempted of viral infection.…”

COVID-19 and metabolic syndrome

“…Benefits and risks of common medications used in metabolic syndrome management in the setting of COVID-19 are an area of intense research and discussion and have been reviewed in detail elsewhere [68] , [69] , [70] , [71*] , [72] , [73] . Data from meta-analyses [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , observational studies [25] and randomized controlled trials [84] , [85*] , [86] , [87] , [88*] , [89] have emerged while several studies are on-going.…”