The following is a summary of the “Risks and burdens of incident dyslipidaemia in long COVID: a cohort study,” published in the January 2023 issue of Diabetes and Endocrinology by Xu, et al.
Post-acute COVID-19 (i.e., >30 days after SARS-CoV-2 infection) has been linked to an increased risk of dyslipidemia, according to animal and human studies with short follow-ups. However, no large-scale controlled studies are currently available that assess the risks and burdens of incident dyslipidemia in the post-acute phase of COVID-19. As a result, we set out to investigate the incidence of post-acute COVID-19-related dyslipidemia in SARS-CoV-2 survivors and the associated risks and burdens over a 12-month period. Patients who tested positive for COVID-19 and survived the first 30 days after infection were included in the study’s cohort (n=51 919) along with a non-infected contemporary control group (n=2,647,654) enrolled between March 1, 2020, and January 15, 2021, and a historical control group (n=2,539,941) enrolled between March 1, 2018, and January 15, 2019.
All 3 cohorts’ participants were dyslipidaemic-free at enrollment, and there was no evidence of SARS-CoV-2 infection in the control groups. As a next step, they estimated the risks and 1-year burdens of incident dyslipidemia, lipid-lowering medication use, and a composite of these outcomes using inverse probability weighting with predefined and algorithmically-selected high dimensional variables. They reported hazard ratios (HRs) and 12-month burdens per 1,000 people as risk measures. Based on the treatment environment for the acute infection, we also estimated the risks and burdens of incident dyslipidemia outcomes in distinct subgroups (i.e., participants who were non-hospitalized, hospitalized, or admitted to intensive care during the acute phase of SARS-CoV-2 infection).
Total cholesterol > 200 mg/dL (hazard ratio [HR] 1.26, 95% CI 1.22-1.29; burden 22.46, 95% CI 19.14-25.87 per 1000 people at 1 year in COVID-19 vs. non-infected contemporary controls; p<.0001), triglycerides > 150 mg/dL (HR 1.27, 95% CI 1.23-1.31; p< .0001).
A combination of these abnormal lipid laboratory results carried a 1 in 24 (95% CI 1 in 21- 1 in 27) risk and a 39 in 19 (95% CI 34 in 71-43 in 73) burden. The risk and burden of incident use of lipid-lowering medications both increased (hazard ratio [HR] 1.54; 95% confidence interval [CI] 1.48-1.61; burden 2.550; 95% CI 2.261-28.50). The burden of dyslipidemia was estimated to be 54.03% (95% CI 49.21%-58.892%) and the hazard ratio was 1.31% (95% CI 1.28%-1.34) for any dyslipidemia outcome (laboratory abnormality or lipid-lowering medication use). The acute phase of COVID-19 infection was correlated with the risks and burdens of these long-term outcomes (i.e., whether patients were non-hospitalized, hospitalized, or admitted to intensive care). Analyses comparing the COVID-19 group to the non-infected historical control group yielded consistent results. Their results suggest that in the COVID-19 infection’s post-acute phase, there are increased risks and 1-year burdens of incident dyslipidemia and the use of lipid-lowering medications. Dyslipidaemia is a possible post-acute sequela of SARS-CoV-2 infection and should be addressed in the post-acute care of patients with COVID-19.