COVID-19 Pandemic Linked to 29% Higher Risk of Dyslipidemia, Study Finds

Gaetano Santulli, MD, PhD

Credit: Albert Einstein College of Medicine

A notable increase in the incidence of dyslipidemia was identified during the COVID-19 pandemic, a major risk factor for cardiovascular disease (CVD), including heart attack and stroke.¹

Estimates suggested nearly 53% of US adults experienced dyslipidemia before the pandemic—a 29% increase in dyslipidemia risk due to COVID-19 would bring the number of Americans at risk for lipid abnormalities closer to 68%.

“Given the extent of the pandemic, this increase in dyslipidemia risk is a cause for concern around the world,” said Gaetano Santulli, MD, PhD, associate professor of medicine and molecular pharmacology at Albert Einstein College of Medicine.² “Based on our findings, we would advise people to have their lipid levels monitored regularly and to consult with their healthcare providers about ways to treat dyslipidemia if detected, especially elderly individuals and patients with diabetes.”

Recent findings from Santulli and colleagues found COVID-19 infection raises the risk of new cases of hypertension and type 2 diabetes (T2D).^3,4 Further literature has demonstrated the effect of SARS-CoV-2 infection on an elevated risk of dyslipidemia in people who survived COVID-19.⁵

“In those analyses, we demonstrated that the risk of developing these disorders was still high three years after the pandemic; moreover, we noticed a suspicious increase in total cholesterol levels, which warranted a closer look,” Santulli added.²

However, investigators were unable to confirm this augmented risk pattern in the general population or attribute this phenomenon to the overall burden of cardiometabolic disease. In this investigation, Santulli and colleagues performed a longitudinal study over 6 years to examine the long-reaching effect of COVID-19 infection in a real-world population of 228,226 individuals in Naples, Italy.¹

Investigators evaluated dyslipidemia incidence before the beginning of the pandemic (2017–2019) in these individuals and assessed the same group during the 3-year COVID-19 period (2020–2022), excluding those diagnosed earlier with dyslipidemia or had a history of lipid-lowering therapy. Follow-up involved ≥1095 days, corresponding to 21,349,215 person-years.

Across the 3-year COVID-19 pandemic period, Santulli and colleagues identified an elevated risk of dyslipidemia development, compared with the pre-pandemic period (odds ratio [OR], 1.29; 95% CI, 1.19–1.39). These estimates were adjusted for comorbidities in multivariate analysis, with higher increases for people aged ≥65 years and those with T2D, obesity, CVD, chronic obstructive pulmonary disease (COPD), and hypertension.

Although the exact relationship between COVID and dyslipidemia is unknown, previous findings from Santuillu and colleagues highlighted the disruptive nature of SARS-CoV-2 on endothelial cells, which play a critical role in regulating blood lipids. Separate evidence identified COVID-19 as a notable risk factor for heart attack and stroke, as long as 3 years post-infection.⁶

“This investigation, published online a month after ours, essentially confirms our observations in this study, since dyslipidemia is a major contributor to cardiovascular disease,” Santulli said.² “It also suggests that tackling dyslipidemia should reduce the risk of CVD in those who have had COVID.”

References

1. _{Trimarco V, Izzo R, Jankauskas SS, et al. A six-year study in a real-world population reveals an increased incidence of dyslipidemia during COVID-19. J Clin Invest. 2024;134(21):e183777. Published 2024 Sep 12. doi:10.1172/JCI183777}
2. _{Medicine AEC of. Covid-19 sharply boosts risk for blood-fat disorde. Newswise. November 1, 2024. Accessed November 7, 2024. https://www.newswise.com/articles/covid-19-sharply-boosts-risk-for-blood-fat-disorders.}
3. _{Trimarco V, Izzo R, Pacella D, et al. Incidence of new-onset hypertension before, during, and after the COVID-19 pandemic: a 7-year longitudinal cohort study in a large population. BMC Med. 2024;22(1):127. Published 2024 Mar 19. doi:10.1186/s12916-024-03328-9}
4. _{Izzo R, Pacella D, Trimarco V, et al. Incidence of type 2 diabetes before and during the COVID-19 pandemic in Naples, Italy: a longitudinal cohort study. EClinicalMedicine. 2023;66:102345. Published 2023 Dec 5. doi:10.1016/j.eclinm.2023.102345}
5. _{Xu E, Xie Y, Al-Aly Z. Risks and burdens of incident dyslipidaemia in long COVID: a cohort study. Lancet Diabetes Endocrinol. 2023;11(2):120-128. doi:10.1016/S2213-8587(22)00355-2}
6. _{Hilser JR, Spencer NJ, Afshari K, et al. COVID-19 Is a Coronary Artery Disease Risk Equivalent and Exhibits a Genetic Interaction With ABO Blood Type. Arterioscler Thromb Vasc Biol. 2024;44(11):2321-2333. doi:10.1161/ATVBAHA.124.321001}