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Cholesterol and Cholesterol-Lowering Medications in COVID-19-An Unresolved Matter
Thomas Grewal1, Mai Khanh Linh Nguyen1, Christa Buechler2
1School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia.
Insights
This review explores how cholesterol levels, liver function, and COVID-19 severity are interconnected. It highlights how cholesterol-lowering drugs like statins and PCSK9 antibodies may reduce severe outcomes from SARS-CoV-2 infection.
Area of Science:
- Cardiology
- Hepatology
- Infectious Diseases
Background:
- COVID-19 (caused by SARS-CoV-2) presents diverse symptoms, and pre-existing dyslipidemia significantly elevates severe disease and mortality risk.
- Reduced serum cholesterol is frequently observed in patients with severe COVID-19.
- Hepatic dysfunction affects approximately 20% of SARS-CoV-2 infected patients, suggesting a link between liver function, cholesterol, and COVID-19 severity.
Purpose of the Study:
- To review the relationship between systemic cholesterol, liver injury, and COVID-19 severity.
- To summarize the potential therapeutic benefits of cholesterol-lowering medications, specifically statins and PCSK9 antibodies, in managing COVID-19.
- To describe the connection between cholesterol metabolism and lung function in the context of SARS-CoV-2 infection.
Main Methods:
- Literature review synthesizing findings on cholesterol homeostasis, liver injury, and COVID-19.
- Analysis of studies investigating the impact of dyslipidemia on COVID-19 outcomes.
- Examination of research on the effects of statins and PCSK9 antibodies in COVID-19 patients.
Main Results:
- Dyslipidemia is a significant risk factor for severe COVID-19 and mortality.
- Impaired cholesterol homeostasis and liver dysfunction are associated with COVID-19 severity.
- Statins and PCSK9 antibodies show promise in potentially mitigating severe COVID-19 outcomes.
Conclusions:
- Cholesterol metabolism, liver function, and COVID-19 severity are closely linked.
- Cholesterol-lowering therapies warrant further investigation for their role in COVID-19 management.
- Understanding cholesterol's role in lung function is crucial for addressing SARS-CoV-2 pathogenesis.
Abstract:
Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cause coronavirus disease 2019 (COVID-19), a disease with very heterogeneous symptoms. Dyslipidaemia is prevalent in at least 20% of Europeans, and dyslipidaemia before SARS-CoV-2 infection increases the risk for severe COVID-19 and mortality by 139%. Many reports described reduced serum cholesterol levels in virus-infected patients, in particular in those with severe disease. The liver is the major organ for lipid homeostasis and hepatic dysfunction appears to occur in one in five patients infected with SARS-CoV-2. Thus, SARS-CoV-2 infection, COVID-19 disease severity and liver injury may be related to impaired cholesterol homeostasis. These observations prompted efforts to assess the therapeutic opportunities of cholesterol-lowering medications to reduce COVID-19 severity. The majority of studies implicate statins to have beneficial effects on disease severity and outcome in COVID-19. Proprotein convertase subtilisin/kexin type 9 (PCSK9) antibodies have also shown potential to protect against COVID-19. This review describes the relationship between systemic cholesterol levels, liver injury and COVID-19 disease severity. The potential effects of statins and PCSK9 in COVID-19 are summarised. Finally, the relationship between cholesterol and lung function, the first organ to be affected by SARS-CoV-2, is described.
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