The following is a summary of “Risks and burdens of incident dyslipidaemia in long COVID: a cohort study” published in the February 2023 issue of “Diabetes and Endocrinology” by Xu, et al.
Non-clinical evidence and a small number of human studies with brief follow-ups point to an elevated risk of dyslipidemia in the post-acute phase of COVID-19 (i.e., >30 days after SARS-CoV-2 infection). While the risks and costs of incident dyslipidemia in the post-acute phase of COVID-19 have been assessed, large-scale controlled trials with longer follow-ups are still needed. Thus, researchers aimed to look at the risks and 1-year costs of incident COVID-19 post-acute phase dyslipidemia among those who make it past the first 30 days after SARS-CoV-2 infection. Using the United States Department of Veterans Affairs national healthcare databases, researchers recruited 51,919 people who tested positive for COVID-19 and survived the first 30 days of infection between March 1, 2020, and January 15, 2021. A non-infected contemporary control group (n=2 647 654) enrolled patients between March 1, 2020, and January 15, 2021; a historical control group (n=2 539 941) were also enrolled between March 1, 2018, and February 28, 2020.
All three cohorts’ individuals were dyslipidaemic-free at enrollment, and there was no indication of SARS-CoV-2 infection in the control groups. When estimating the risks and 1-year burdens of incident dyslipidemia, lipid-lowering drug usage, and a composite of these outcomes, they utilized inverse probability weighting using specified and algorithmically-selected high dimensional factors. Researchers presented hazard ratios (HRs) and burden per 1000 people at 12 months as risk metrics. Depending on the treatment method for the acute infection, they also evaluated 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). Higher risks and burdens of incident dyslipidemia were observed in the COVID-19 group after the acute phase of SARS-CoV-2 infection, specifically for total cholesterol > 200 mg/dL (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.22-1.29; burden 22.46, 95% CI 19.14-25.87 per 1,000 people at 1 year), triglycerides > 150 mg/dL.
The abnormal lipid laboratory outcomes were 1·24 (95% CI 1·21–1·27) and 39·19 (95% CI 34·71–43·73), respectively. The incidence and burden of incident use of lipid-lowering drugs also rose (hazard ratio [HR] 1.54; 95% CI 1.48-1.61; burden 2.550; 95% CI 2.261-28.50). The burden of dyslipidemia was estimated at 54.03 (95% CI 49.21-58.92), and the hazard ratio was 1.31 (95% CI 1.28-1.34) for any dyslipidemia outcome (laboratory abnormalities or use of lipid-lowering drugs). The intensity of acute COVID-19 infection was directly correlated with the risks and burdens of subsequent illness (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. The data suggest an association between post-acute COVID-19 infection and elevated risks and 1-year burdens of incident dyslipidemia and the use of lipid-lowering drugs. Dyslipidaemia is a possible post-acute sequela of SARS-CoV-2 infection and should be addressed in the post-acute management of patients with COVID-19.
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