Lipidology and Center for Extracorporeal Therapy, Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Division of Vascular Endothelium and Microcirculation, Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Horm Metab Res. 2022 Aug;54(8):514-521. doi: 10.1055/a-1860-2610. Epub 2022 Jul 14.
An elevated cholesterol concentration has been suspected to increase the susceptibility for SARS-COV-2 infection. Cholesterol plays a central role in the mechanisms of the SARS-COV-2 infection. In contrast, higher HDL-cholesterol levels seem to be protective. During COVID-19 disease, LDL-cholesterol and HDL-cholesterol appear to be decreased. On the other hand, triglycerides (also in different lipoprotein fractions) were elevated. Lipoprotein(a) may increase during this disease and is most probably responsible for thromboembolic events. This lipoprotein can induce a progression of atherosclerotic lesion formation. The same is suspected for the SARS-COV-2 infection itself. COVID-19 patients are at increased risk of incident cardiovascular diseases, including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure, and thromboembolic disorders. An ongoing lipid-lowering therapy, including lipoprotein apheresis, is recommended to be continued during the COVID-19 disease, though the impact of lipid-lowering drugs or the extracorporeal therapy on prognosis should be studied in further investigations.
胆固醇浓度升高被怀疑会增加感染 SARS-CoV-2 的易感性。胆固醇在 SARS-CoV-2 感染的机制中起着核心作用。相比之下,较高的高密度脂蛋白胆固醇水平似乎具有保护作用。在 COVID-19 疾病期间,LDL-胆固醇和 HDL-胆固醇似乎减少。另一方面,甘油三酯(也在不同的脂蛋白亚类中)升高。脂蛋白(a)在这种疾病中可能会增加,并且很可能是导致血栓栓塞事件的原因。这种脂蛋白可诱导动脉粥样硬化病变的进展。这也被怀疑是 SARS-CoV-2 感染本身的原因。COVID-19 患者发生心血管疾病(包括脑血管疾病、心律失常、缺血性和非缺血性心脏病、心包炎、心肌炎、心力衰竭和血栓栓塞性疾病)的风险增加。建议在 COVID-19 疾病期间继续进行降脂治疗,包括脂蛋白吸附,尽管应在进一步的研究中研究降脂药物或体外治疗对预后的影响。