Dyslipidemia Increases the Risk of Severe COVID-19: A Systematic Review, Meta-analysis, and Meta-regression

Abstract

Objective: This systematic review and meta-analysis aimed to evaluate whether dyslipidemia affects the mortality and severity of COVID-19, we also aimed to evaluate whether other comorbidities influence the association.

Methods: A systematic literature search using PubMed, Embase, and EuropePMC was performed on 8 October 2020. This study's main outcome is a poor composite outcome, comprising of mortality and severe COVID-19.

Results: There were 9 studies with 3,663 patients. The prevalence of dyslipidemia in this pooled analysis was 18% (4%-32%). Dyslipidemia was associated with increased composite poor outcome (RR 1.39 [1.02, 1.88], p=0.010; I²: 56.7%, p=0.018). Subgroup analysis showed that dyslipidemia was associated with severe COVID-19 (RR 1.39 [1.03, 1.87], p=0.008; I²: 57.4%, p=0.029). Meta-regression showed that the association between dyslipidemia and poor outcome varies by age (coefficient: -0.04, p=0.033), male gender (coefficient: -0.03, p=0.042), and hypertension (coefficient: -0.02, p=0.033), but not diabetes (coefficient: -0.24, p=0.135) and cardiovascular diseases (coefficient: -0.01, p=0.506). Inverted funnel-plot was relatively symmetrical. Egger's test indicates that the pooled analysis was not statistically significant for small-study effects (p=0.206).

Conclusion: Dyslipidemia potentially increases mortality and severity of COVID-19. The association was stronger in patients with older age, male, and hypertension.

Prospero registration number: CRD42020213491.

Keywords: ACE2, Angiotensin Converting Enzyme 2; BMI, Body Mass Index; COVID-19; COVID-19, Coronavirus Disease 2019; CVD, Cardiovascular Diseases; HDL, high-density lipoprotein; LDL, low-density lipoprotein; MOOSE, Meta-analysis of Observational Studies in Epidemiology; NOS, Newcastle Ottawa Scale; RR, Risk Ratio; TG, Triglycerides; WHO, World Health Organization; coronavirus; dyslipidemia; hyperlipidemia; prognosis; vLDL, very-low-density lipoprotein.