Metabolic implications of COVID-19 with a focus on lipid profiles and inflammatory markers

COVID-19 is associated with cardiometabolic complications, including lipid abnormalities, but its effect on lipoprotein(a) [Lp(a)] remains unclear. This pilot cohort study was conducted at an academic tertiary hospital and a primary healthcare facility (6 July-31 August 2021). It included a cross-sectional baseline comparison of patients hospitalised with COVID-19, diabetic controls, and healthy controls, with COVID-19 patients additionally followed for three months post-discharge. The study evaluated the relationship between lipid profiles, Lp(a), disease severity, and recovery. Among 169 participants, patients with COVID-19 (n = 84) had lower low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and total cholesterol (TC) but higher triglycerides (TG) and TG: HDL ratios compared to controls (42 diabetic, 43 healthy). Non-survivors were more likely male, with higher body mass index (BMI), fasting plasma glucose, and significantly lower LDL-C levels compared to survivors. Inflammatory markers, particularly Th1/Th17 cytokine clusters, predicted mortality and intensive care admission. LDL-C independently predicted mortality, with an optimal cut-off of 1.81 mmol/L (AUC: 0.68), improving to 0.85 when combined with BMI and inflammatory markers. At follow-up, survivors showed increases in BMI, waist circumference, LDL-C, and Lp(a), compared to healthy controls. Black and Mixed-Race participants maintained higher Lp(a) levels. New-onset hypertension and dyslipidaemia were also observed. COVID-19 disrupts lipid metabolism during acute infection and contributes to persistent cardiometabolic risk after recovery. Low LDL-C, elevated Lp(a), and new-onset hypertension highlight long-term vulnerability, warranting validation of lipid biomarkers and mechanistic studies of Lp(a).