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Rapid response to:

Practice 10-Minute Consultation

Covid-19: a remote assessment in primary care

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1182 (Published 25 March 2020) Cite this as: BMJ 2020;368:m1182

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Rapid Response:

Statin treatment and Covid-19

Dear Editor

In their comment about the role of lipids in the Covid-19 epidemic, Dr. D´Erasmo and colleagues wonder whether high lipids are bystanders or players (1).

It is not an easy question. For instance, in the study by Graselli et al. (2) D´Erasmo and colleagues mention that hypercholesterolemia was the third most common comorbidity. However, according to the authors the patients´ cholesterol was a “baseline measure”, which means that many of them may have been on statin treatment when they fell ill. The same may explain the findings in the study by Mehran et al. (3) because the patients´ lipid values were from “a history of hypercholesterolemia”. According to D´Erasmo and colleagues, hyperlipidemia was found in 25% of the hospitalized patients reported by Petrelli et al. (4), but according to their paper the difference between the number of those with critical and non-critical illness was minimal (26.6 vs. 24.1%) and there was no information about the type of hyperlipidemia.

Was it a high level of LDL-cholesterol or a high level of triglycerides? An important question because, as I mentioned in my previous Rapid Response (5), high levels of the former are beneficial because the cholesterol-carrier LDL participates in the immune system, whereas high levels of the latter may be a marker of the metabolic syndrome.

1. D´Erasmo L et al. Plasma lipids in COVID-19: bystanders or players? www.bmj.com/content/368/bmj.m1182/rr-20
2. Grasselli G, Zangrillo A, Zanella A et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574–1581. doi:10.1001/jama.2020.5394.
3. Mehra MR, Desai SS, Kuy S, et al. Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. N Engl J Med. 2020 May 1. doi: 10.1056/NEJMoa2007621
4. Petrilli C, Jones S, Yang J, et al. Factors associated with hospitalization and critical illness among 4,103 patients with Covid-19 disease in New York City. Available at MedRxiv: doi: 10.1101/2020.04.08.20057794.
5. Ravnskov U. Cholesterol-lowering treatment may be a major cause of serious Covid-19 infections. www.bmj.com/content/368/bmj.m1182/rr-21

Competing interests: No competing interests

06 May 2020
Uffe Ravnskov
Independent researcher
No affiliation
Magle Stora Kyrkogata 9, 22350 Sweden