Study identifies predictors of worsening of atherogenic lipid profile during pandemic
Women and racial and ethnic minority groups were more likely to have substantial worsening of atherogenic lipid profiles during COVID-19 stay-at-home orders compared with before the pandemic, researchers reported.
“The onset of the COVID-19 pandemic prompted unique public health measures, including stay-at-home orders that provoked altered dietary and exercise patterns and may have affected medication access and use,” Arun Manmadhan, MD, fellow in the Leon H. Charney division of cardiology at NYU Langone Health, and colleagues wrote in the American Journal of Preventive Cardiology. “Although these impacts have the potential to influence lipid levels, little is known of the consequences of COVID-19 stay-at-home on objective atherosclerotic cardiovascular disease risk factors.”
Manmadhan and colleagues conducted a patient-level analysis that evaluated outpatient lipid panel data from 30,667 adults (mean age, 65.2 years; 52% women) obtained immediately following the strict stay-at-home period in New York City (May 15 to Aug. 31, 2020) and 3 months before the stay-at-home period (Dec. 15, 2019, to March 15, 2020). Researchers also included an identical data set for the same periods 1 year before May to August 2019 and December 2018 to March 2019 as a reference.
One-quarter had diagnosed ASCVD, 30.5% had diagnosed diabetes and 68.1% were prescribed lipid-lowering medications before the stay-at-home orders. Before the stay-at-home orders, average total cholesterol was 174 mg/dL and non-HDL cholesterol was 120 mg/dL.
Researchers observed a “modest” mean change in non-HDL cholesterol from before the stay-at-home period to after, but a significant difference in change during the stay-at-home period (increase of 0.9 mg/dL) compared with the same time period in 2019 (decrease of 5 mg/dL; P < .0001).
Younger age, hyperlipidemia diagnosis, pre-stay-at-home treatment with lipid-lowering medications, female sex, “non-white” race and Hispanic ethnicity were factors predictive of non-HDL cholesterol increases during the pandemic, the researchers wrote.
Female sex (HR = 1.42; 95% CI, 1.27-1.58), Hispanic ethnicity (HR = 1.36; 95% CI, 1.15-1.61) and “non-white” race (HR = 1.24; 95% CI, 1.1-1.4) were associated with greater odds of a 38 mg/dL or greater increase in non-HDL cholesterol during the stay-at-home orders, after the researchers adjusted for age, medical history, use of lipid lowering and antidepression medication and pre-stay-at home non-HDL cholesterol.
“Further research on social determinants of health and the impact of pandemic-related public health interventions is needed to inform policy considerations to enhance the multifaceted recovery from the COVID-19 pandemic and to minimize unforeseen consequences of interventions taken in future public health emergencies,” the researchers wrote.