High density lipoprotein cholesterol and risk of subsequent COVID-19 hospitalisation: the UK Biobank study

Introduction While unfavourable changes in High Density Lipoprotein (HDL)-cholesterol appear to be a consequence of COVID-19, the reverse has been little-studied. Our objective was to test whether HDL-cholesterol within the normal range is associated with subsequent COVID-19 hospitalisation. Design We examined 317,306 participants in the prospective UK Biobank study with complete data on HDL-cholesterol and covariates at baseline (2006-2010). Follow-up for COVID-19 status was via hospitalisation records in England (16th March and 31st May 2020). Death certificates for the period 1st March to 30th September 2020 with an underlying cause denoted as COVID-19 (emergency ICD-10 code U07.1) were also utilised. Results Lower COVID-19 hospitalisation risk was apparent in people with higher level of HDL-cholesterol, adjusting for factors including health behaviours, inflammatory markers, and socio-economic status. The association appeared to be linear so that for each 0.2 mmol/L increase in HDL cholesterol, the odds ratio for COVID-19 hospitalisation was 0.91 (95% confidence interval: 0.86, 0.96). A similar pattern of association was apparent when deaths from COVID-19 was the outcome of interest. Conclusions Adequately high levels of HDL-cholesterol are associated with a lower risk of severe COVID-19.