The importance of LDL-cholesterol and infection in the etiology of cardiovascular disease: a meta-analysis of COVID-19 survivors and non-survivors

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Uffe Ravnskov Kilmer S. McCully


Object: As cardiovascular mortality has increased during the COVID-19 epidemic, and as low-density-lipoprotein cholesterol (LDL-C) participates in the immune system, we examined whether infection is a more serious risk factor for cardiovascular disease (CVD) than elevated LDL-C.

Method: In a systematic search identifying cohort studies of COVID-19 patients we identified 21 studies including 25.647 patients with COVID-19 where LDL-cholesterol was compared with mortality.

Results: In 20 of the 21 cohorts where LDL-C was compared with mortality, LDL-C was lowest among the non-survivors and with statistical significance in 19 of the studies. LDL-C was highest among non-survivors in one cohort that included only 250 patients and the difference was not statistically significant. In three reviews, the authors found that severity of COVID-19 was also more prominent among patients with low LDL-C.

Conclusions: The results are in accordance with the hypothesis that LDL-C participates in the immune system by adhering to and inactivating almost all kinds of microorganisms and their toxic products. The results contradict the general view that low LDL-C protects against CVD. Obviously, infection is a more serious risk factor for CVD than high LDL-C. To verify this hypothesis, blood cultures should be performed in all patients with acute myocardial infarction (AMI) and if positive, appropriate antibiotic therapy should be administered.

Keywords: LDL-cholesterol • COVID-19 • inflammation • infection • hypothesis • statin • cardiovascular disease • ox-LDL • bacteremia • sepsis • mortality

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RAVNSKOV, Uffe; MCCULLY, Kilmer S.. The importance of LDL-cholesterol and infection in the etiology of cardiovascular disease: a meta-analysis of COVID-19 survivors and non-survivors. Medical Research Archives, [S.l.], v. 12, n. 5, may 2024. ISSN 2375-1924. Available at: <>. Date accessed: 19 june 2024. doi:
Research Articles


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