niacin (nicotinic acid) has been used for more than 50 years as a pharmacological agent for the treatment of dyslipidemia and remains an effective strategy to decrease serum triglycerides and increase HDL cholesterol concentrations
Low HDL and high triglycerides predict COVID‑19 severity
Circulating lipids play a key function in the pathogenesis of the virus and exert an inflammatory response.
Elevated HDL-C and ApoA-I levels were associated with reduced odds of testing positive for SARS-CoV-2, while higher BMI, type II diabetes and HbA1c were associated with increased odds. The effects of BMI, type II diabetes and HbA1c levels were no longer significant after controlling for HDL-C, suggesting that these effects may be mediated in part through regulation of HDL-C levels.
Niacin Administration Significantly Reduces Oxidative Stress in Patients With Hypercholesterolemia and Low Levels of High-Density Lipoprotein Cholesterol
"found the spike protein of SARS-CoV-2 (SARS-2-S) bound to HDL. Antagonists of HDL receptor-Scavenger receptor class B type I (SR-B1), strongly inhibited SARS-CoV-2 infection."
During severe COVID-19, HDL-C and apoA-I concentrations are dramatically decreased in non-survivors. Moreover, High CRP/HDL-C ratio is significantly associated with an increase in mortality and a poor prognosis.
