Thread by @DaveKeto

1/ Thread:

Does having lower LDL Cholesterol associate with worse outcomes of #coronavirus/#covid19?

I'll answer that question, but first let's rephrase it to what you were actually wanting to know...

2/

Does having lower LDL Cholesterol **before getting infected** associate with worse outcomes of #coronavirus/#covid19?

In other words, if you had low LDL when you were healthy just before you got sick, did that associate with things being generally worse?

3/ Answer: We don't know.

Further, if we found it did associate with a worse outcome when having previously lower LDL while healthy, would that be enough reason to avoid low LDL?

Answer: We don't know. We'd need to try to rule out reverse causality.

4/ Many are interested in this study (as am I) where we see LDL typically drop during infection and indeed those with the greatest drop fair the worst. But that said, these LDL levels are being tracked *while* infected. We aren't seeing them pre-admittance papers.ssrn.com/sol3/papers.cf…

5/ Yes, both @siobhan_huggins and I talk frequently about the role of lipoproteins and their connection with the immune response. But we likewise acknowledge we don't know what we don't know.

cholesterolcode.com/lipoprotein-po…

6/ While there are a lot of encouraging studies around lipoproteins (with many specific to LDL), there are many more unknowns than knowns. This is especially true with #covid19 given this data is extremely new and developing.

Let's not draw conclusions before we have the data.

7/ All that said, yes, please keep pinging me on any/all lipid studies as they emerge regarding #covid19.

But FWIW, I'm not going to be quick to conclude causal evidence regarding LDL and immune response very easily.

Causality is the same high bar for me it always was.