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Are lipedema patients at increased risk for COVID-19 or more severe cases of COVID-19?

Lipedema histology shows macrophage inflammation in lipedema tissue.  Dilated blood and lymphatic microvessels are present as well as an increase in the size of fat cells and development of new blood vessels in lipedema thigh skin and fat tissue.  Unfortunately, lymphatic vessels do not develop new vessels along with the increase in blood vessels and fluid accumulates in the tissue.

Lipedema is a Chronic Disease

Lipedema, like other chronic diseases, certainly causes inflammation and changes to the number of immune cells in the subcutaneous tissue compared to BMI matched individuals without lipedema.  The fat cells with lipedema also do not secrete normal levels of hormones.  There is no evidence that lipedema patients are immunologically suppressed.  Lipedema patients generally do not have elevated sedimentation (sed) rates and C-reactive protein (CRP) levels unless they develop obesity on the abdomen or trunk or develop lymphedema.  The complement pathway (CH50 or CH100) overall appears to be elevated in activity likely due to the inflammation in the lipedema fat tissue.

Immune System Changes that have been reported with Lipedema

Some laboratory abnormalities you may have if you have a chronic disease which may affect your immune system and have been reported to occur in some patients with lipedema:

• Elevated CRP and sed
• Elevated cholesterol and/or triglycerides
• Low HDL (good cholesterol), high LDL (bad cholesterol)
• Elevated IgE, which can be indicative of allergies
• Elevated factor VIII clotting activity, which is a risk factor for venous thrombosis (blood clots). Predisposing factors include increased BMI, elevated glucose levels, high triglycerides, and chronic inflammation
• Elevated Interleukin-6 (IL-6), indicative of an inflammatory condition
• Elevated liver enzymes, which can be seen with fatty infiltration of the liver
• Elevated creatinine clearance and low glomerular filtration rate (eGFR), which is often linked to kidney insufficiency
• Low hemoglobin level and iron deficiency (low total iron levels), suggestive of anemia
• High cortisol level in the morning, In women, most commonly caused by a high circulating concentration of estrogen which results in an increased cortisol-binding globulin.
• Elevated CH50 (total complement), characteristic of the presence of chronic inflammation
• Low vitamin D (usually <15 mg/mL)
• Elevated C-reactive protein (CRP), as mentioned above, which indicates the presence of chronic inflammation
• Elevated homocysteine, which is an amino acid and the breakdown product of protein metabolism within the body. When present in high concentrations, has been linked to an increased risk of heart attacks and strokes.
• Elevated fasting blood glucose and/or high hemoglobin A1C

COVID Risks with Lipedema

 Currently there is no published information on COVID and lipedema. Based on our understanding of Lipedema and COVID we do not expect lipedema  patients to be at a higher risk for contracting COVID-19 but because they have a chronic disease they may be at a higher risk for a more serious case of the disease/infection and may exhibit more severe symptoms simply because lipedema is a chronic medical condition.

 High Risk for COVID-19 Complications

According to JAMA article of the WHO data on the Chinese experience of the Coronavirus:

“Q: Who is most at-risk for getting severely sick from the coronavirus?

A: The coronavirus that causes COVID-19 is new, so we don’t yet understand exactly how it impacts specific groups of high-risk people.  But, those who are thought to be most susceptible to serious complications of COVID-19 include people who:

• Are over the age of 65.
• Have cancer.
• Have hypertension.
• Have lung disease.
• Have diabetes.
• Have heart disease.
• Have another condition that compromises the immune system.
• Are taking medications that suppress the immune system.”
• https://www.cdc.gov/coronavirus/2019-ncov/hcp/underlying-conditions.html

Additionally, the CDC website says:
“Patients at higher risk for infection, severe illness, and poorer outcomes from COVID-19 should protect themselves.  Guidance for patients includes:

• Take steps to protect yourself.
• Call your healthcare provider if you are sick with a fever, cough, or shortness of breath.
• Follow CDC travel guidelines and the recommendations of your state and local health officials. https://www.whitehouse.gov/wp-content/uploads/2020/03/03.16.20_coronavirus-guidance_8.5x11_315PM.pdf
• https://www.cdc.gov/coronavirus/2019-ncov/index.html

High-Risk Conditions:
COVID-19 is a new disease and there is limited information regarding risk factors for severe disease.  Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.

Based upon available information date, those at high-risk for severe illness from COVID-19:

• People aged 65 years and older
• People who live in a nursing home or long-term care facility
• Other high-risk conditions could include:
  • People with chronic lung disease or moderate to severe asthma
  • People who have heart disease with complications
  • People who are immunocompromised including cancer treatment
  • People of any age with severe obesity (body mass index greater than or equal to 40) or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk.
• People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date, data on COVID-19 has not shown increased risk.

Many conditions can cause a person to be immunocompromised, including cancer treatment, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications.”

The best way to stay healthy, protect yourself and prevent spreading COVID-19 to others during this time is to:

• Wash your hands regularly for at least 20 seconds with warm water and soap or an approved alcohol-based hand rub
• Cover your nose and mouth with a tissue or flexed elbow when you cough or sneeze
• Allow adequate space between yourself and others, especially avoid close contact with people who are unwell
• Avoid touching your face with unclean hands

If you feel like you have been in contact with someone with COVID-19 or are experiencing symptoms of fever, cough, or shortness of breath, contact your healthcare provider.

Authors: Karen Herbst PhD, MD and Thomas Wright MD

Iinks: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html