{
  "abstract": "Background\n\nInfectious mononucleosis (IM) with hepatitis suppresses HDL cholesterol (HDL-C), but its magnitude, specificity, recovery, and cardiovascular implications are uncharacterised.Objective\n\nTo determine the prevalence, specificity, recovery, and long-term cardiovascular significance of very low HDL-C in IM hepatitis.Methods\n\nIn the TriNetX Global Collaborative Network (∼190 million patients), we studied 1,944 adults with IM and hepatitis. Presenting HDL-C distributions were compared against 15 propensity-score-matched (PSM) comparator cohorts and characterised by Gaussian mixture modelling; longitudinal trajectory was assessed across six post-index windows. Long-term major adverse cardiovascular events (MACE) were analysed in PSM cohorts with very low HDL (≤20 mg/dL, n = 979/arm) versus without, over up to 20 years, with independent COVID-19 (n = 83,888/arm) and pharyngitis (n = 10,618/arm) cohorts as external validation. Robustness was tested with E-values. All cross-sectional and survival analyses were repeated in sex-specific PSM cohorts, and pre-illness HDL-C was retrieved for patients with a lipid measurement recorded at least three months before the index illness.Results\n\nMean presenting HDL was 36.7±22.6 mg/dL versus 49.7 pre-illness; 23.9% had HDL ≤20 mg/dL. Suppression matched CMV hepatitis but exceeded pharyngitis and IM without hepatitis, indicating a hepatitis-driven mechanism. Mixture modelling identified a discrete suppressed subpopulation (mean 16 mg/dL, 41%) absent in non-hepatitis controls. Across repeated cross-sectional sampling, HDL returned to pre-illness values by 16-30 days in the cohort overall and by 31-90 days in patients presenting ≤20 mg/dL. Patients who suppressed most deeply had pre-illness values ∼10 mg/dL below the rest of the cohort, and referred to their own baseline had recovered fully by 1-3 years. Very low acute HDL predicted higher long-term MACE (HR 1.92-2.47), reproduced in COVID-19 (HR 2.04-2.70) and pharyngitis (HR 1.43-1.69). Women presented with higher HDL-C than men (36.8 vs 31.3 mg/dL; p < 0.001), but the proportion ≤20 mg/dL did not differ by sex (28.3% vs 31.2%; RR 0.91, 95% CI 0.77-1.07), and hazard ratios were similar in women and men for every outcome.Conclusions\n\nVery low HDL-C is a prevalent, hepatitis-driven finding in IM that identifies a subgroup at elevated long-term cardiovascular risk. However, the acute HDL-C dip is likely a marker of lipid phenotype rather than an independent risk factor, warranting prospective evaluation of cardiovascular follow-up.",
  "abstract_shown": true,
  "affiliations": [
    "Internal Medicine B, Hadassah - Hebrew University Medical Center, Jerusalem, Israel."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Iddo Z Ben-Dov"
    },
    {
      "affs": [
        0
      ],
      "name": "Alaa Danoon"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/acv2jcgdva243.bib",
  "cited_by": 0,
  "doi": "10.1016/j.athplu.2026.100609",
  "fulltext_url": "https://europepmc.org/articles/PMC13685444",
  "id": "acv2jcgdva243",
  "issns": [
    "2667-0909",
    "2667-0895"
  ],
  "landing_url": "https://europepmc.org/article/MED/42909391",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Lipoproteins and Cardiovascular Health"
    ]
  ],
  "openalex": "W7218534888",
  "pdf_url": "https://europepmc.org/articles/PMC13685444?pdf=render",
  "pmcid": "PMC13685444",
  "pmid": "42909391",
  "published": "2026-10-03",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/acv2jcgdva243.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:14Z",
      "native_id": "MED:42909391",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42909391"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Lipoproteins and Cardiovascular Health",
      "subfield": "surgery"
    }
  ],
  "title": "Very low HDL cholesterol in infectious mononucleosis with hepatitis: a real-world evidence study.",
  "title_text": "Very low HDL cholesterol in infectious mononucleosis with hepatitis: a real-world evidence study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:14Z",
  "url": "https://research.draconitic.com/paper/acv2jcgdva243",
  "venue": "Atherosclerosis plus",
  "versions": []
}