Familial hypercholesterolemia and COVID-19: A menacing but treatable vasculopathic condition

Abstract

SARS-CoV-2 infection continues to cause increased morbidity and mortality, and due to the slow pace of vaccination COVID-19 will probably remain a global burden to health systems for a long time. Unfortunately, the necessary prevention and treatment strategies of COVID-19 have led to restriction measures that are hampering the routine care of common chronic metabolic conditions like hypercholesterolemia. It is of particular concern that during the acute phase of COVID-19, the control of pre-existing metabolic diseases tends to get worse which again increases the risk for complications and a poor outcome in these patients. A significant contributor to these complications is endothelial dysfunction which is associated with COVID-19. This Commentary will discuss the impact of COVID-19 on endothelial function particularly in patients with familial hypercholesterolemia (FH), a metabolic inherited disease known to in itself adversely affect endothelial function. There should be no hesitation to continue with statin therapy in severe hypercholesterolemic patients with COVID-19. We argue that in FH patients with COVID-19 the clinicians need even consider intensifying statin therapy as well as the addition of other lipid-lowering agents, such as proprotein convertase subtilisin/kexin type 9(PCSK9) inhibitors. In contrast to statins, the PCSK9 inhibitors lower lipoprotein(a) [Lp(a)] level, and, accordingly, these latter drugs need to be considered particularly in FH patients with an elevated level of Lp(a). This call applies to the in-hospital stay and also beyond. When considering that the vasculopathic effects of COVID-19 may persist, a long-term follow-up of individualized therapies in FH patients is warranted.

Prevention of Cardiovascular Burden in COVID-19 Patients Suffering from Familial Hypercholesterolemia: A Global Challenge

“…The authors also raised concerns related to the long-term effects of the burden of morbidity and mortality related to cardiovascular health, especially in low-income developing regions of the world. It is thus justified to remind clinicians that preventive lipid treatment among FH patients with COVID-19 needs to be continued or even intensified after the acute illness [ 14 , 37 , 38 ]. In COVID-19 patients, in general, significant benefits of the use of statins have been shown in terms of cardiovascular risk reduction [ 39 – 41 ].…”

Long-Term Cardiovascular and Cerebrovascular Challenges Posed by COVID-19 in Patients With Familial Hypercholesterolemia

“…In an earlier commentary, we have discussed the acute phase of COVID-19 in patients with familial hypercholesterolemia (FH) ( Vuorio et al, 2021a ). We now wish to highlight concerns related to the long-term effects of SARS-CoV-2 infections and the increases in the risk for complications and potentially a poor outcome in this group of patients.…”

Statin Needs to be Continued During Paxlovid Therapy in COVID-19

“…For the physicians managing such patients, what needs to be emphasized is that statin therapy should not be discontinued and, in many cases, may need to be even intensified. This particularly applies to patients with severe hypercholesterolemia, such as those with familial hypercholesterolemia, who are at highly increased risk of coronavirus disease 2019 (COVID-19)–related vascular incidents including acute myocardial infarction and ischemic stroke [ 5 , 6 ].…”