Journal
ATHEROSCLEROSIS
Volume 320, Issue -, Pages 53-60Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.atherosclerosis.2021.01.021
Keywords
COVID-19; Familial hypercholesterolemia; Statins; PCSK9 inhibitors; Endothelial dysfunction
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Patients with familial hypercholesterolemia (FH) are at increased risk for COVID-19 complications, with a focus on lowering LDL-C levels through statin use to mitigate cardiovascular risks. Epidemiologic data on FH patients and COVID-19 severity are needed to understand the increased risk and severity of infections.
Patients with familial hypercholesterolemia (FH) are likely at increased risk for COVID-19 complications in the acute phase of the infection, and for a long time thereafter. Because in FH patients the level of low density lipoprotein cholesterol (LDL-C) is elevated from birth and it correlates with the degree of systemic endothelial dysfunction, both heterozygous FH (HeFH) patients and, in particular, homozygous FH (HoFH) patients have a dysfunctional endothelium prone to further damage by the direct viral attack and the hyper-inflammatory reaction typical of severe COVID-19. Evidence to date shows the benefit of statin use in patients with COVID-19. In FH patients, the focus should therefore be on the effective lowering of LDL-C levels, the root cause of the expected excess vulnerability to COVID-19 infection in these patients. Moreover, the ongoing use of statins and other lipid-lowering therapies should be encouraged during the COVID pandemic to mitigate the risk of cardiovascular complications from COVID-19. For the reduction of the excess risk in FH patients with COVID-19, we advocate stringent adherence to the guideline determined LDL-C levels for FH patients, or maybe even to lower levels. Unfortunately, epidemiologic data are lacking on the severity of COVID-19 infections, as well as the number of acute cardiac events that have occurred in FH subjects during the COVID-19 pandemic. Such data need to be urgently gathered to learn how much the risk for, and the severity of COVID-19 in FH are increased.
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