Familial hypercholesterolaemia and COVID-19: A two-hit scenario for endothelial dysfunction amenable to treatment

Area of Science:

• Cardiology
• Infectious Diseases
• Genetics

Background:

• Familial hypercholesterolemia (FH) is characterized by lifelong elevated low-density lipoprotein cholesterol (LDL-C).
• Elevated LDL-C in FH patients correlates with systemic endothelial dysfunction, increasing vulnerability.
• Severe COVID-19 involves direct viral attack and hyper-inflammation, posing significant risks to compromised endothelial function.

Purpose of the Study:

• To highlight the increased risk of severe COVID-19 complications in patients with familial hypercholesterolemia.
• To emphasize the importance of LDL-C management and statin therapy in FH patients during the COVID-19 pandemic.
• To advocate for stringent LDL-C level adherence in FH patients to reduce COVID-19 related risks.

Main Methods:

• Review of current evidence on COVID-19, FH, and lipid-lowering therapies.
• Analysis of the pathophysiological mechanisms linking FH, endothelial dysfunction, and COVID-19 severity.
• Identification of gaps in epidemiological data regarding COVID-19 outcomes in FH populations.

Main Results:

• FH patients, particularly those with homozygous FH (HoFH), have a dysfunctional endothelium prone to COVID-19 damage.
• Statin use has demonstrated benefits in patients with COVID-19.
• Effective LDL-C lowering is paramount for reducing COVID-19 vulnerability in FH.

Conclusions:

• FH patients are at elevated risk for severe COVID-19 and subsequent cardiovascular complications.
• Continued use of statins and other lipid-lowering therapies is recommended for FH patients during the pandemic.
• Urgent collection of epidemiological data on COVID-19 severity and cardiac events in FH subjects is needed to quantify the excess risk.