Familial hypercholesterolemia and statins in the COVID-19 era: Mitigating the risk of ischemic stroke

Area of Science:

• Cardiovascular Medicine
• Infectious Diseases
• Neurology

Background:

• COVID-19 is associated with an increased risk of ischemic stroke.
• Endothelial dysfunction, potentially exacerbated by viral infection, is a proposed mechanism for COVID-19-related immunothrombotic complications.
• Familial hypercholesterolemia (FH) serves as a model for lifelong endothelial dysfunction.

Purpose of the Study:

• To highlight the potential role of statins in mitigating ischemic stroke risk in COVID-19 patients.
• To inform clinicians and neurologists about statins as an adjuvant therapy for COVID-19 patients with endothelial dysfunction.
• To raise awareness regarding the increased risk of ischemic stroke in hypercholesterolemic COVID-19 patients, especially those with FH.

Main Methods:

• Review of current clinical evidence and pathophysiological mechanisms.
• Focus on the interaction between viral infections, endothelial dysfunction, and thrombotic events.
• Consideration of statin pharmacotherapy in the context of COVID-19 and pre-existing cardiovascular risk factors.

Main Results:

• Pre-existing endothelial dysfunction, worsened by viral infection, may drive thrombotic complications in COVID-19.
• Statins demonstrate potential to counteract these pathophysiological processes.
• Evidence suggests continuing or initiating statin therapy is crucial for stroke prevention in at-risk COVID-19 patients.

Conclusions:

• Statins may serve as a valuable adjuvant therapy for preventing ischemic stroke in COVID-19 patients with endothelial dysfunction.
• Clinicians should consider statin use in hypercholesterolemic COVID-19 patients, particularly those with FH.
• Further research and clinical vigilance are needed to optimize stroke prevention strategies in this population.