Metabolic

Patients With Familial Hypercholesterolemia at Higher Risk for Cardiac Complications From COVID-19

Dibash Kumar Das, PhD
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2015 saw a great leap forward in the development and use of PCSK9 (proprotein convertase subtilisin/kexin) inhibitors. This past July, the FDA approved alirocumab (Praluent, Regeneron), followed 1 month later by the approval of a second PCSK9 inhibitor evolocumab (Repatha, Amgen). The drugs were approved for use in addition to diet and maximally tolerated statin therapy in adult patients with heterozygous familial hypercholesterolemia or those with clinical atherosclerotic cardiovascular disease requiring additional LDL-C lowering. A third drug, bococizumab (Pfizer), is currently in development. Data from large, long-term randomized controlled outcomes trials—ODYSSEY Outcomes (alirocumab), FOURIER (evolocumab), and SPIRE (bococizumab)—are anticipated to provide clear answers as to the drugs' impact on cardiovascular events and safety profiles. –from "The Promise of PSCK9 Inhibitors by Brian Ellis,” published 11/9/15.
2015 saw a great leap forward in the development and use of PCSK9 (proprotein convertase subtilisin/kexin) inhibitors.

This past July, the FDA approved alirocumab (Praluent, Regeneron), followed 1 month later by the approval of a second PCSK9 inhibitor evolocumab (Repatha, Amgen). The drugs were approved for use in addition to diet and maximally tolerated statin therapy in adult patients with heterozygous familial hypercholesterolemia or those with clinical atherosclerotic cardiovascular disease requiring additional LDL-C lowering. A third drug, bococizumab (Pfizer), is currently in development.

Data from large, long-term randomized controlled outcomes trials—ODYSSEY Outcomes (alirocumab), FOURIER (evolocumab), and SPIRE (bococizumab)—are anticipated to provide clear answers as to the drugs’ impact on cardiovascular events and safety profiles.

–from “The Promise of PSCK9 Inhibitors by Brian Ellis,” published 11/9/15.

Individuals with novel coronavirus disease 2019 who have familial hypercholesterolemia may be at higher risk for cardiac complications and atherosclerotic cardiovascular disease in the long-term.

Individuals with novel coronavirus disease 2019 (COVID-19) who have familial hypercholesterolemia (FH) may be at higher risk for cardiac complications and atherosclerotic cardiovascular disease (ASCVD) in the long-term, according to a study published in the Journal of Internal Medicine.

FH is characterized by a lifelong a 2- to 3-fold increase in plasma low-density lipoprotein-cholesterol concentration. If left untreated, FH may lead to premature ASCVD and a higher risk for acute coronary events during middle-age.

A significant proportion of patients with COVID-19 in Wuhan, China were men aged 40 to 60 years with comorbidities (for approximately one third).

Patients with COVID-19 and FH were found to be at increased risk for cardiac complications compared with patients with COVID-19 but no FH. Of the 138 patients hospitalized with COVID-19 in Wuhan, 25% had cardiovascular disease and 58% had hypertension. Of the patients with COVI-19 who did not require to be treated in intensive care units, 10% and 22% had cardiovascular disease and hypertension, respectively.

COVID-19 infections may result in long-term adverse abnormalities in lipid and glucose metabolism as well as chronic Chlamydia pneumoniae infection which has been associated with an increased risk for coronary artery disease in individuals with FH. Patients with FH may be at increased risk of developing an atherothrombotic event during and after COVID-19 infection. Cholesterol-lowering regimens should be intensified in patients with FH and COVID-19, as the virus may affect endothelial function in the coronary artery. In addition, treatments with statins and PCSK9 inhibitors should be continued.

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”[P]harmacotherapy for severe hypercholesterolemia in [a patient with FH and] COVID‐19 should not be discontinued during infection and, due to possible excess risk [for] ASCVD, could even be intensified following recovery from COVID‐19,” concluded the study authors.

Reference

Vuorio A, Watts GF, Kovanen PT. Familial hypercholesterolemia and COVID-19: triggering of increased sustained cardiovascular risk (published online April 3,2020). J Intern Med. doi:10.1111/joim.13070.

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