The treatment of patients with familial hypercholesterolemia (FH) and coronavirus disease 2019 (COVID-19) with dyslipidemia medications may prevent the occurrence of thrombotic events, according to a letter to the editor of the Journal of Clinical Lipidology.
Patients with FH may have a lifelong history of elevated levels of serum low-density lipoprotein cholesterol (LDL-C), which increases the risk for a premature atherosclerotic cardiovascular disease (ASCVD) event. A history of ASCVD had been linked to increased in-hospital mortality in patients hospitalized with COVID-19. The severe acute respiratory syndrome coronavirus 2 virus, which leads to COVID-19, has been found to cause endotheliitis, which results in systemic impairment of the microcirculatory function and activation of the coagulation cascade.
In patients with COVID and FH, the formation of microthrombi has been noted, particularly in patients with pre-existing endothelial dysfunction associated with a history of increased levels of serum LDL-C and of Lipoprotein (a). Statin and PCSK9 inhibitor medications are frequently prescribed to patients with FH and an ASCVD event to lower LDL-C levels. Statins achieve this goal by decreasing serum levels of D-dimer, and PCSK9 inhibitors, by reducing the levels of atherothrombogenic Lipoprotein (a).
“[S]tatin—PCSK9 inhibitor dual therapy has the potential to decrease two factors underlying the increased risk [for] thrombotic complications in COVID-19, and patients [with FH and] COVID-19 should receive maximal cholesterol-lowering therapy also for this reason,” concluded the authors of the letter.
Vuorio A, Kovanen PT. Prevention of endothelial dysfunction and thrombotic events in COVID-19 patients with familial hypercholesterolemia [published online June 9, 2020. J Clin Lipidol. doi:10.1016/j.jacl.2020.06.006