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

Vuorio, Alpo; Kaste, Markku; Kovanen, Petri T.

doi:10.1016/j.ensci.2021.100344

Cited by 8 publications

(6 citation statements)

References 28 publications

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“…In the prestatin era, HeFH patients had a strongly elevated risk of ischemic stroke, while in the statin era, the risk of ischemic stroke in statintreated patients has been found to be similar to that in the non-HeFH population [48,49]. However, as most HeFH patients remain undiagnosed and the hypercholesterolemia even in the diagnosed HeFH patients is often undertreated, the risk of a highly deleterious ischemic stroke in the majority of HeFH patients remains elevated [50].…”

Section: Ischemic Strokementioning

confidence: 99%

Familial hypercholesterolemia: The nexus of endothelial dysfunction and lipoprotein metabolism in COVID-19

Vuorio

Raal

Kovanen

2023

Current Opinion in Lipidology

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Purpose of reviewPatients with heterozygous familial hypercholesterolemia (HeFH) are at increased risk for COVID-19 cardiovascular complications in the acute phase of the infection. Elevated levels of LDL-C and often lipoprotein(a) are present from birth and lead to endothelial dysfunction, which is aggravated by a direct viral attack of the endothelial cells and their exposure to the toxic levels of circulating proinflammatory and prothrombotic mediators during the hyperinflammatory reaction typical of COVID-19. Recent findingsEvidence to date shows the benefit of lipid-lowering therapy in patients with COVID-19. In HeFH patients who are at much higher cardiovascular risk, the focus should, therefore, be on the effective lowering of LDL-C levels, the root cause of the greater cardiovascular vulnerability to COVID-19 infection in these patients. The ongoing use of statins and other lipid-lowering therapies should be encouraged during the ongoing COVID pandemic to mitigate the risk of cardiovascular complications from COVID-19, particularly in HeFH patients. SummaryEpidemiologic registry data show that the incidence of myocardial infarction is increased in SARS-CoV-2infected HeFH patients. There is a need to study whether the risk for acute cardiovascular events is increased in the long-term and if there are changes in lipid metabolism after SARS-CoV infection(s) in patients with HeFH.

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Section: Ischemic Strokementioning

confidence: 99%

Familial hypercholesterolemia: The nexus of endothelial dysfunction and lipoprotein metabolism in COVID-19

Vuorio

Raal

Kovanen

2023

Current Opinion in Lipidology

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“…As effective drugs for reducing cholesterol, statins can prevent cardiovascular events which are key risk factors for COVID-19 infection and poor prognosis (9,(67)(68)(69). Cholesterol reduction allows statins to affect cell membrane structure and function, particularly lipid rafts that play important roles in viral entry and cellular processes like signal transduction (70)(71)(72).…”

Section: Values and Mechanisms Of Statins In Covid-19mentioning

confidence: 99%

Biological Actions, Implications, and Cautions of Statins Therapy in COVID-19

et al. 2022

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The Coronavirus Disease 2019 (COVID-19) showed worse prognosis and higher mortality in individuals with obesity. Dyslipidemia is a major link between obesity and COVID-19 severity. Statins as the most common lipid regulating drugs have shown favorable effects in various pathophysiological states. Importantly, accumulating observational studies have suggested that statin use is associated with reduced risk of progressing to severe illness and in-hospital death in COVID-19 patients. Possible explanations underlie these protective impacts include their abilities of reducing cholesterol, suppressing viral entry and replication, anti-inflammation and immunomodulatory effects, as well as anti-thrombosis and anti-oxidative properties. Despite these benefits, statin therapies have side effects that should be considered, such as elevated creatinine kinase, liver enzyme and serum glucose levels, which are already elevated in severe COVID-19. Concerns are also raised whether statins interfere with the efficacy of COVID-19 vaccines. Randomized controlled trials are being conducted worldwide to confirm the values of statin use for COVID-19 treatment. Generally, the results suggest no necessity to discontinue statin use, and no evidence suggesting interference between statins and COVID-19 vaccines. However, concomitant administration of statins and COVID-19 antiviral drug Paxlovid may increase statin exposure and the risk of adverse effects, because most statins are metabolized mainly through CYP3A4 which is potently inhibited by ritonavir, a major component of Paxlovid. Therefore, more clinical/preclinical studies are still warranted to understand the benefits, harms and mechanisms of statin use in the context of COVID-19.

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“…Thus, severe COVID-19 illness has been found to increase the risk of myocardial infarction in FH patients whether they have or have not been diagnosed with atherosclerotic cardiovascular disease (ASCVD) ( Myers et al, 2021 ). Additionally, the elevated risk of ischemic stroke associated with COVID-19 potentially also applies to FH patients with COVID-19 ( Vuorio et al, 2021c ).…”

Section: Familial Hypercholesterolemia and Covid-19mentioning

confidence: 99%

Long-Term Cardiovascular and Cerebrovascular Challenges Posed by COVID-19 in Patients With Familial Hypercholesterolemia

et al. 2022

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

Cited by 8 publications

References 28 publications

Familial hypercholesterolemia: The nexus of endothelial dysfunction and lipoprotein metabolism in COVID-19

Familial hypercholesterolemia: The nexus of endothelial dysfunction and lipoprotein metabolism in COVID-19

Biological Actions, Implications, and Cautions of Statins Therapy in COVID-19

Long-Term Cardiovascular and Cerebrovascular Challenges Posed by COVID-19 in Patients With Familial Hypercholesterolemia

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