Why continued lipoprotein apheresis is vital for homozygous familial hypercholesterolemia patients with COVID-19

Vuorio, Alpo; Raal, Frederick J.; Klingel, Reinhard; Kovanen, Petri T.

doi:10.1016/j.jacl.2021.02.002

Cited by 6 publications

(6 citation statements)

References 18 publications

(33 reference statements)

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“…( 6 ) Thus, patients undergoing lipoprotein apheresis mandatorily constitute a high‐risk group for an adverse course of the disease. ( 7 , 8 ) Thus, a sustained vaccine‐induced immune response to SARS‐CoV‐2 is of crucial importance for these patients. The present cross‐sectional study shows for the first time that an individual lipoprotein apheresis session reduces the vaccine‐induced anti‐spike SARS‐CoV‐2 IgG concentration by approximately 20%.…”

Section: Discussionmentioning

confidence: 99%

Low‐density lipoprotein apheresis is associated with removal of SARS‐CoV‐2 antibodies

Bertram

Pfab²,

Albert³

et al. 2022

Ther Apher Dial

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Background Low‐density lipoprotein apheresis is not specific to lipoproteins but removes immunoglobulins as well. It remains elusive, whether protective SARS‐CoV‐2 antibodies after vaccination from COVID‐19 are eliminated as well. Methods A cross‐sectional case–control study on 55 patients undergoing weekly lipoprotein apheresis and 21 patients with comparable comorbidities and epidemiology not undergoing apheresis. SARS‐CoV‐2 IgG was assessed in all patients prior to apheresis and in 38 patients both before and after apheresis. Results SARS‐CoV‐2 IgG concentrations before a session of lipoprotein apheresis were comparable to control patients not undergoing apheresis(1727 IU/ml, IQR 365–2500) vs. 1652 IU/ml,(IQR408.8–2500), p = 0.78). SARS‐CoV‐2 IgG concentrations were reduced by lipoprotein apheresis from 1656 IU/ml(IQR 540.5–2500) prior to 1305 IU/ml (IQR 449–2500) afterwards( p < 0.0001). Conclusion Lipoprotein apheresis removes SARS‐CoV‐2 IgG. The average elimination rate was 21.2%. In the present population of patients undergoing apheresis once weekly, however, the elimination did not lead to inferior concentrations compared to patients not undergoing lipoprotein apheresis.

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Section: Discussionmentioning

confidence: 99%

Low‐density lipoprotein apheresis is associated with removal of SARS‐CoV‐2 antibodies

Bertram

Pfab²,

Albert³

et al. 2022

Ther Apher Dial

View full text Add to dashboard Cite

show abstract

“…PCSK9 monoclonal antibodies should be continued in all patients with a confirmed diagnosis of COVID-19 [39]. In addition to the effective decrease in LDL-C levels, PCSK9 inhibition may mediate antiinflammatory and antioxidative mechanisms [5] and enhance the antiviral action of interferon [47]. In critically ill patients, treatment can be paused until recovery and discharge from the critical care unit.…”

Section: Pcsk9 Monoclonal Antibodiesmentioning

confidence: 99%

“…In hospitalized COVID-19 adult patients in general, acute myocardial infarction occurred in 3.3% (95% CI 0.3–8.5) of cases. It can be assumed that the event rate will be even higher among hospitalized patients with homozygous familial hypercholesterolemia 47 . In this high-risk group, the lipoprotein apheresis treatment must be permanently performed.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 and Lipid Disorders

et al. 2022

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An elevated cholesterol concentration has been suspected to increase the susceptibility for SARS-COV-2 infection. Cholesterol plays a central role in the mechanisms of the SARS-COV-2 infection. In contrast, higher HDL-cholesterol levels seem to be protective. During COVID-19 disease, LDL-cholesterol and HDL-cholesterol appear to be decreased. On the other hand, triglycerides (also in different lipoprotein fractions) were elevated. Lipoprotein(a) may increase during this disease and is most probably responsible for thromboembolic events. This lipoprotein can induce a progression of atherosclerotic lesion formation. The same is suspected for the SARS-COV-2 infection itself. COVID-19 patients are at increased risk of incident cardiovascular diseases, including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure, and thromboembolic disorders. An ongoing lipid-lowering therapy, including lipoprotein apheresis, is recommended to be continued during the COVID-19 disease, though the impact of lipid-lowering drugs or the extracorporeal therapy on prognosis should be studied in further investigations.

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“…Furthermore, it has been reported that regular LDL apheresis in HoFH patients was hampered during the COVID-19 pandemic because the apheresis unit had other liabilities, or because patients were reluctant to come to the hospital during the pandemic [ 34 , 63 ]. LDL apheresis helps to improve endothelial dysfunction in HoFH patients which is of utmost importance during SARS-CoV-2 infection, since the viral infection and the associated hyperinflammatory responses further impair the anti-atherosclerotic and antithrombotic functions of the endothelium, as discussed above [ 3 , 64 , 65 ]. In addition to the acute harmful effect, discontinuation of LDL apheresis may also have long-term adverse cardiovascular consequences because the LDL-C levels will increase.…”

Section: Special Features Of Cholesterol Lowering In Different Fh Pat...mentioning

confidence: 99%

Familial Hypercholesterolemia Patients with COVID-19—Effective Cholesterol-Lowering Therapy is Urgent both during and after Infection

Vuorio¹,

Raal²,

Kovanen³

2022

Rev. Cardiovasc. Med.

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Heterozygous familial hypercholesterolemia (HeFH) patients are the prime example of subjects who are at high risk for both acute myocardial infarction (AMI) and ischemic stroke during, and post, SARS-CoV-2 infection. HeFH per se, if left untreated, results in premature clinical atherosclerosis often presenting in the fourth or fifth decade of life. The other concern in HeFH is endothelial dysfunction which is already evident from early childhood. In untreated HeFH patients, the severe hypercholesterolemia causes endothelial dysfunction from an early age, and as a result thereof, atherosclerotic lesions develop prematurely, particularly in the coronary arteries, and result in further endothelial dysfunction and inflammation in these critical segments of the arterial tree. As the pre-existing endothelial dysfunction in HeFH patients is most likely sensitive to further direct and indirect SARS-CoV-2 virus-dependent damage, we can infer that HeFH serves as an example of a comorbidity that predicts a poorer prognosis with COVID-19 infection. Indeed, a large US national database study showed that patients diagnosed with HeFH and SARS-CoV-2 infection had significantly increased Annualized Incidence Density Rates (AIDRs) of AMI when compared to matched HeFH controls not having been diagnosed with SARS-CoV-2 infection. Effective cholesterol lowering is essential for the prevention, or at least alleviation, of the detrimental effects of SARS-CoV-2 infection among HeFH patients. Due to the pre-existing subclinical or even clinical atherosclerotic cardiovascular disease in subjects with HeFH, cholesterol-lowering treatment needs to be continued or, better still, intensified during, and for an extended period post, SARS-CoV-2 infection.

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Why continued lipoprotein apheresis is vital for homozygous familial hypercholesterolemia patients with COVID-19

Cited by 6 publications

References 18 publications

Low‐density lipoprotein apheresis is associated with removal of SARS‐CoV‐2 antibodies

Low‐density lipoprotein apheresis is associated with removal of SARS‐CoV‐2 antibodies

COVID-19 and Lipid Disorders

Familial Hypercholesterolemia Patients with COVID-19—Effective Cholesterol-Lowering Therapy is Urgent both during and after Infection

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