COVID-19, dyslipidemia and familial hypercholesterolemia: an up-date

Abstract

COVID-19 (coronavirus disease 2019) is an infection caused by the SARS-CoV-2 coronavirus, which can evolve into a severe respiratory condition, affecting the world population in a pandemic manner. In this study, we aimed to update the findings of the mechanisms that associate dyslipidemia with COVID-19 infection, the evolution of severe form and the influence of lipid-lowering treatment on outcomes. The search was performed in the PubMed and Embase databases and the selection was based on dyslipidemia and COVID-19 studies, which resulted in 31 articles. In results, the evidence in changes in cholesterol metabolism was found in SARS-CoV-2 virus infection with variations in high-density lipoprotein (HDL) levels. In addition, it provided an increase in triglycerides (TG) and very-low-density lipoprotein cholesterol (VLDLc). Patients with familial hypercholesterolemia (FH) with COVID-19 representing a group of individuals who develop early atherosclerotic disease with a higher risk of cardiovascular event, which should intensify the lipid-lowering treatment due to the potential risk of coronary endothelial dysfunction caused by viral infection. Cholesterol modifying drugs have a potential to change the life cycle of the virus, resulting in a range of pleiotropic effect on infectivity, immunity and inflammation, such as statins, fibrates, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors (iPCSK9), omega-3 fatty acids, bile acids sequestrants and nicotinic acid. As dyslipidemia is one of the main risk factors for the severe form of COVID-19, causing endothelial dysfunction previously installed in dyslipidemic patients, the use of lipid-lowering drugs can reduce the risk factors for the unfavorable outcome in these patients.