Abstract
SARS-CoV-2 infection continues to cause increased morbidity and mortality, and due to the slow pace of vaccination COVID-19 will probably remain a global burden to health systems for a long time. Unfortunately, the necessary prevention and treatment strategies of COVID-19 have led to restriction measures that are hampering the routine care of common chronic metabolic conditions like hypercholesterolemia. It is of particular concern that during the acute phase of COVID-19, the control of pre-existing metabolic diseases tends to get worse which again increases the risk for complications and a poor outcome in these patients. A significant contributor to these complications is endothelial dysfunction which is associated with COVID-19. This Commentary will discuss the impact of COVID-19 on endothelial function particularly in patients with familial hypercholesterolemia (FH), a metabolic inherited disease known to in itself adversely affect endothelial function. There should be no hesitation to continue with statin therapy in severe hypercholesterolemic patients with COVID-19. We argue that in FH patients with COVID-19 the clinicians need even consider intensifying statin therapy as well as the addition of other lipid-lowering agents, such as proprotein convertase subtilisin/kexin type 9(PCSK9) inhibitors. In contrast to statins, the PCSK9 inhibitors lower lipoprotein(a) [Lp(a)] level, and, accordingly, these latter drugs need to be considered particularly in FH patients with an elevated level of Lp(a). This call applies to the in-hospital stay and also beyond. When considering that the vasculopathic effects of COVID-19 may persist, a long-term follow-up of individualized therapies in FH patients is warranted.
Highlights
SARS-CoV-2 infection continues to cause increased morbidity and mortality, and due to the slow pace of vaccination COVID-19 will probably remain a global burden to health systems for a long time
This Commentary will discuss the impact of COVID-19 on endothelial function in patients with familial hypercholesterolemia (FH), a metabolic inherited disease known to in itself adversely affect endothelial function
We argue that in FH patients with COVID-19 the clinicians need even consider intensifying statin therapy as well as the addition of other lipid-lowering agents, such as proprotein convertase subtilisin/kexin type 9(PCSK9) inhibitors
Summary
The COVID-19 illness continues to cause increased morbidity and mortality, and due to the slow pace of vaccination COVID-19 will probably remain a global burden to health systems for a long time. Hypercholesterolemia, such as familial hypercholesterolemia (FH), a metabolic condition known to in itself adversely affect endothelial function. Short comments on other metabolic conditions associated with endothelial dysfunction are made. One of the fatal mechanisms is the widespread damage of endothelial cells due to direct viral infection combined with the high levels of circulating cytokines associated with COVID-19, which predispose to both macrovascular (venous and arterial) and microvascular thrombosis [6,7]. The microvascular endothelium of vital organs is sensitive to combined infectious and immuno-inflammatory attacks which results in the activation of the coagulation cascade and occluding microthrombus formation and causes multiorgan dysfunction – often with a fatal outcome. Generalized thrombotic microangiopathy and associated endothelial dysfunction typically develop in severe forms of the COVID-19 [8]
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