University of Oulu

Alpo Vuorio, Timo E. Strandberg, Frederik Raal, Raul D. Santos, Petri T. Kovanen, Familial hypercholesterolemia and COVID-19: A menacing but treatable vasculopathic condition, Atherosclerosis Plus, Volume 43, 2021, Pages 3-6, ISSN 2667-0895,

Familial hypercholesterolemia and COVID-19 : a menacing but treatable vasculopathic condition

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Author: Vuorio, Alpo1,2; Strandberg, Timo E.3,4; Raal, Frederik5;
Organizations: 1Mehiläinen, Airport Health Center, Vantaa, Finland
2University of Helsinki, Department of Forensic Medicine, Helsinki, Finland
3University of Helsinki and Helsinki University Hospital, Helsinki, Finland
4University of Oulu, Center for Life Course Health Research, Oulu, Finland
5Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
6Lipid Clinic Heart Institute (Incor), University of São Paulo, Medical School Hospital, São Paulo, Brazil
7Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, Brazil
8Wihuri Research Institute, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
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Language: English
Published: Elsevier, 2021
Publish Date: 2022-02-07


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.

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Series: Atherosclerosis plus
ISSN: 2667-0909
ISSN-E: 2667-0895
ISSN-L: 2667-0909
Volume: 43
Pages: 3 - 6
DOI: 10.1016/j.athplu.2021.08.001
Type of Publication: A1 Journal article – refereed
Field of Science: 3141 Health care science
3121 General medicine, internal medicine and other clinical medicine
Funding: Dr. Santos is a recipient of a scholarship from the Conselho Nacional de Pesquisa e Desenvolvimento Tecnologico (CNPq) process # 303734/2018-3, Brazil.
Copyright information: © 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (